04030253 CITY OF CUPEILTINO
BUILDING DIVISION PERMIT ORMA
CONTRACT®R INFpTION
BUILDING ADDRESS: PERMIT NO.
OLD COUNTRY ROOFING 04030253 '
OWNER'S NAME: PERMITtxsE DATE
A11
ONE: SANITARY OLNO.
ARCHITECrfENGINEER: BUILDING PERMIT INFO
BLDG ELECr PLUMB MECH
u00 LICENSED CONTRACTOR'S DECLARATION Job Description
C w 1 on aRrm Met I on li loud ureter ry�visions of CNPmr 9(rnmmcncing
U ifullf n 7IXp)af ivC,39
, NC Buv dProfccsiona Code,and mylicense is
s in foil f M cflttL ((]]
7g� Licenu Class Cc� 1 Lic.N L2 �-31 REROOF
a p`p Dale 3/ Contractor 0A1 T /
qq \ / ARCHITECTS DE ION YQOO 1.46 !9 ,N
'�H� ✓1 underaund my plans shall he used as public records
JaV
k m G
Licensed
onelG1hhereby Ofr DECLARATION
at I am exempt from W Contractor's
LicenseLaw far the
Oo fallowing reason.Soctonben I.S.Business and Psofessors;Code:Any city or county
which mquima Permit to
conswel,alter.improve,demolish,m repair any ormmm
'm poor in its ham ee.oleo resporeS die applicant for such pcmlil 1001 a signed 9aNmenl
t�< was he is licensed imeausnt to Me pmvieiansaf doe Caaresexas U..law(Chapter 9 Sq. Ft. Floor Area Valu non
.FG (commencing with Sudan 7000)of Division 3 of the Business and Professions Code)or
i $ wet he is exempt 0mrtfrom and the bus for we allagcd exemption.Any violation of
Section 9031.5 by any applicant for a permit subjects the applicant o a civil penalty of 32VI1IbT*gr00 Occupancy Type
not mom wen fns hundred dollen(SHO).
❑ I.Mto ofthepmpmy,mmycmploymawithwagesuthtirmiemmpnudon.
will do the work and thestumure is notinm and offered for We(Sec.7W .Bnsim..
and Pmfesslans Code:The Contrteum's License Law does not appy to an owner of Required Inspections
property who builds or i mprovu thereon,and who does such work himsel f or Olmugh his
own employees,provided wet such improvements art maintained mantled forsale.If.
however.the building or improvement is sold within one year of completion.Ne owner.
builder win have the burden of proving that be did not Wild or improve for purpose of
sale.).
1.as owner of Me properly,am exclusively contacting with IicerueE comeacmm to
conatuct we project(Sec.7064,Business and Professions Code:)The Contraction's L6
me Law does not apply to an owner of propcny who Wilds or impram thereon,and,
who convects for such projects with a coutexul s)licensed pursuant to the Contactor'.
License Law.
0 lamexempturoer See ,B&PCfor Ru..on
Owner Data
WORKER'S COMPENSATION DECLARATION
1 Wmby aRrso under penalty of perjury aro of the,following declarations:
I have and will mainuin•CcNOare ofcmnxnuo self-insure for Worse",Compen-
sation,as provided for by Section 3700 of the UW,Code,for the performance of the
work for which this permit is issued.
I have and will maintain Worker's Compensation brsunncc,as required by Section
37 of thc labor Ccdc,for thc performance of the work fm which this permit is issued.
M Workers Cam nsaof lnsuranmearicrandpalirynumberarc
.m N/I (�/td'»+J I/�.e Pol'p'No.: '�' �'sl�a�
INS. 0CERTIFICATEOFEXEMPION rWORKERS'
p, COMPENSATION INSURANCE
(Thssection need not bemmpleted if IW Permit is for one hundred dollars($100)
car ksa)
I canary Met in thc perfonnarce of thc work for which this permit s issued,I shall not
employ any pecan in any manner so as to Wame subject to the Workers Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Workers Compensation provisions of the labor Cod,,you mut
.J O founwith comply will such provisions or this pernit shall W deemed rewkcd.
