02050066 (2) CI TY GDIVISION
PERTNO
IPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
11631 ORCHARD SPRING CT OLD COUNTRY ROOFINGpp 02050066
AdL G F&FALAN R AND ADELE A 387 UMBARGER RD #B A0�`rD6�fffh
11 1 PHONE: (408) 362-1111 SANITARY NO. CONTROL NO.
MaiO ARCHI'1 ECTILNGINECR: BUILDING PERMIT INFO
aBLDG ELECT PLUMB MF.CH
ito
NLICENSED CONTRACTOR'S DECLARATION o Ibunchyaffirmthat Iamlicensed under provisions ofChopier9(commencing REROOF Job Description
,yCm m5 ,,am 71o0)of Division 3 of th nes and Professions Cade.and my hermie
oI. Wuurnm=an,�gfre ''� 'd 3 REMOVE 1 LAYER SHAKE, INSTALL 304 FELT
eenrc est ADD MONIER CEDARLIE TILE, INBO 42656
1_ia o y .5e CD DECnr
a /` ARCHITECT'Sas public
TION
_ 1 understand my plans shall he used as public rtco,ds
ao 0 Licensed Pmfcssional
neir
OWNER-BUILDER DECLARATION
FINALE93
I hereby"(Sect on I o imps fano the Con�n,Co Licmue Law for the q
FZa
following m a1cmiioi7onstiBusinesseMPmfdemoliCose:A0yshyorcounty V 2002
am
which,squids a I1lrmii m nmswcL Direr,improve,demolish,or repair any srmaum NO 1
A, Pionsofthe perdu flea L (Chapter
thgtnr .licensedpnm pursuant pfo ont Done Commodesl lawlcnapmr9 $130)0*ation
(ca n mng with Smin ]111Nry ofD Is on3of th=Buanes JI f trot CoJ=) � �'� Rt y ;�y; i+%`
or thvi he is exempi tM1ekfmm'erd the bads for Ne alleged erempnon.Any violation
of morethan hundred (n35p0=0rm).ittanj=atn=appr=annnaavdpindty 366Vf`bl9e11bDI0 OCCUPaneY Type
D I,as owner of the'ro'e"y.nr my empleyeav'whh wages us their stele codpemaiion.
will do the work,and the..Ore<is not intendedor offered for Wit(Sea.]PW, 3 05 - FRAME
Business and'Powner mfcssinns Code:The Contmcmr's License Law does not apply to an Required Inspections
of progeny Who builds or improves thereon,and who does such work himself 3 07 - INSULATION
. through his own employees.provides that such improvements arc not intended or
..comple P,i Hale.owner-Wilder
the building nr burden cnvm n Arid tha he did not build or _ __ ...6 O.l.__- . ROOF TEAR-OFF.__
Improve ua th=ownerbuilder will have the burden of proving that he did not build or '
imps.=rmpamat=artale). 602 - ROOF PLYWOOD NAIL
603 -- ROOF -BATTENS '- ---- - -----
I'm
_
❑I,m r of the pmpertY•am exclusively contracting with Imenma conraaam to .:..1 a I-i
_ rnn.w=t the project(see.vw,Business and Prarea.inna n,a=:)The Contmctors 604 - ROOF IN-PROGRESS`r T •• .,
License Law dos not apply to an owner of pmpcny who builds or improves thereon.
_and who contracts for such prejxa with v commnons)licensed pursuant to the
Convenors License I-uw. ,
D 1 am exempt under Sec. " ,B ffi P C for this reason ..
