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03020008 CITY OF CUPERTINO -V'_*r I.- ', '' =<'� . BUILDING DIVISION PERMIT :CO TRACTOR,&F ATION:-` + BUILDING ADDRESS: OLD COUNTRY ROOFING PERMITNO. 19781 OWNER'S NAME: 125—B GROBRIC CT APPLICATION SUR DATE BIERMAN RONALD E AND KATHERINE 02/04/2003 ZONE: (707) 864-5557 SANITARY NO. CONTROL NO, ARCHITECTMNGINEER: BUILDING PERMIT INFO RLDO ELECT PLUMB MECH 0 0 0 0 uFrslpp LICENSED CONTRACTOR'S DECLARATION Job Description w p I herby affirm Thal I am licensed under provisions of Chapter 9(commencing p ii1X2 with Section 7000)of Division J of the Business/aRJ Professions Code,and 1 my becase is rn< in fu111ume unJ effectL^.f� W 6Z L/Y REROOF Z O 1�Z License Class �V/ can a oz-_ Damcomranor a REMOVE SHAKES INSTALL OSB, 30 #FELT & It ARCHITECT'S DFLI.ARATIO s H� :� I understand my plans shall be used as public records ELK 40YR. SHINGLES �,p y� r tr WuWu FINA ED uO Licensed Professional OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Commmm's License Law for the FEB 2, 6 2003 i 00 following reason.(Section 7071.5,Business and Professions ty tar Code:Any cicounty $� which requires a permit to construct,alter,improve,demolish nr repair any&Irurwre prior to its issuance,also requires the applicant for such Permit to Ne a signed summem that he is licensed pursuant o the provisions of the Contractor's License Law(Chapter 9 Sq. Ft. Floor Area V ation (commencing with Section 710X)of Division J of the Business and Professions Code)or BUILT o. that he is exempt therefrom and the basis far Ne alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant o a civil penalty of APN Number y Type not more than five handled dollars($500). ❑ I,as owner of the property,or my employees with wages as their sole compensation. will do me work,and the suuciu.is nm intended or offered for sale(Sec.7044,Business 36909032 . 00 end Professions Code:The Contractor's License Law does not apply to an owner of Required Inspections property who builds or improves thereon,and who does such work himselfor through his own employers,provided Nat such improvements arc not intended or offered for We.If, 305 — FRAME however,Ne building or improvement is amid within mm year of completion,Ne owner- builder will have the burden of proving that he did not build or improve for purport,of 307 - INSULATION Asia'). 601 - ROOF TEAR OFF ❑ I,a owner of Ne pmxmK am exclusively contracting with licensed con ractore to 602 — ROOF PLYWOOD NAIL construct me pri(Sec.7014,Business and Profession&Code:)The Contractor's Li. cense law does not apply to an owner of property who builds or improves Hereon,and 603 - ROOF BATTENS who contracts for such projects with a conuacmr(s)licensed pursuant o the Contraztais Lie nse L 604 — ROOF IN-PROGRESS eaw. El am exempl under Sec. B&P C for this Troon Owner Data WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury,one of the following declarations: 1 have and will maintain a Cenifcare ofConsenuo at l binsure for Workers Compete sation,u provided for by Section 390su0 of the Labor Code,for the performance of the wt for which this permit is ised. I have and will maintain Worker's Compensation Insurance,as required by Section J I of the labor Code,for the performance of the work for which this permit is issued. My Workers Compenamar In uranm Cartier and Policy 1nu Ner am: Cartier: P.B.,.:1 � CERTIFICATE FROM WORKERS' COMPENSATION INSURANCE (This Accident need not rte completed if the permit is for one hundred dollars oI(Xq or leas) I certify Nm in the performance of the work for which this permit is issued,I shall pill employ any person in anymann�5asasit�come au ce,to the Workers'Compensation Laws of California.Dal, ._ Applicant "� NOTICE TO APPLI A :1, t m mg this Ccnificare of Exemption,you should heemac subject to the Worker's Compensation provisions of the labor CMC,you must OO forthwith comply with such provisions.1 01.permit&hall he deemed revoked. CONSTRUCTION LENDING AGENCY [r ,N—t (hereby affirm that them is a construction lending agency ler Nc performance of at� the work for which this pemrit is issued(Sea 3097,Civ.C.) fgd Q Lender's Name Z Under's Address V 1 certify that 1 have read this application and more that the¢move information is I+ F+ correct I agree to comply with all city and county oNinama and sure laws relating to O V building construction,and hereby auNrrim mpmaenmrives of Nis city to enter upon the tad &hove-mentioned properly for inspection purposes. G (We)agree to save,indemnify and keep hamdcss the City of Cupertino against TA Iiabilities,judgments,co&ts and expenses which may in any way acerae against said City V 7 in consequence of the granting of this permit. F7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON POINT Issued by: Date / SOURCER Q ,lit- 03 Re-roofs Signature of ApplicanVCammcoa Dale HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building Occup.,shoc or handle hvmdous malerinl As derined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety ode,Section 25532(x)'! All roofs shall be inspected prior to any roofing material being installed. �Yao Will the applicant m lmure building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove Tit hasardoua air cumurommia us defined by the Bay Arca Air Quality Management all new materials for inspection. iatrict? ❑Yes t� Ihave lead NrhavaNtwna 25505,2553 iu:menu undcrChatand th5ofine Wilding � ria SafetyCoce,Stttiom On, rayrx,rd255J4.1 understand atifNrannof Wilding K/ 7 does ran currently have a¢root.Nat it is my respomibiliry to notify the tacupent of Nc req�ireme�ts which ttcmcl prior to issuance ofa Cerincme of Occupancy. Signature of Applicant Date ownrr'araum ti/aagr z tet/ o t� All roof coverings to be Class"B" or better r Building Division 10300 Toren Avenue Cupertino,CA 950143255 ` Telephone: (408)777-3228 410 F= (408)777-3333 CUPERTINO 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 Wand 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 Y"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: 4'il/ rj ! Address: �/ / �J t X y 'j:)<j dcc� Reroofing Company Name: O 7 O u ©0,= G Applicants Signature� -Date: Joe Antonucci (Chief Building Official) 6/25101