04070017 CITY OF CUPERTINO
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coft"— cirbkiN
BUILDING DIVISION PERMIT FonMATtd IOM,&
BUILDING ADDRESS: OLD COUNTRY ROOFING PERMIT"04070017
7848 JEANETTE CT.
OWNER'S NAME: PERMIT ISSUE DATE
GEORGE MATTINGER 125-9 GRORRIC ( T . _02/0212nn,et
NE: SANITARYNO. -CONTROL NO.
(707) 864-5557
ARCHITECTIENGINEER: BUILDING PERMUINFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR S DECLARATION
igI bereby affirm Bar I arch licensed under provisions of Chapter 9(emmocricing Job Description
with*fi.O 7000)of Division 30`the Busbacm and P.Ressim-Colia.maloyllocrool-
L I firthfIrce,and effect. REROOF
CC.Cl.
:�42-ia"l
Dale C.L`.
ARCHITECT'S DEQ 2004
VrION
Itmetmentordinypitepashoditcuseed., mciodit
o Licensed Mificallorml
OWNER-BUILDER DECLARATION
I hemby leffilon that I am exempt from me Combranctol's License Law rot the
nO following much.section 7031-5.Business and performons Code:A.,city Or .only
which recrums.permit Io co—I.-1w,improve.deconfish..1.,.1,my .to.
Prior runs issionce.also merropes the applicant for such permit to file a signed statement Sq.Ft. Floor Area Valuation that he is licensed pursomillh,the provisions of da,Commetor's License Law(Charles 9
ivisOo 3 of the Briainceliout Porrommin.Code).1
(commencing with Section 7")(if D
that he b;exempt t1herefirparn and the basis for the alleged exemption.Any violation 01
Section 7031.5 by A"applicant for a permit subjects the aPPILl to A Civil Penalty of er0 0 Occupancy Type
not more than fin hundred dollar(5500).
❑I.as owner Of,C pmpmy,m my employees with wages a their solccrompenstall...
will do Newark end theswcturt is not intended oro@reA 1.(S..7W.Busims
and Professions Code:The Counsel License Law does not Apply ill an Owner Of Required Inspections
pruperty who Wilds Or improws themor,andwho doensucts worklishisciforthrough his
Own employ=,provided that Such firprioshooks inal not intended crofiseed for sale.If.
however,the helium,or improvement is cold within one you of completion,dit,owner-
builder will ban the bookn
of proving that he did not build or improve for pm,Wc of
sale.).
0 1.se Owner of on,routinely,am escludimly contracting with licensed contactors to
construct the PmjCCL(Sec.7044.Business and Proficiedonst Cade:)The Contractonis Li.
coveLaw does not apply to an Owner of property who Wilds or improves timmon,and,
who contracts for such projects wit a contractor(s)licensed pummam 10 do COMmetOeS
License Law.
(3 1 mo exempt us&,So,. B&P C for this mason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hemby affirm under penalty Of perjury arc Of RIC following amehandirms:
I ban and will maintain a Ceadficam of Consent to self-minum far Workicar,Compal
'mann.
mann.res Mi,uiol for by Selim.37M of Be Liono Code.for Bar,PCffO----Of th-
m
work for which this Permit is issued.
0whicI ham aral will maintain Worker's Compensation houshrect.Is m4uimd by Section
hthi,perniliaismed.
31M of 0.Labor Coast.for ft perrommum;of thlismikrol
My Worker's Comparm, d P.1i5immilic
Came
�AI44 � ll g0i` ��b 002 2
CERTIFICATE OF FXEMMON FROM WORKERS'
7 COMPENSATION INSURANCE
(This unlion need Out kc completed if the Permit is forthic hundred dollen(3100)
Or lem.)
I Century that in the performance of use work for which this Permit Is issued,)shall nut
,mph,any N.O I.any Copper sor as to heal subject to th,Worked clusirconam.
Laws of California Date
Applicant
NOTICE TO APPLICANT.If,after making this Cenificate of Exemption,you should
become subject 0 the Workers Compensation Previsions of he LOW,Code.You onot
0 z Forthwith comply with such provisions or But;Permit 091 he dai revalued.
Z CONSTRUCTION LENDING AGENCY
EV` I hereby affirin that them is a construction lending agency for the performance or
> the work for which this permit is issued(See 3097,Ci,,C.)
6. LCOZW.
I Name
Lender's
QU 0 1 cenify that I have lead this lippliCluillm and show that the move,infoomadun is
U.PCorrect.I agree to comply with all city and county ordinances and state laws mating 10
U building Construction,and hereby authomin mpremensitins Of this city to enter upon the
move-mernioned property for ihapa,umi Pon..
(We)ISree to save,indemnify rad dimcp homeless the City Of CaPeortiour Itsiont
fildhitilles,judgments,costs and expe which may in any way acepre,against said City
confgrimun of hu . -
APPL A NDER D I ALL NO Poll Issued Date
UZ in const, mor by:_
S GUL ONS. r
:Z2 Re-roofs
S'9 .of ApplicanitICIrmoscon, eType of Roof
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building Occupant store or handle hiscandous Intrepid
as defined by the Cuperunh Municipal Code.clutpler 9.12.and use Health and Safety
We,Section 25532(a)7 - All roofs shall be inspected prior to any roofing material being installed.
0 Yes future No If a roof is installed without first obtaining an inspection,I agree to remove
future
Will the Ispiplicapplicantr fubuilding pe,uprol use equipment or devices which
.I,W.Cmus a,. contami has deffood hyurcI3ayAm3AirQuahIYMznaprnCm all*newm iials for inspection
DisviaT
to ""S�e
0 Y's
polooll S. 15 1 un=1 I uthe or Ozc.a;
&0, SI PPI
Si at eofApplicant to
All roof coverings to be Class"B"or better
d it;y to ,Zt1c
I
Ow or auth.d.d agent as
V
Community Development
10300 Torre Avenue
g _ Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
�.UPEI�TINO
BuildingDe artment
JOB ADDRESS: PERMIT#
Q o o /2
OWNER'S NAME: Geo 2G e. R. /L PHONE #
GENERAL CONTRACTOR: pL D GU(i!u 1/L FAX # �-
fLo
0 iNG
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the followinginformation:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Ti
Z
Owner/Contractor Signature Date
Community Development Department
Building Division
act
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
U P E kT 1 N OY OF Fax: (408) 777-3333
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: t/ , i/ i✓G r
Job Site Address: (F4/ t�' �c:F el CON✓C 7
Roofing Company Name: Q f-> CGOIN �/ri/ 2 00 r, .dC
A plicant's Signature: 1 / &1� Dater "30"- Oy
Greg QOeel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF � �o v/1;7
CUPERTINO PERMIT APPLICATION FORM
wlpkPN3 60'� O 33 Date: 30 oy
Building Address:
%/1 c% —i C.
Owner's Name: Phone #: `
c---- M T G Cc T"YOF- 7 F Sa J
Contractor: Phone #: License #:
L NT ooF G O(Y' FL3oo (S �a 3/
Contact: Phone #: Cupertino Business License#:
f:r L/-OP P30o QO3 �
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles )' Asphalt Shingles
X 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;
ob Description: 12 u-� o ✓cs ��X 1ST/NG �C-71, o(-- s H l�? ''
/Us /rc C_ as 5 3 o
Residential 5� Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project: Type of Construction: Occupancy group:
Qty. i
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
VZ63 ,