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)