02070117 (2) CITY OF CUPERTINO '
BUILDING DIVISION PERMIT CONTRACTOR IWORMATION:
BUILDING ADDRESS: PERMIT N
11692 WESTSHORE CT OLD COUNTRY ROOFING X12070117
019KA GREENE 125-B GROBRIC CT APPLICATIO /NS HDATg 2002
1PHONE: (707) 864-5557 SANITARY NO.
17/ CONTROL NO,
i
u O O ARCHITECLENGINEER: BUILDING PERMIT NFO
z w C BLDG ELECT PLUMB MECN
n« LJ C=1 L. U
N i LICENSED CONTRACTOR'S DECLARATION gb Description
Ihertbyalfrmmmlamlmamm�pruvisionsofChap,cr9bmurn Bing REROOF lIQ��P��'®
x i,h Sm,ionI W)of Division3 of Italy
ta Bus n dProlessiom Cad e.and my license
im F= is in full fQbande Tec �.
"a""a ¢ Licenu Cly L¢.x C9 mor
Ga"'rar/� SEP 1 8 2002
3+G A CHITECT'S GIi('(JARATI N
° I undersmntl my plans shall W used D puhlic mcoNs
Y
dp O Licensed Rafcssianal
e OWNER-BUILDER DECLARATION '1
6:51, 1 hcrtby a0inn sea 1 am esemp,from me Conwnor'a Licenu taw r«the UAL®'
following reason.(Section 7031.5.Business and Professions Cade:Any city or county �� 13 0 0 0
o which requires a Permit to construct.alter,improve,demolish,or repair my structure
aim _pct« s issuable,alsorequirasshe applicm,
thm hdis licensca p,iisuam m the pow slims of the Contractors License U.(Chapter 9r�SLy <lyf 1 Valuation
(comencing with Section of Division 3 onm he Business aProfessions Code) '',Y.'
m " Ll 3_•.' t 'p. Li1 I
or that he is exempi m efro,ri and the basis for the alleged exemption.Any violation
-of Section 7031.E by any applicant for a pamJt subjects the applicam m a civil penalty` .. Occupancy Type
mho
f ,ma:e,nan h.i h.ndred collars(s3o ). PN a el-•.
01.as owner onhe rr.orm mos with woes as their sole cath nmron. 307 - INSULATION
�d tK s my e a
will de,he'work-o ions ode: Contractor
i intended s Li License
Lawered for sacs apI.ply
to an _ muur D$t1P�tI : r •r
Bus o pry Who
Code:no ntmcmro License Low does no,apply,o an 602 - ROOF PL me f O
owneandr f Who Wiles or improvesdthat such impr who encs such work himself or
ci through his own employees,provided that such vement is sol within
no,amended or
corned for sale if,aowuilde the Wue ng a Improvement is Bala wnmo ane year or - -'6 03 ---ROOF BATTENS ..__....... _._.._._...... ..
ompla"n,meawncr owner-builder will have meb de otp Being that he ata not build or 604 - ROOF IN-PROGRESS
improve for purpose of sale.).
oi;as owner of Property.amexclusively cannoning with licensed contractors to - - --- --� - - �-�� --- -� - -��� , - -- - ------'-"`construct the the protect(Sm.7044,Business and Professions Code:)The Con,rnemr i Dt
License law does net apply,o an owner of property who builds or improves manor,
:a = _.and who contractsfor such.proiacu with.a conwctems)licensed goal.w.,he. ._. ._ ._ _.-__... , _._. .__.._.,__.. .__.__.....__�__._....,..._.t___..: -
' Caro is Licnue law,: .....___. ._._..._.. ..._.... __.___.._.__..,,_._
❑lam excmp,mnder Sec.'i _ `;B&P C for this rtason , 'I' ilrg.,:71-:7✓i,
Owner'' - ''Date'
WORKER'S COMPENSATION DECLARATION,
I hemby afri m under penalty of perjury one onhe following declantions:
f.�. C 1 have and will maimed fa by Sect n Consent to self-insure for Worker's
Camrmanc oo, he provided for by Scion Jis0 of ,he Labor Code, for the
performance of me wark,ror.nien thio permit is ina<a.
