02090093 (2) CIBUILDING
UL INGUDN
PERTONO
IPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10430 MILLER AVE. OLD COUNTRY ROOFING 02090093
0 S N APPLICATIONC� UB DATE I BAKER 125-B GROBRIC CT 09/16/2002
(707) 864-5557
PHONE: SANITARY NO. CONTROL NO.
O 6 ARCHffECfIENGINEER: g BUILDING PERMIT INFO
w❑❑ BLDG ELECT PLUMB MECH
a O L+ r l O L-A LJ
ad
"H= LICENSED CONTRACTOR'S DECLARATION
o z-0 1 hereby aIR�that 1 am Rcensea sneer pmssiona of Chapter 9 feommer¢ing Job Description
p„C with seerlon7 )of Doiion a ohne Business andd'Pm�reesoome Code and my licenseREROOF FII ALE®
c z z Licenslt d"I�-� �i- CvZl.ic.p tD pi��'o I
3 a Dam ARCHITECr'S DECLCori ARATION APR 2 2 2003
CLL O 5 1 understand my plans shall W used as public awards
T
OO Licensed Professinwl
d og OWNER-BUILDERDECLARATION
ontro BUILDING
rn
1 hereby.(Sero that 11. csemps from she Consrns Co License Low for the
t 2 G following reason.(Section 7 onow Business and Professions h,or Any can stcounty $12000
aaS which requires a Vomit m nmaUtha alley.improve.demolish,ore a sig any arvaure
63 Q prion v 'c.acs rc4 thapplicantf M1isrmiva hkaugn«I statement -
thalheslanseapuemonli WPoov_an, f"aC.—onsL'emeLow(Chapmr9 tow Y Valuation
(co g t Seen ,7008 fD rs 3 ,the Business and Professmns Codel -,3,73A0 �0§100 `v"!z ff ii„
or hot he fidmpt therefrom and the basis for the alleged esemptloP.Any nolatmn ° i1.1 t j i_�
of Scnion]OJ LS by any appl'cant mora pcmrit sa', thcapplicammacivilpcnahy
-
I of not marc than five hundred Jogars assn. 3 0 5APN PiprAME .: t Occupancy Type
01,as owner of the pmpeny,or my employees with wages as their wle compensation, .307 - INSULATION _
will doNe'work.and'the succmrc isnot Intended or offered'far'sale'(Sec:70U.- 6 01 - ROOF TEABQe q]'eH'Inspections
'Buiinehdara1Pmfessions Gide:The Contractor's License Low does not apply to an q p 111
owner r or property Who build.or improves thereon.and who does such work himself 602 — ROOF PLYWOOD NAIL
or through M1is own employees.provided that such improvements 4 ro are not tmeWar or
drtewr r B:nd m wading p mtrswla th�oneyearof " ' ” - 603 - "ROOF ��BATTENS -
f�compl i thener W lde ill M1mx theburden f proving that he d E not Wild or `
imp r purpose of 1 ) 604 - ROOF IN-PROGRESS
..D i.as owner !heproperty.. . ..y ...gµ .. .....__ .._...._.. ..... . . __.._._ . ."......_... .... . __._
. exclusively contracting with Ikenwhe Contractor's
to I
- - License
the project(Sec,7841,Business and Professions Coded The C thersor's u : FLi�.' r ., -
and-we law does not apply m an owner of propanY who Wilds ourfe improves thereon,
'
and-who for.such projects,with o.canuanurt�QJicenscJ.pursuam m.Ihc -
Conuacmrs License Low.
❑lom exempt under See.'' t .f o.:�'&PCfor this mason s , ..c•C l:a!: ;Il
Owner:'.• Daie'.. •' ... •I
WORKER'S COMPENSATION DECLARATION
11 hereby affirm under penalty of perjury one.of the following declarations
1 have and oil] maintain a CerificSie of Conant"'io self-insum for Worker's
\\ Compensation, as provided for by Section 7]00 of the Labor Cade, for the
compensation,
the work,for which this permit is issued.
- t . .:
sal Ifs and will nuummim W k s Gin pe 1 1 'lance as m9mmd by Stenon
f the IaWr'Code ffii ithic istromarmaca of he work far whT1t this
'Byron is
Issu d My W rkels C pe t insurance ura cattle,and Poly be met -
/' [' _
ton �I S
PolicyN' CNSSa S'^ d� 1 •-1 r,1 r ,: ..Yu '.l {„ zY. " G.'a!✓ ik; ....--- All tt ..,
1,, CERTIFICA OF EXEMPTION FROM,WORKERS'- 1,f t - .. i 4 r f It
..� ,..,, COMPENSATION NSUPRANCEfanmc hundred dollars
(This ocdonnceJnm be
. . . ... I . ....'111 1:'•; �•, _
ISIWI elees,I
n, ,. . -
temfythatntheR(omr •of Ih kf hch'Ihi.perms neJ1
'halfrot employ v n,'conn n any manner<�i a.m hecom ublect io tM1e Work n
Co pen Lows 'C
NGrC",A'pLICA1I If afmnnaking lh Ccnfu¢alE cmpuon,you sh old ` I• ` '•
"orae subje"m the Worker's Cumpenusion prnvisionlnr the Lowe Code,you must.