Z CONSTRUCTION LENDING AGENCY
"' I hereby affirm that them is a eonstumina lending agency for we perfurmana of
Cls> the work fur which this permit is issued(Sec.3097,Civ.C.)
Is7 0 Under's None
6. Under's Address
fJ O I ccnify that I have land this application aM sons,that thc show information is
P correct.1 agree to comply with ell city and county ordinances and sums laws relating in
�U building construction.and hereby authon¢rpresenutivcs of this city to enter upon the
r shove-mentioned property for inspection purposes.
(We)agree to saw,indemnify and keep harmless Me City of Cupertino against
� liabilities,judgments,cmks and expenses which may in any way accrue against said City
U z in consegmnc, a granting of is
^' APPLICA Worm
S N MPLY-WITH ALL NON POINT Issued by: Date
SO RC E LATIONB. 3/vJ(
Re-roofs
ignmor fApplicanJConuacmr te W�
r HAZARDOUS MATERIALS DISCLOSURE Type of Roof
7 Will thc applicant or future Wilding occupant store or handle haxardourma¢dal
defined by the Cupertino Municipal Cod,Chapter 9.11,and we Health and Safety
Coda Schon 155]2(4)? / All roofs shall be inspected prior to any roofing material being installed.
Ycs 6 Nm
Will we applicant or future Wilding occupant use mInfinent or dcvias which If a roof is installed without first obtaining an inspection,I agree to remove
mit hvardnus air conuminanu u Jcfinc0 by we Bay Arta Air Quality Management all new m 'els for inspection.
Diurin?
Yes
No
1 have read thc haxardnus mawdals mquimm,nu under Chapter 6.95 of thc Caliror-
niaHralw nyCodc, 2533 am1255k.lundcrmand Wrest thc Wilding -- —_ �(
dos
our he .IctporuibilitY.ta moutj do aaupant of we
,eq. U.11clom- - a cmncamor(kc sely. /S ature of Applicant Date
or,moffimixed agent Dm, All roof coverings to be Class "B"or better
£ Community Development
10300 Torre Avenue
T/ Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408) 777-3333
�UPEkTINO
Building Departn ent
JOB ADDRESS: PERM #
(0421 CA-s-rlNe flV . 302-5-3
OWNER'SN M M ®OLe PHO f�d�- -�3s✓�2
GENERAL CONTRACTOR: 0w) C-(3ut,3T1ZY Roo W6 FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
21 SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
Glass / Glazing
Heating
Tnsulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing CQ(m-ICiAl L o2 �
Septic Tank
Sheet Metal
Sheet Rock
Tile
— - - - - � <3Idi
r/Contractor Signature —`Date
Community Development Department
Building Division
City of Cupertino
" 10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
CUPEkTINO
Building Department
Subject: Re-roofing policy for the City of Cupertino
1. Prior to permit issuance,you must agree to comply with 1997 UBC Standards
and manufacturers specifications on re-roofing.
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 re-roofing
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) Pre-inspection 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 a 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 on inspection.
I understand and will comply with the above stated policy on re-roofing.
Homeowner's Name: 6C_ �2vzv ^l-LC-4204-�'S�
Job Site Address:
Roofing Company Name: /O 4jD
D C 0 0 6�1 � X 00
A plicant's Signature: W�+//� —�-✓�� Date: 60�04
i • \�lF6lNDt�
Greg Jleel
Building Official
Revised 1/30/03
Printed on Recycled Paper
1
CITY OF CUPERTINO
REROOF o 2-s5�
CITY OF
CUPERTINO PERMIT APPLICATION FORM
APN # Date:
3 aG y 0 3 q_ 3
Building Address:
Owner's Name: on
`/o ass b3�' 3
Contractor: PbQne : License#:
04- 1 LO U NT2 0r -q-PQ "o,0 G as
Cont t: Phone#: Cupertino Business License#:
y4)i V-,5&DD I R 03
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles X Asphalt Shingles
Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report#
❑ To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description:RL%m o VL 4Xt STI n1G S•-� C_ o
SO-Il _ C O,-t ,-- 4 3 S N.v Tu AW&_L 3
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning De t
there are any restrictions:
Cost of Project: Type of Construction: Occupancy group:
C
Qt . 'f
A li a e Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY, Energy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
•