01 haaa vnd will maintain Workc2i Colnpenm,ion Insurance,as required by Smian
3700 of the Labor Code,for the performance of the work for which this permit is
issued My Worker's Conal sub 1 surane er enc Poly number sec _
.. .. v. _ ..-
'
ar. . Pa '//.592 yPo2 (\ 'xtl �.' f•; 11. '..(tr :I,T ', a -.... . ;r. .. ,
,.CERTIFICATION OF E%E ON FROM,WORI ERS�„- - +-
CQMPENSATIONINSURANCE'� _
"' (ID s sermon nem no,be completed if the permit,s for mu hundred ball
m
IEI00)or IcssJ
" 1can fYy tin she performance bye of, rkfr hick,Mict t sorkdI
Churl nos employ any pawn m ony'manncr so as,o become nublec,to me Workers -
Court pcniatio,i laws of California:Da¢
XpPliechat
NOTICE TO APPLICANT eWork is armrmaking this Genion of of Labor Code.you
•� '
Wchwith coal
with
Workers Colons or this provisions of Leer Cme,you must
z 0
forthwith eomply'wiM tach provisions orchis permit shell be dimmed revoked., , - _ �i
PB) lc fC6NSTRUCf10N LENDING AGENCY v
s' 1 hillD ,h,be.,s construe I nding agency forthe perfo ant
W.E of,he work for which th permit issued(S, 3097 C v.C I
L Q ILnder's Neme'-tl _ .. n.,; H.:. _. .._.,__
Lender's Andress"'+"' •' -' .r
V'0 II grecs.cyouomply rtad thlcity icatiooaod nam dustthe
and ovte laws information is
ioWildinacme ir complyI have d he all city and a repr ordioancn and cute laws relining
�•L1
to Wilding tuns,mesion:and neor"autharize rcprcsenietiJes of city menmr upon
theabove-memianed for inspa,ion purposes
y Wc7 exp Java.in cmnify tied kee he Ci,y of Cup nano against
VJ liabilities,jydBmyrfs.cosu m expenses whi y in any way ecc a agurssi uid '
U.Z. City in a a!ggCam f M taming o s i,: - " -
`� APpLICI CP llNDER VDS WI. ' ONPLY,N7TBA bN' O
due n_ Issued by: Date
INwul tha. .n m°mR nptiding . . D t -. Re-roofs
III IS DISCLOSURE ,
becupa, tae hit]a erutlous baseball Type of Roof --
as Eefisr4 by.the Cupemao Mu ,PBI ode Chepur 9 13 end,he Health and Sa(cry _ - - -' -
Code ❑YInuta 7.532(O? sax o L1'70
;n \ t T All roofs.shall.be Inspected p I rd y roofing.matenal being Installed...__,
((( _ ..
Will the applicant or fu buildiiin «bapan,use egwp t or aeviceawhich If a roof is installed without fi obt min an ins ection,I agree to'remove
emir Nrafaous air conununants he d b)me Bey Arte Au Iday Mwgement g P g
Digin, \ ' all new m_ at s r inspecti n. plicant understands and will comply-with
A r 0Y {�,,,, '+,'� - _.,,,, all nota- o�ce iegul i n I ,. . . .......,..
�./
in`lthe ceadead6ds maions q 33a untie C.-1 m ermand me
If li a g: cur Code Svc that
d733341uneersuodthat
the
Rd�eb gd current 0y t ,ha, ns my responsibility to notify the
am of the' wrtrnc u a ,tr me,p , sea ce d( C tBrn'of
o °a 7 Signature o Applicant Dat _
_. . .. _..
ovines. amM1 seds,ent, ateAll roof coverings to be Class "B" or better '
-OFFICE .. .
' 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/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: �J�1 (2. ( (l C-c c%
Address: goZ c. Si f�2cr' C'
Reroofing Company Name: �%L���C-0G4L �'�00 F I NCS
Applicants Signature: Date:
Joe Antonucci
(Chief Building Official)
6/25/01