02050144 (2) t o NG DPERONNO
*CITY PERMIT CONTRACTOR INFORMATION:
' BmLDINfpD2DRF,$$_,VEN SPRINGS DR OLD COUNTRY ROOFING PERMITNO. 02050144
D�r�MEFREDERICK K AND ALICE 125-B GR03RIC CT A161!`FnsP"52
I�PHONE: (707) 864-5557 SANITARY NO. CONTROL NO.
3,-,. ARCHITECTMNGINEER: BUILDING PERMIT INFO
1-tri❑ - BLDG ELECT PLUMB MF.CH
w2 LICENSED CONTRACTOR'S DECLARATION 'Job Description
I hereby affirm that l am licensed under provisions of Chapmr 9(commencing REROOF
C�. with Section 7000)mfDivi,mn3mmeB",im,,and Prnfca.mn.rolde. mntyficcn,e T/0 1 LAYER SHAKE
in full force and effect a�
73
i.% Limn Class_ Lica_ 2
:ods Date Cantme,or INSTLL GAF 50 YR COMP
A CHITECT'S DECLARATION
•u o S 1 unch mond y�I be n,cQ ublic
`CQL[1l'r /h
3 a o p o Licermed l'rmfesst nal
e u OWNER-BUILDER D CLARATION
u�=' I hereby a1Btm that 1;,it,exempt from the Cm ura,m,'s License Law for the
following mason.(Section 7031.5.Business and Professions Code:Any city or county
5 O
watch requirts a pennit ttmct. It p demolish. repair- y structure
6 3$
print to its'ss 1so requines the ppl'a t for suchPermit o file a signed statement
_
that 'licensed purst to the provisions of Contractors Lie La (Chapter 9 S Ft. FloorArea. -, r , ation
(com ening with Sect[ ."JOIN))of Division 3 of be B 'mesad professions Cole) _.�•, y ?l stq. y. F1 'Floor-Area,
or that he is exempt therefrom and the basis for the alleged exemption.Any violation
of Section 7031.5 by any applicant for a permit suhjeas the applicant.u civil penalty
,of not mom than five hundred dollars(SSW). 3 6 - Occupancy Type
❑I•as owner of the priiarhy.ur my employees with ragas ns tbcir sole onmpematinn.
will do,he work.and the no,nim is not intended fir Offered for sale(sec.704,1.
Business and Profcssimns Code:The Contractor's Licenu Law does not apply to on R fired Inspections
owner of propeny Who builds or improves thereon•and who does such work himself 3 07 - INSULAT I
or through his own however the
provided that such improvement
arc non intended fir
offered for.ale.If,However.me bwleidg or inpmvement ix anti wantn one year or 601 - - ROOF TEAR -OFF . .. .. . . . . ..... ,. ... ..
impovenopurposc`of°vi j,`w'uba"emcname„ mram.ingmatheamnotnatlefir 602 - ROOF PLYWOOD NAIL
6„rip y. mese communing .603 - ROOF-BATTENS �p��p p�a
-Ol.as owner of ih n lusivel ,actin th licenssd conow.to NALED
construct the project(Sec.76W.Business and Professions Code:)The Commemrs 6 04 - ROOF IN-PROGR Y�n u�a G 16/
License Low does not apply to an owner of property who builds or improves thereon,
i ] .and who contracts for such projects with a comracmrm)licensed pursuant m the . .-.. ... .. . .-. .._-.... .__ O 2�0�
C..upG&a License Law. _ - , DEC.-
- ❑1.m exempt under Sec .B&P C for reason
Owner ' Dme
WORKER'S COMPENSATION DECLARATION 'WILDING
I hereby affirm under perohy of perjury one of the following declarations
O I have and will maintain a Cemncam of Consent to self-insum for Worker's
Compensation. as provided In, by Section 37W of the Labor Code• for the
performance of the work for which this Permit is issued.
❑I have and will maintain Worker's Compensation Insurance,as required by Senior
37W of the labor Code,for the performance of the work for which this permit is
isued.My rkc,.ComESo omon l mance carrier and Policy nnuumrrbr,arc:.
. . camR Yah Policy Na:
CERTIFICATION OFEXEMTI'ION R MWORKERBI B 1?. �., I '-t i^
COMPENSATION INSURANCE
(This section need not he completed if the permit is for one hundred dollar T '
1S100)m less.)
I employ
Na in the p in an,
of the work for which this permit a ...rke 1
cora via employ any arson,n any manner so as no become,object m the Workers'
compensation Laws of California,Doe
NOTICE TO APPLICANT:If.is after [lips Cerin s of of Exemption. .you muld
st
become abject y the such pr Compensation provisions of the Labor Code,you mus.
Q O fonhwiN comply with such provisions m this perms shall W deemed cooked.
- -
CONSTRUCTION LENDING AGENCY
a.' I bffirmcrcby athat there is'a conswnion leading agency for the performance
of 5the work I,,, hinh In,permit is issued(Sec 3097.Civ.C.)
No.Pr Lender's Na - .... ..: „t . —...v....._ ... .. ...
o:z L rider's AJdress ;L
t..lC 1 aenify that 1 have mad this application and state that the above information is
IY'F. ennecel agree to comply with all city and county moirmat,s and state laws relating
O V no Wilding construction•-and hereby authorize repmunmtimS of this city to enter upon
the above-mentioned propeny for inspection pnposc.
r 1
(We).9.1.save,indemnify and keep It ss the City of Cupenlno against
V] liabilities,judgments, d expenses which yin any way same against said
C.) z City in romcqucn the ming of nhi c
^' ApP1.ICANTO ERST D¢AND 1 UMPLYWITHALLN' -POI ' ISSUedb Date
SOURCE RF T y 7 y
Signa ofAp,lmmdC act .' . - J Re-roofs
HA RDOUS MATERIALS DISCLOSUR s `
ss . Will the applicant at future building Occupant store or handle haz;vdousmaterml Type of Roof. - -
as dialroad by the C.promis M p)Cade Cb pee 9A2. d the Health and Safety ,.
Code,Seenom 255321a) l /'. ; 5 t -t z _I. 1 --
❑Yea - 1�' � All roofs,shall be inspected prior to-an oofing material being installed.
Will the applicant or ru ore Wilding..,.at at mecgdpment or desacs which If a roof is ins ithout first obt ' mg an inspection; I agree to remove
emit hazardous air contaminantsd edby'the Bay Arca Air Quality Management
Di.tricn •, all new m als fo inspectioq licant understands and will comply with
r' ❑Ye., .t '. a. . all non- t sour regula ' d ..
1 have rtad the nazallous ma¢dals rc under Chapter 6.95 of the
Conforms Health Code,Semion155 -J and15534.1 undemand than _ 7I
i[the building of cu only haveatenant. it is my rcsponsibilirymnotify the (/
&'cupam of e u m,which mus e,prior to issmsn e f h Cenif am of '
°”"°'°`ry' ( Signature of A scant Date
3 2 j All roof coverings to be Class"B”or better
ow r a ea
-. .. .-,.•:. ,. .,. _... OFFICE '
Building Division
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
WCITY 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/n" 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: Zeyrj'�
Address:
Reroofing Company Name:
Applicants Signature: Date: 2 �Z
Joe Antonucci
(Chief Building Official)
6/25/01