_ _ Owner
Our, '
WORKER'S COMPENSATION DECLARATION
I hereby affirm under,pcatill ofperjury one ar the following declarations:
D I M1ns iandon, As
inainiedi a Cby Sects of Consent to t self-insure for Workers
Compensation, he provided for by Section 3]00 of the Labor Code, for the
35Wtlof�¢MLAW, ast for the lromanceo t' rad
_ performance of the 'coni ' owed. '
D I ha ra w mains N lm?x Compen.at I ance - q d by Sect on
C&fe 1 th pI s.. c f In,- "ork f h I this permit s
PoIICY (be art:
ccA
R
f-. a CI RTIFlCATIONOFEKEM ON FROM wORKG�
' COMPLNSAIiDN INSURANCE 1 f
' Thissecs in need ivit be-completed'(the permit is bar no hundred dollars
(31 W)or loss) ... .. ..... , - -
t' "d venify that In ih'e IuifnrmLnm of th'c woik ro,which this mil is issued,1
Ihall not employ any�rcrom in any ma nor s^as to become subject to the Workers -
CampcnsotionLaws arCalifdrnia.Date'
'NOTICE TO APPLICANT If,after making the Comficale of Exemption,you should
iecome s cod tl o thWorker's Compensation pr��F;ons 6f the Labor Code,you must
O 0 comply withprovisions s pc shall be dmmed revoked.
'CONSTRUCTION LENDING AGENCY
a ' I hereby Affirm that them is a conavacuon lending agency for the performance
of the k for which this permit is Isw.J(Sec 309] C v C) ..- .. ...._. -,... .._. _.... .. . ._. .... .-._.. _ _ . ..
QLender's Namb .. . . - . .. ., - - ._.._.. .. .
Lender's Address -
t..i 0 1 scaly that I have read this application and state that the'aIsovc information is '
IT. [r cimeri.1 ogre=to comply with all city and county ordinances and ,are laws miniing
O:V to building contraction.and hemby autnonm representatives mi city to Into,upon
y;W the aboveemcnfioned prapcny for inspection purposes.
y
(We)agree td tube;indemnify and keep harmless ibe City of Cupcnm6 against
Fr lZi liabilities,judgments,costs and expenmt which may in any way eceme against said
U.Z City in nmsequcnce of the granting of this permit.APPLICANT UN "
DF STANDS AND WILL COMPLY WITH NON-POINT
D Issued by: Date
Signa etofAp IcaMCoaranor -'•t - . Date Re-roofs
HAZARDOUS MATERIALS.DISCLOSURE
Willto' ic pplimnt orfuture litabling MCUPhL store or handle haurdom material Type of Roof_ - .... --
as defined by the Co,,cruirm Municipal Code,Chaper 9.12, d the Health and safety
,Code Season 25532(-)2, q
v
°Y All roofs shall be inspected prior.to-any roofing.material being installed, _
W ll he ppLc {t n Be g t inu p t device,which If a roof is installed without first obtaining an inspection,•I agree,to remove
emti m n t rq r py Management inspection.g , fPP
all non-point source re ula[ions ds and will comply with
fi co Ila c m t Area A a t and e
oft Iz all new materials for A Leant understands
DYe n - - . .. .. ._
`C1 1 have read the W. us mal"We rc u reircumbunder Chapter 695 of the
it theuil Hg does Safetymldhae. ve a cina55o5.2itis yrespoAd 3a,litytonana that -
ifo.pwra of
resnoenrconmwhhmost antthat nis dyssuanceiof.ymnmify the
ocupSm of the rtquircmems which'must be con prior m issuance of a Ccnifinte'or
Occup _;1J;• 'J >� , )_ Signature of Applicant -,, - - -, . Dale
Ow_, , h.,aed,agent .. nate All roof coverings to be Class "B" or better
- ,; '. . ,. .. .. .. . ._ ... . . .OFFICE
Building Division
t 10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
CITY OF 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) 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 1/4"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: . L 65;P—, 0A)
Address: �r 3 / Q� C1 � SGw2i n1G C�
Reroofing Company Name: '�L� COu^�I� �I �Z Oo r"✓G
Applicants Signatur ei�- Date:
JoeAntonucci
(Chief Building Official)
6125/01