02050078 (2) CITY
'BUILDING DIIVIISIONNOPERMIT CONTRACTOR INFORMATION:
811694RSEVEN SPRINGS DR OLD COUNTRY ROOFING PERhfIrNo. 02050078
E:KAREN 125-B GROBRIC CT A"'697 'WyYfl2
PHONE: (707) 864-5557 SANITARY NO. CONTROL NO.
Mai
O ARCHITEC(ENGINEER: BUILDING PERMIT INFO
C BLDG ELECT PLUMB MF.CH
6 h i LICENSED CONTRACTOR'S DECLARATION Jhh D
3Zy'- Ihereby affrmthat Iamlicemmunder provisions ofChapter 9(commencing REMOVE L LAYER 8F i, INSTALL 30# 36"
- F-uw withctin
Sen7MU.I'Division 3oftneBLLLSi'0p�,sand Prole,siens Code.enJmylicama
IsinIn f aadd ye 7e1 �[ NIER CEDARLITE TILE CBO# 2656
:,,2n
u,a Licari xeIadd l Lia.Is ��
LLO 5 1 undcrlund my plan oat I naSS EB`jmblRArccmds
0 9 2002
id,.0 Licensed Professional r
' as f OWNER-BUILDER DECLARATION
d- E
m 1 hereby atfmt th,t 1 n ese rapt from tl Contractor',t License Low foDhe
L'?Q following mason (Section 70315.Business adP fie Code.Any city or county ���+
f ❑ M1ch q pc n t t It P e demolish o epaiany uroa Vf
ad -port u 1: req ' th ,l' rl chpn add. a 's Jntm D 24.Q0.0- ._
that he Ic ,dpax ntheprmd softhecntfttmrsLice. (Cnpla. j.1, Sq. Ft:jFloorArea�_ -. $ ).- , Valuation
(commencing aunt Smio 7000) iDbvion3 fin Butine,ad Pro ,I a Code) ;1 \" t
or ihat he is exempt therefrom and the basis for the alleged demlaton.Any violation 3 6 6 5 4'0 Q 1 . 6
of Section 70315 by any applicant for a permit subjects the applicant to a ovil penalty
,ofnot more than five hundred dollars(E5W). APN Number ni+d, ,,: Occupancy Type
EI 1,as owner ohne property,or my amployces with wages as their sole compemation, 305 - FRAME
-will'do the work.and the s.a,..is not intended or oHemd for sale(Sec.103,1,
Buviness'and Profcasinns Code:The Convector's Lice nm 37 - INSULAT Law does not apply to an 9%ired Inspections;'
owner of propamy Who wilds or improves thereon,amt who does such work himself 601 - ROOF TEAR OFF
or through his own employees.Provided that such improvements are not intended or
'.offered tar Rale.H,however.the building or arpmvcment is sold'vvuhm mi'year or ._ ..602— ..ROOF -PLYWOOD-NAIL-';¢. -11
coinpletion,theowner-Wilder will have the wrdenofpowingthat hedid not Wild or 603 — ROOF BATTENS
imp so for parposa or sole.),
_ ❑Cdsown,;i ndpro — --- - - --- ----- 604.' _ _ROOF IN—PROGRESS — —
pc r,oro exclusively cnntmetlng with licented uontmcmrs to
ro m at the project(Sec.7044,Business and Professions Code:)The Contractor's
License Law does not apply to an owner of property who Wilds or improves thereon.
1 i. _oad.wno cuntracu.fors.an.pmjact,with...ettmimnor(s)licensed pursuantto.the_ _...._ .... ._ .. ........ ........._ _. .-._._. .._.-._ .,,.. _..... _,. .: _................
Contracmr's License Law.
