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02030038 (2) TI ea°FCPERTTINO CONTRACTOR INFORMATION:t o PERMIT BUILDING ADDRESS: PERMIT NO. 1120 ROLLINGDELL CT OLD COUNTRY ROOFING 02030038 OWNER'S NAME: APPLICATION SUB DATE RESHNIA BANERJEE 387 UMBARGER RD #B 03/11/2002 PHONE: SANITARY NO. CONTROL NO. (408) 362-1111 CRT O ARCHITECI]ENGINEER: BUILDING PERMIT INFO zFF BLDG ELECT PLUMB MECH 6 u L= a L_2 LICENSED CONTRACTOR'S DECLARATION a3 1hereb from that ons of Job Description I N_ Y a provisi P 8 -h with Section 7000)of Division 3 of the B nes end Professions Code,and my license REROO F. � is in fu ema�eriq (p/,I:Z�Cj �_ T/O 1 LAYER TILE izga Lleenw lass ✓ / l.lc.a , INSTALL OSB, 304 FELT oc.v Date contractor & US LE CLAYMAX ICBO 3523 . I u r�i HITECI"S DECLARATION t i3 g 1 understand my plans shall be used"s public records i as p O Licensed Profauional a� OWNER-BUILDER DECLARATION �\ p hereby mit to90 the�hov setons of the e.denim li License Law for the \a z< riono us issuance,also re Code:Any city or county y O o into that am exempt roto aContractor'sh,or repair any stricture _ following mason.(Benton]OILS,Business end Professions ` whichits i..ape provghperos 3- rs Lice se Law(statement. ,pt�ua that he is licensed p p S License Law(Chapter 15 0 VV (commencing s exempt Seagnom)and the bsisort the thiedeuand Profusions Code) . , q•; }: L-Area. A `-.> V ation on ex be is exempt thercfmm and the basis for the et the ekeoqPdoh.to Any lection �' _ Y: S t`i 2 s.; 't h'2,-•s.P t ...U: -of Sttvon]031.5 by any applicant for v permit subjects the applicant to elry Type ser not room man eve hundred dollars 0500). �I u�TbttTO Occupancye ❑I,as owner of thepmpeny,army employees with wages at ei solecom It. will do the work.and be someone is not intended o brie dor sole - - - --- - - •Bursiness'and Professions Cade:The Gmtmetor'c Lic se`La pas an 305 — FRAME Required Inspections' - °water of property Who builds or improves thereon;ea who d •�ch tank hi f or through his own employees.provided thin such imP"eorents not intend 307 - INSULATION .Rend for stale.If.H°wevec the buildin8 or improve 'i.is sold �-_ ° 601 - ROOF TEAR OFF compinian,the ownervbuiWer will have the harden of pro'g that he ad or {reprove Tor parlwse°t=ale.). 602 - ROOF PLYWOOD NAIL .. _. . - - - -- - - ❑Lvsawneprojeche property,(Se7W,BsinessandPrwrnionsCh :)TheCon<mtatn 603 - ROOF BATTENS .____ __ . ..t:l.l . comuon the does n(Sec. to a Business and Prty Who a ills or The Contractor's License Lawdus nor ltilr an ownero(propenywho builds or i,pursusthto the 604 - ROOF IN-PROGRESS' '" f. -send-whorl Linsforwch.pmjuts with acnmmcmr(s)licensed.pursuant to the. .. . .. ____.. . . .,. ....__. -. _...._... .. ._._ _._.. :._......__. .,'........... ..... .. . . 01 mese License Sect ❑1 em uempt under Sec. � � ',B At P C for this reason _ Owner Data WORKER'S COMPENSATION DECLARATION 41. I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a'Cenificate of Consent to self-insum for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the Performance of the work for which this permit is issued. 1 have and will maintain Worker's Compensation Insurance,as required by Section of the Labor Code,for the performance of the work for which this permit is issued My Workers Compensauan Insurance canter and Policy number arm Cam'ic)'f�r�f �fQ't Pohcy No /(0�5 /dJ - . ._ 66 _ *. h Y, •r n � _ _ .. _ I , .. ..,.. ' CBRTIPICACOMPENSATION INSURANCE' ' muse union need not W completed if the permit is for one hundred dollars •°f ($100)or less.) 1 certify thin in the o I.any..of the work for which this permit a issued,I , shell not employ say person in any manne,w as to become subjrn .,he Workers Compensation laws of California.Dem . Applicant NOTICE TO APPLICANT:If,after mnsationp Cilias a of Exempting you should become subject y the Worker's Colons or provisions l the Labor Code,you must O forthwith comply with such provisions or Nis permit shall be deemed invoked. CONSTRUCTION LENDING AGENCY. I hereby affirm that then is a conewnton lending agency for Ne performance of the work for-which this permit ia issued(Sec 3097Civ.C.) QLender a Name-"' . . ... .:.