03010021 ! CITY OF CUPERTINO " ' ` •"t
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:1'
BUILDINGADDRESS: OLD COUNTRY ROOFING PERMIT NO,
10359 HENEY CREEK PL 03010021
OWNERS NAME: 125—B GROBRIC CT APPLICATION SUB DATE
LACCABUE FRED C AND MICHELLE R 01/06/2003
ZONE: 707 SANITARY NO. CONTROL NO.
ARCHO'EC IENGINFER: FEB
O12 ZOUJ BUILDING PERMIT INFO
I-GD BLDG ELECT PLUMB MECll
o 0 0
�wr LICF.NSEDCONrRACrder DECLARATION b WILDING P
rc U F 1 hcmby )firm that I am licensed under odyn fes of Chapter 9(rommense i• WILDING �OI1 Description
<i wJM1 Scanm A(Mq of Divisien3nf dm Busincaa and mfcssinnaCmlc,and my license is
in full come and effect& �� REROF
gni License CIees Lic.M
FN_'o wm__IJlglp] cnmmnnr T/O SHAKE, INSTALL OSB 30# FELT &
I ARCIIIlTCTS DECLARATION
Nww 1 understand my plans shall W used as public records MONIER LIGHTWEIGH TILE
�3au
t-LL d. Licensed Professional
S OWNER-BUILDER DECLARATION
<S I hereby affirm that 1 am exempt from,he Contractor's License Law lin the
i n o following reason.(Section 7031.5.Business and Professions Gale:Any city or county
w m� which hideouts a permit to construct,atm,,improve,demolish,or repair any sundelum
prior to its issuance,also requires the applicant or.such Permit o file a signed atwerrem
in.,he aw(Chapter9 Sq. Ft. Floor Area Valuation
C€� (commencing with Section7BXd of Division 3 or the Business and Professions Code)nr
i 3 that W is exempt themfrom and the basis for the alleged exemption.Any violation of
Sandon 7031.3 by any applicant for a permit subjects the applicant to a civil penalty of APN Number
no,mom man five hundred dollars($500). cy Type
❑ I.as owner of the pmpery,or my employees with wages as their sole compensation,
will Jo the work,and be structure is not intended or offered for sale(See.7044.Business 3424 8028 . 80
add Protestations Code:The Contractor's License law the not apply to an owner of Required Inspections
property who builds or improves thereon,and who deassuch work himself orthrough his
own employees.provided Oat such improvements are no,intended or offered for sale.If. 305 — FRAME
however,me building or improvement is sold within one year of completion,the ow,net.
builder will have the burden of proving Nat he did not Wild or improve for purpose of 3 07 — INSULATION
cal'.). 601 — ROOF TEAR OFF
01,as owner of the property,am exclusively contracting with Bcenaad coneactors to 602 — ROOF PLYWOOD NAIL
construct the pmjecn(Sec.7064,Business and Professions Code)The,Contrxclors Li-
ecreanawthcsnotapplytoanownerofproNnywhoWildsorimprovestherenn,and 603 — ROOF BATTENS
Lae nee Lewes for such pmjecks with a convanorts)licensed purauanuo the Canvaaors 604 — ROOF IN-PROGRESS
❑ 1 am exempt under sec. .B&P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I Wmhy affirm under ptnaily of perjury nuc of the following declarnlons:
1 have and will maintain a Cardamom of Consent o self-imure for Workers Compere
cation,as provided for by Section 370()of the Ichor Code.for performance of the
work for which this permit is issued.
❑ 1 have and will maintain Worker's Compensation Insurance,as required by Section
3710 of the Labor Code.for Je performans,of one work for which this permit is issued.
My WnrkCS' t�lnxum�"ro canter and Policy needier amp/�
Cantered t'C s/ Vn o1 Polt �d�/V—ZOO)
CERTIFICATE OF EXEMPT ION OM WORKERS'
COMPENSATION11 RANCE
mu.s melon need no,W completed if the parmh is for one hundred dollars(SIBIB
m less.)
1 candy that in the performance of the work for which this permit is famed.1 shall nor
employ any person in any manner so as to Wcrme Subject o the Workers'Compensation
Laws of California.Dare
Applicant
NOTICE TO APPLICANT:If,after making this Ccomficare of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
D O fuMwith comply with such provisions or this permit shall he oriented revoked.
'z'y CONSTRUCTION LENDING AGENCY
rThereby affirm ma,them is a communion lending agency for the performance of
X 7 for wmk for which this permit is issued(Sec,31X97,Civ.C.)
ISI Q Lender's Name
z Lender's Address
V O 1 ccnify mar 1 have read,his apdinu ns and t..,bar the aWvc information is
(+. F correct.I agree to comply with all city and county oNinances and stale laws relating to
�Ubuilding construction,and hereby authentic representatives of this city to enter upon the
FD.1 'a 'one emionedprnpeny(or inspection which ra
ds (We)agree to save,indemnify and keep har ily of Cupertino against
Z inc.itics.juJgmc����n 555-- apcmcs which may in nyw a¢ntc agaiaa said City
U z inconscyu015NDERSTAf(DS is pern'r
ti SO CA 5(SrJ' UUNDERSTA SAN ILL C .e LY WITfI ALL NO -POINT Issued by: Date
SO C ULATION .
"' �l /1L. Re-roofs
Signature or Applmam/co9ry1 our I Dale
ff4ZARDOUS bMERIALS DISCLOSURE Type of Roof
Will the applicant of future building occupanu,ore or handle h izarsom mammal
as tlefiueJ by the Cupertino Municipal Code.Chapter 9.12,and,he Health and Safety
cone,sectfe,z553z1a):1 1 / All roofs shall be inspected prior to any Too material being installed.
❑Yes WNo
Will the applicant or future Wilding occupant use equipment or devices which If a roof is installed with first obtaining an I section,I agree to remove
mor haraNnus aircon,aminants as defined by the Bay u0ily Management all new materials f nsp [ion.
Uiuricry 1
❑Ytx ft�1'RJ,J
Ihave m e. smamrialsrey3. Jct Cmonamt.95oflhc Califn, _
ria,not
sic. nt.Oat 13, 33 an .534.1 to sonlndthmif the Paul
the
dies not cu ly hove noel,the' , r mobility to notify the cupanl of Nc
mquimm a Wmetp' r,oiav wntactNBtamor ant SignalureofApplican Dale
Owncrof amhoriced age / D„t All roof coverings to be Class 1'B” or better
Building Division
10300 Torre Avenue
Cupertino,CA 950143255
` Telephone: (408)777-3228
coo Fax: (408)777-3333
CUPEI�TIN�
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 1/4"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 of inspection
We understand the above policy on reroofing and will comply with this policy.
Homeowners Name: �Q�� L r--t c-c
Address: 435�/
Reroofing Company Name: 0 L- 7 C-O c i ri�F-rL4.4 20,oF, ��✓G
Applicants Signature—IE ���Date: c,3
Joe Antonucci
(Chief Building Official)
5/25101