Qlnm exempt under Sec. .B&PC fimthis mason
twiner' Date "
WORKER'S COMPENSATION DECLARATION
`•�' Ihereb Ilirm ander l f rine of the following declarations:
y a .pens y o reriary g
-T .J ❑ 1 hmc and will maintain a 61 ificale'of Comm to self-insure for Worker's
�Y Compensation. as-provided for by Section 37W of the Labor ewe, for the
performance of the work for which,this .if is issued;
❑1 have and will maintain N'oiker's Compensation hoo mnce.as required bi Section
37001 "the Labor C de'f (be pc m m f the work forwhich tits permit s
cd MyW ke 'Compc - 1 c a Policy W ''
Pnhcy�
,;',�" L CERTIPICATION OF E%FMPTION OM WORK ` t t 7's �? S'i.
ti
' 'COMPCNSATION INSURANCE � ,sits _-----.-.,
-'t iCh.nuc ton need rant he 6roplided if the permit is for one hundred dollars
(SI W)Or less.)• ,.
d 1 cenifY it m n the perfmmnnce of M- k f' Hsh tit prm l's issued; -
iImll not employ any person in any manner so as 10 become subject no the Worker,
Cpplica t I- Law,nl'Calif nrnia.Dam
NOTICE TO APPLICANT eWaik a Compensing tion povisio sofate of Labor ode,you uld heroine subject y the such pr Compensation provisions shah!the Labor Cale,d. mon
z 12 nr ' ,-'•comply - provisions is permit shall be de- revoked.
fonhw tit m I with such or this
^ I thereby R nthat CONhTRUCf10N'LENDINGAGENCY J_. 4�. rma .__ _ -------
Leader',
.._._ .. _ - ___ _.__ - •:1
C a (Sea lendinga enc for the rt rola ce
Lethe work f which this perm i s s. W ISce 3097 Civ C 1
y;G LeodersName-
corider4Agree5t n- O
I comity that 1 have read this application and scam that the above information is
correct,
Gu.E icn build I acme to comely with all city and county ordinances of
state laws relating
DSV mbnNoegconxurininnand nyhereby amhonic mp.scnmtivcs of this city to ether upon
r� she clave-memioneJ prnpeny far inspection p accon.
..0. (We)agree to save.mderynify an - p If lees tW City of Cupertino against
N liabilities,judgmen s,cost
andexpe s which may in any way a.com against said /
City in cart- c of the Brantie this permit: �s
SOULICR. II DER$ ND WILL COMPLY Wrrfi ALL'NON- SMT ]SSUed by: Date
runkSocnrA cant actor ' D ` Re-roofs
' HAZARDOUS MATERIALS DISCLOSUR '
,t".' bollf edb rhe ptheCupertino
pl dam f t c bti Idng oc<p tt or handle huraMous mammal . .Type of ROOF -
❑Yy pen noMunicipal Code Chapter
9.12,and the Health and Safety _ •, s_ t. '.t... s .t
,.dela)?
role 5 r 25532,t All roofs shall be inspected prior to any roofing,material_being installed.-
Will
talled,wu the pgreugt fidthidfdmi occupant use equipment I,devices which If a roof is installed'without fist btaining an inspectidn,=,'agree to remove
emit atrocious cotta t as d f ed by the Bay Am.Air Quality Management
* Dsw t all new material inspection pplicant understands and will comp) with
. ❑Y - .-
all non-poin - rc egula 'o -
..� ' 'I'ha e ,ad the h za dapsmaterials,requirements underChapter 6.95 of the
Calif ' [Ili Safety Code' 2550525533 and!25534.1 understand that
.titch Id ns ammodyha mw tth Yt' my respo stilly to notify the '-
'cups t o! aqui tan t muse be t p to ssusove of.5:mbfia'&of
OhuPa
gnature of pplicant Date
aatnn p oath All roof coverings to be Class "B" or better
it
`. .lI -`___ �,l — OFFICE
Mw Building Division
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:
C, A&II
.,;Address: /��/� / / �� �OY/�1-7 441
Reroofing Company Name:
Applicants Signature: Date: S y O
Joe Antonucci
(Chief Building Official)
6/25/01
l
Building Division
10300 Torre Avenue
• �y i � Cupertino,CA 95014-3255
•M"" Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
CUPEkTINO
Building Department
RER®®F TEAR ®FF 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 p.m.
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)
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