- ... ,,.c.t.... . . . .. .... ......_.._ __... __ _.. z Lender.s Address' V 0 1 certify that 1 have mad Nis application and one thauhe above information is Gs. contact.1 agme to comply with all cityy and county ordarmor,end cum laws relining Q to building construction,and hereby aJNorixe representatives,ofthis city to enter upon fa] the above-mentioned property for inspection purposes. L 0. (We).9.td save,indemnify and keep harmless the City of Ctipeitino.gaunt FF-ri 14 liabilities,judgments,costs and expenses which may,in any way accrue against said V z City in consequence of the granting of this pc.I, 77--' 'APPLICANT ND RSTANDSANDWI LCOMPLYWITH'ALI:NON-POINT'' Issued b sD t •'p 1I fI s.. Vim'/1- 62-", y e Si�mmre,ofAppliant/Conranoq" " •Dune'. Re-roofs HAZARDOUS MATERIALS DISCLOSURE WII ate vpplicam or Pomre.bu'IdinB acupant state m handl hturdws mmmad Type of Roof. def nod by th Co n kf n c rd Cada Chaps 9.12.and the Health and Safety Carl - - oAeSect°n25532(e)+ ,.^i. , fP. - l�'•.t '•{ If .•�., , °YC5" All I.406-shall be ms ectgd prior to ariy_roofing material being installed_, Will the applicant or,future building occupant use equipment or devices which' If a roof is installed without first obtaining an-inspection,I agree to remove emit hazardous air contaminants u defined by the Bay Area Air Quality Management District, - all new materials for inspection._Applicant understands and will comply with - ❑Yes .• all non-point source regulations. 'I have read the heramlous mamials requimments under Chapter 6.95 of the California Health&Safety Code:Sections 25505,25533 and 25534.1 understand that iFhe building docs not currepIIY have a tenant,that it is my responsibility to notify the - ' - - 2 - - occupants of the requircme is which man be ton prior m isvuance of a Cenifieem of 1 .. oecapt y - Signature of Applicant Date :Owner or ;. i Data All roof coverings to be Class "B" or better ' OFFICE - _. .. .. _ . . Building Division 10300 Tom Avenue • I Cupertino,CA 95014-3255 777 Telephone: (408) -3228 CITY40 Fax: (408)777-3333 CUPEkT1N0 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 V"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: RnS 14'-1/4 (3 S N C �'Z.-�� Address: /1'IR 0 d Z 0 L-L)'l/G a>LSLL 'C5F Reroofing Company Name:OL_� G(0(An)- h4 rZJo F �,7)G Applicants Signature 32�1 Date: Joe Antonucci (Chief Building Official) 6/25/01 y.N t Building Division 10300 Torre Avenue Cupertino,CA 95014-3255 Telephone: (408)777-3228 • CITY OF Fax: (408)777-3333 CUPEkTINO Building Department REROOF TEAR OFF POLICY revised 6/25/01 1. You must schedule an inspection for the tear off the day before the date you wish the inspection to be made.The procedure is to call the Building Division (777-3228)between the hours of 8:00am and 4:00 p.m. for next day inspection. 2. When the roof is torn off,the nails removed or driven in,and all of the dry- rotted wood has been replaced,then you must call the City Building Division. An inspector will be there within one hour.There are special hours for this service:between 8:00 a.m. and 11:00 a.m. and between 1:00 and 3:00 pm. 3. If you call for the tear-off inspection and the job is not ready there will be a re-inspection fee of$100.00 charged,which must be paid before another inspection is made. Joe Antonucci (Chief Building Official)