Q Q forthwn,comply with at,
provisions or this permiuhall W deemed revoked.
y ^`CONSTRUCTION LENDING AGENCY • 'I' �` 1
a ' I heb by Sffirm bar them is 4 Lourametion lend ng agency for tbe performance -
cfthcvvmk'f hch thk pemti .ue,a 5 7q] Civ-.C.-).
Is de sNm
Z Lde Address
-I miry thanh Bread tn. ppe t a.tl thath W fsit no is
La [^r <orrecs 1 agree Io comply wnh all city and county oNiwnces and xum laws .,n
. C.0 to buildingconnrrinion.and hertby amhonzc'represemntivcs of thii<iry memt,erupon \
6r IWIg ms ' demufy onJ keeph rl.sthe Cly of Cupen
oinst said
ost ssaid
h !coil le t dg Ix, .f d pc ss hch y any y rue g
U Z Ciry nc nseq en<e of she6 t g fah 'error - �l7 1
SOURIGA\T 11t\DERO>\DSA\D T!11LL COMPLYN'ITH ALL SOS-POINT Issued by; Date
Signa u2 itl AP IieantlContmeme .." -',.. . " ,. ...Date:''
Re roofs
HAZARDOUS MATERIALS DISCLOSURE
' wumeapphet n Wlaingo«awmirci,enanuliravrJas'n,amr;al Type of Roof.. _ _..... -..-, ,> ,.. ,,..,- ...,..._.,__......._..
as def Jby sM1 C peon M 'cp LCWe Ch pt r912, dth H ❑M1 aM Safety r, f I-Iw Y'I .
Cod S t n25�721a) 1 >. l a lt 1 'v ' �fs•.vl:
oY ' i All roofs shall be'inspected prior.to any.roofing material being installed,.,....- ..
WTI IhN ,_applia oto future Wildingi occupant use cop t devices which If a roof 1s 1n§tall d without first obtaining an'inspecuoni I•agrr Co remove
eathareuconmmnn sAefn dby lh PyArcaA Q Ily Manag no
Di m0, allnew materials for inspection. Applicant understands and well comply with 4.
°y'es lwl all'no-n point source reguIauonst ,i , ; ;1, ,
I have read[the hist.adcal rameiial,requirements der Chap ersumef Ne ^ '
C: f Health&Safe,,ar CM Sections o 25505 itis and 2 I do and that
cath
building doe.not dYM1 have 1fhlt . tY responsibilityt notify
_
M
acupam oIheregm .o Ccnlficmc of:
f Signature of Applicant
Date
au;�Ott
mco 0,
Oatmoraedagepl -;,; 1 r Data All roof coverings to be Class"B"or better.
OFFICE '
-
Building Division
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
OCITY0 Fax: (408)777-3333
CUPEkTINO
Building Department
Subject: Reroofing policy for the City of Cupertino.
1. Prior to permit issuance,you must agree to comply with 1997 UBC Standards
and manufactures specifications on reroofing.
2. New roof coverings shall not be applied without first obtaining all inspection
*.and written approval from the building inspector.A final inspection and
approval shall be obtained from the building inspector when the reroofing is
completed.
3. All roofs shall be inspected prior to any roofing installation
4. To receive a final sign off from the City the following steps are required.
1) Preinspection and/or tear off approval.
2) In progress inspection approval-
3)
pproval3) Final inspection approval.
• a) Spark arrester installation.
5. If plywood is installed,a plywood nail inspection is required.
6. Any roofing which is applied without first obtaining an inspection,will
require the removal of all new material down to the sheathing so that the
proper City inspection can be performed.
IMPORTANT:
1. Flat roofs must have a minimum of 4"per foot slope and demonstrate that
there is no ponding.
2. An I.C.B.O.report is required to be on the job site at the time of inspection.
We understand the above policy on reroofing and will comply with this policy.
Homeowners Name:
Address: I o q,,-72 O /ti i u-&-Y< A vL
. Reroofing Company Name: �L ' Oy �� r /A
Applicants Signature ��� .
Date• 9-
Joe Antonucci
(Chief Building Official)
6/25/01