02050145 (2) CI BUILDING �,ISIONNO
DIIVPERMIT CONTRACTOR INFORMATION:
BMCbA "MUTHSHORE CT OLD COUNTRY ROOFING PERMIT NO. 02050145
OPMUORE ULICK 0 125-3 GROBRIC CT AUgC/Nl'3"'i
JIONE: (707) 864-5557 SANITARY NO. CONTROL NO.
C e 2 ARCHITECTIENGINEER: BUILDING PERMIT INFO
k w C BLDG ELECT' PLUMB MECH
Ci I� O 1 I-7
Z LICENSEDCONTRACTOR'SDECLARATION Job Description
1 hetehy of inn mat 1 a,tt licensed under Pmv,i ofchawe-9 anmmench, REROOF
I-Liu with Station 7001 of Division 3ofthe Business and Rasions CushaInder, icense
;y i- is inmEmrteandeffe T/O LAYER SHAKE, INSTALL MONIEN
sous Licensecmas uen_ 2Z7,J� CEDAtNja0 #2656
U Date Conuxtor
I G ARC111TECr'S DECLARATIO
1 understand i9yg,1/,.v Jall yrU`ps!u�bH rcc �r nr
�¢E (/ COOOFFt C CCCll4�t OCT 3 12002
I d O O Licensed Professional
OWNER BUILDER DECLARATION
co—, 1 hereby M.that 1 am exempt from the Contractor's License Low for the
tZlallowingrcasno.(Section]OJLS.BusinuzandPmfcssionsCade:Any<ilymcounty BUILDING
2 F O which regnire,a pemtii m conslrucL alcor,impmve,Jemulish,nr«pair any strvcturt
at
ca3es
m pont l ssu nn,als�rt9 m pplicam for suchpenniu fl a 'g"e'I nammem -'hat he is licensed puoutt the provisions of the Contractors LicenseLaw Ichaptar9 Sq.-FI..Floor Area , + ;; •. ation
(commencing with Section]0011)ofD' ision J of the Business andP f inns Corel �, l+. .. .i• t'
.,Our he is exempt therefrom and the baso fnr the alleged ciemgmn.Any riohuon
of Section 7031:5 by any applicant fors permit subjects the applicant to a civil penalty
bf not mum than five hundred dollars(S50(y, t '1' Occupancy Type
°1,as owner of he proper,,or in,employee,with cages as their sole compensation,
will do the work,and the amcom is not intended or offered for sale(See.70al
owner al aoert feWhonhulds orTheroves hereon.and who doesosuch workhimself307 - INSULATlU�Ired Inspections '
Business
an
or through his own employee,.provided mat mpr vementeI,sol art net intended ter, -'601--- -ROOF TEAR -OFF
completion,
!or sale.If;however,the building or improvement is sold within one year of
nmpleeun,the owner-builder will have the burden orproving that he did not build or 602 - ROOF PLYWOOD NAIL
impmve pupnse 603. -- ROOF BATTENS
°1,as owner of the property,am nnclusivci contractingwith licensed contractors to . . _. ... .- . . .
p(Sec.7 and w' 604 - ROOF IN-PROGRESS .
License the p sen(Sec.]Oban Business and Professions Code:)The contrectus.
License Law does not apply to an owner of pmpeny who builds or improves t In the
and wbu rnLicens fL such projecs win a contractors)licenced pursuant to the .... _. __..
Contractor's License Low.
°I am exempt under Sec. B&P C forthis remon ,
Ousse, Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty offertory one of the following declarations:
° I have and will maintain a Certificate of Consent to self insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
V performance of the work for which this permit is issued.
°1 have and will maintain Worker's Compensation Insurance,as required by Section
37W of the Labor Code,for the peKa mance of the work for which this permit is
issued.My Wo kali Cun nsatio risco < carrier and Policy nu nher are
Cartier .. .,.. ...... .- ..
XEMPT. �G S�ORKER I .
CERTIFICATION Op E TION INSURANCE
ROM WORKERS'; s f '
COMPENSATION INSURANCE
This section need not be completed it the permit is for one hundred dollars
Mot, less.)
I v.erify'to.,in the perfommnee of the work for whieh this permit is issued,l
shall not employ any pemon in any manner so as to bcoome subject to the Wmketo '
Compensation Laws of California.Date
Applicant "
NOTICE TO APPLICAN`E If,after making this Cenificate of Exemption,you should
become subject td the worker's Co r,ma,ion provisions of the Labor Code,you st
O con
Z for comply with such provisions or Npc
is ,mit shall bea
deemed rcvoked. I
rawCI
CONSTRUON LENDING AGENCY '
�-' I�hereby affirm that them is a construction lending agency for the performance
s of the work for which this permit is issued(Sec.309],Civ.C..
)
d ^� Leo er s Name'. ._.. .. . ........... . _
.7. z li J Address ...
U. II agree that I have read this application and ordinances
that,the above laws ation isls� �)
Q0 F to buil.1 agree to comply with all city en county sedateness and state laws relating
C.) the Ibcvcgrro innedonoperty for
nspectionercpreses,, of this city mentor upon
;„ the shove-nieniinned property for inspenike purposes.
a
demnifyaa ee ha ass Ne Ci ayti Npenino against
N liabilities.jund expcnsns+ ¢ yin any way accrue against said
Citns ,anu.l�,yyf,hi n.APPLIGNDS C.'Dw COMPLYWTnEALI .'ON-P NT Issued b (^ Date
SOURCE If S L I Z y
Si... nk/ComctDate
tareofA li VP mm HAZARDOUS MATERIALS DISCLOSURE Re-roofs
ru dcfm
Will NL epplieam 6,rumrc building(mcupam sore nr.handle haallous material Type of Roof •- - -
eIII,ymecupenMupvuuCode.Chapm912.and mH Health and gafny -
CMc Scn on 25532fv)"am 1 x. . . / •.
°Y All roofs shall_be.inspected.prior hi any roofing material being.installed.
wn he applicant or for building occupant use equ pm I or devices whch If a roof is installed with first o inng an inspection, I agree to remove
emit haea rd - contaminants i s Incd h)the B y Area Air Q I ty Management
District - all new maters or inspec[� Ap icant understands and will comply with
I
°Y /",'"° all-
non-poi ourc regulation .
Iia He.rcad the hazardous Zals�uims under Chapter 695 of the
Cglifomia Hcahh&Svfn .S3 and 255711 underhandtatEthe buitdingdoes nn ,rcml hmy responsibility 10 nntilytheocapamof mem icto iaivancc o a CcniR m of
_. Occupancy.
S- Z Z Signature o plic _ to .
Owner ora mr1lager, Date All roof coverings to be Class "B"or better
- ' OFFICE - " '
sNw-
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 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/andd will comply with this policy.
Homeowners Name: > /�/�G- V/l GIc
Address: X 70/ Suv 11 s/-,/,
Reroofing Company Name: �G
Applicants Signature: Date: 2i
• Joe ntonucc� i _
(Chief Building Official)
6/25/01