01070037 (2) CITY OF CUPERTINO
DoD.DING,DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMITN0.
21125 SEVEN SPRINGS DR OLD COUNTRY ROOFING 01070s0y37
TE
o�r�F,Wf4E:SPRING H.O.A. 387 UMBARGER RD A07G/ All/2001
PHONE: (408) 362-1111 SANITARY NO. CONTROL NO.
❑c Z ARCHITECr/ENGINEER: BUILDING PERMIT INFO
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Z i N Z LICENSED CONTRACTOR'S DECLARATION Job Description
O Z_O I hereby affirm that l am licensed under provisions of Chapter 9(commencing
FNF.; with Section 70(1 of Division 3 of the Bnsincss and Professions Code.and my license REROOF (CLUB HOUSE)
e, is in full for=e and jge_t 173 SHAKE TO DEDARL I LE .
z c ce a License Cla.s�sf , Lic.»
w 0LLO Date I�biw�/ Canted to,
ARCHITECr'S DECLARATION
d - I undersmnd my plans shall be used as public records
ce a o p License"Professiowl
c. OWNER-BUILDER DECLARATION
toI hereby anion shut 1 ain from the Contractors License taw(or the I
t-z following mason.(Section 7031.5.Busier,,and Professions Cade:Any city or county
Z 4 e which requires a permit to construct.alter,improve,demolish,or repair any swewrt
6l= _poo to sante.alsoq d applicantf .such permit to File signed statement - - - - --- -
3- thathe islicensed purm ttoth,pro f the C t cton's License Law(Chapter 9 ,Sq.-FL Floor-Area - ,, ' Valuation
son s 'm Section'7000)of In q or the 1} sines dPrresCotns Cn ?i.'. .t.�t*'k1! .�• :�j.i_, 1
or that he is exempt therefrom and the basis for the alleged cxemp lim.Any violation
of Section 703 IS by any applicant for a permit subjects the applicant to a civil penalty �
or not more than five hundred dollars S500). APN Number l.' " .:: Occupancy Type
01,as owner of the property.or myemployccs with wages as their sole compensation, 305 — FRAME
will do the vara.and the atracmrris not intended or offered per sale(See.7044:
Busineis and Professions Cade:The Contractor's License Law does not apply to 3 07 — INSULAT an TIQ1juired Inspections' ,
owner of propany Who builds or improves thereon,and who does such work himself 601 - ROOF TEAR OFF I
or":rough his own employeesprovided ohm such impovemenn are not intended or
"
offered for sale If,however,the budding or tmproJetent is add within one year of .. .. .. __602-_-...ROOF 'PLYWOOD _NAI L-,�.- .... . .
completion.the ownenbuildcr will have the Wmen of moving that he did not build or
mmmve for purt,aseafsme). 603 - ROOF BATTENS
. � f9pr Defy. exclusively- ..., - ... . .. .._"-604-- -- -ROOF -IN-PROGRESS.
i ren
contracting th licensed conomerms to
construct the project(Sec 7044 Business and Professions Cot The Contractor's
License Law aces nos apply to an owner of propeny,who builds or improves thereon.
.and who contracts for such.projects with a canuanodA licensed pursuant to.the
.cr License law.
0 1..am exempt under Scc. '.B&PC fonhis,coon p��y� :t � •- - ''�
Owner Date ' ., Fe� `����®'..
_ WORKER'S COMPENSATION DECLARATION
I hereby affirm ander Penalty of Perjury one of tate following declanitiunu: O 9 2001
° 1 have and will maintain a•Cenifcate'of Consent to self-insure for Wmker's OCT
ComPensptiun, as provided f1 . or by Section 37M of the Latin,Code.-for the '
permor ane of the work for which this permit is issued., 1 I.s,
01 have and will maintain worker's Compensation Insurance:as required by Section BUILD ry
3700 of the Labor Code,for the performance of the work'for which this permit is
.Sud MyWorkers C pe:f Isurance carer and Poly number am
Curt N . . :. Daley No
TI ICATIONOFEXEMPTION FROM WORKERS'I �.I
Mi,Seaton acid n0PE ON INSURANCE t'"' -.___._..�._.___.._._—_
NSATI _ . . ... -
_ .,.'t'' (ID' ,- omdeed ifthe permit is for one hundred dollar , a .N „•7 �I
131001 nr lett"i, ..
1 cerfify that in thapef eof m' � 'kf witch th':Perrot" wii _ „ ,t -i1 x,t.h :l�
'shall not employ any person m y a as o became subject to the Workers
Compensation Laws of California:Date
Applicant '
..Applicant _ _ -
NOTICE TO A_PPLICAN7:traitor making this Comficata of Ewonu nr you should '
Z Z cume.suomply bcfONSTRLtCnON tLiNpermsionsofmc Labor Cute,you Inuit
bi'
0 O fpVM1 ih t reply with cath provis ons or th'.p,mit shall b<deem<J revoked.
y DING AGENCY '
F I he affirm that there is a consruclion lending agency for the performance
W'► 'athe work for which thk p"it is Issued(Sec.3097•Civ.C.), ,..,.•i n.__ a_- .. _. .... _.. .. _ .. ._
L'ender's Name .. .. ... .._, ._ ... _. ._ . ...,.
z Lender's Address
V 0 'I certify that I have=it this application and state that the above information is.
corer:I agree to comply with all city and county ordinances and state Imus relating
0-U tabuilding w do dh by notha c rep .representatives of tyt me upon
;4the h e menterod prope ty f sect p p c
A. (W)agoce tis indemnity and JPI I in
Cit y tC pennuogams
tZ)E liabilities,1 Jgm tsti t. d pcn,es which y'n any ) « gain said
V.Z City n<on'equ c-(heg Ing oho.me t.
APPLICANT NDF ANDSANOWILLCOMPLYWITHAlitNON-POINT Issuedb Date
SOURf LA 5 Y'
Sig car ,pplcary of natmo. `1 'Umc Re-roots
' HAZARDOUS MATERIALS DISCLOSURE �_
: ill the applicant or future building«eupsn store of handle haivdous material _Type of Roof• - - •••^ - "'"" - "' •' ' '
u defined by he Cupen a Municipal CodCharter 9.12.and trHealth and Safety. _ t^ .T 1 -,s r .:t,,t, I s
Code.Section 25532(1)! - i'�' 1 r ',
°Y °^'" .All roofs shall be_inspected prior to any..roofing material being installed._, __. .-..
a
W ll to ...fr t or tolice,holding rer.1tart se eq l t v vi=es which' If a roof is installed without first obtaining an inspection,I'agree to remove
creir hatennious air ca can t. Jelin by the Bay Area A' Quality Management'
District? all new materials for inspection. Applicant understands and will comply with
all non-point regulations.. -
,'1 have read the hxcurdouk materiels requiremctns under Chapter 6.95 0(thet
Cahr.oniuu Health&Safety Code Sectio 1,25505,25533 and 25534.P undecnand that
lithe building does nm cu 11y h: reatenant.ihatitismyrespunsibilitymnntifythe' -
ret of the¢qu trent s which'must Corer prior to issuance of a Cenificate of:
72 //�ry�p�(,(/// 70.0(. Sir Lure of Applicant Date
._. marlrea agent - Dm= All roof coverings to be Class "B" or better
nervy OFFICE
Building Division
Torre Avenue
Cupertinono,,C -3255
(4
Telephone: (408)8)777 777-3228
CITY OF Fax: (408)777-3333
CUPEI�TINO
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/a" 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: SEtleo `Jfl.t�G �� O
Address: Z II ZS t?tI� S �J f`liy [ .
Reroofing Company Name:
Applicants Signature: Date:
Joe Antonucci
(Chief Building Official)
6/25/01