05090117 ` CITY OF CUPERTINO
BUILDING DIVISION PERMIT �5,CONTRACTOR INFORMATION ".;
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BUILDING ADDRESS: GROMO ROOFING INC PERMITNO.05090117
937 LIBERTY CT
OWNER'S NAME: PERMIT LSSUE DATE
Alk MICHAEL CADOURI 121 W WASHINGTON AVE 09/16/2005
ONE: SANITARY NO, CONTROL NO.
(408) 746-2075
ARCHITEC'PENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB - MECH
0 0 0 0
,00 - LICENSED CONTRACT'OR'S DECLARATION
W I hemby affirm that l am licensed under provisions of Chapter 9(commencing Job Description
with Section 7M))of Division 3 of Nc Businessand Professions Code,and my license is � /'a n na
L m110srec and cne REROOF-T/O SHAKE INSTALL". ,SHING1LE„SS
License Clas Lic.x t U +•'a—V," !J
n
.0 Dam COmramar 4a 13 •i;_: x, f{Tp
"r ARCHITECTS DELLA ATHIS
a1 understand my plans shall be used as public records 0'
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s C LiecveJ Professional
2005
5 OWNER-BUILDER DECLARATION
<q I hereby air,.Nat I am exempt facto Ne Con"con's License Law for the !.,
00 fallowing moon.(Section 7031.5.Business and professions Cale:Any city or county �y�
t m which rewires repair.permit to cut.,.alter,improv,demolish.or repair any swnum (;._01 x(;n \\ (,E=3T,$13 5 0 O
prior to its issuance.also requiro the applicant for such Permit o file a signed suitement —..
< that he is licensed punomu.doe provisiomaftu,Conlsacmr'sLic,m.Law(Chm.,9 Sq. Ft. Floor Area ` Val"cation
YFG (commencing with Section 70(10)of Division 3 of the Business and Prornsions Code)or
i that he is oempt thcmfmm and the basis for Ne allcgcd oemptlom,Any violation of
Section 7031.5 by any applicant for a permit subjects thc applicant to a civil penalty of r Occupancy Type
not more man live hundred dollars($5,0).
❑1,as owner of ttie property,or my employers with wages n Meir sole campenetimn,
will do the work,and theswctum is notimmmded or offered for sale(Sec.704,Business
and Pmressiona Code:The CanmOors License Law don not apply to an owner of Required Inspections '
properly who buildsor improves thereon,and who doessuch work himself or through his
.we erplayco,provided that such improvements..or intended of offered for sale.If,
however,the building or improvement is sold within one year of completion,the owner-
builder will have she burden of proving that he did not Wild or improve for purpose of
sale I.
❑I.as Owner of the propcny,am exclusively,contracting with licensed commemors to
Co.,.[she p.jcd(Sec.7044.Business and Professions Cod.:)The Cmdrmtor's Li
ecree Law does not apply to an Owner of pmpeny who Wilds or impfoves Neuron,and
who contracts for such projects with a eontractoKs)licensed pursuant to the Contramrs '
Licence Law.
Iamncmotmeterste. ,B&PClor Nisreuon
Owner —Dan —
73710WORKERS
amWORKERS COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of Ne following declarations:
T have and will maintain a Certificate of Consent o self-insum for WorkcraComyce-
0
um,as ro vidrd for by Section 3700 of Ne labor Code,for Ne pnrlrmmce of the
rk for which this permit is issued.
I basic and will maintain Worker's Compensation Insurance,as required by Section
of the Labor Code,for Ne performance ofthe work for which Nis permit is issuedy Worker=C/999/���_Mny�,n'pnlfnsu�ra�n�a�rgmer and Policy number am:rrier. l G r"""v'1 Policy No.: 2 k� 5-3
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Cron;section need not W completed dtie permit u form hundred dollen(SIM)
or lava)
1 cmtlfv that in me performance of Ne work for which this permit is issued.I shall not
employ any parson in my mummer so as m become subfcet to use Workers Compensation
Laws of Cslifomia.Dam
Applicant
NOTICE TO APPLICANT:If,after making mus Certificate of Exemption,you should
become subject to the Worker a Compensation provisions of the Labor Code,you must
.J O forthwith comply with such provisions lir this permit shall be deemed revoked.
z vy CONSTRUCTION LENDING AGENCY
E" I hereby affirm that then is a convection lending agency for the performance of
fYi ? the work for which this permit is issued(Sec.3097,Civ.C.)
{a7Q Landers Name
5 z Lenders Acidness
U 0 1 certify that 1 have rod Nis application and suite that the aWw information is
r cmmu 1 agme to comply with all city and county ordinances and suss laws orating to
0U Wilding convection.and hereby aumorim representatives of thiscityto enter upon me
aWve.mcntiomd property for inpe0fmn purposes.
(We)egrte to save,indemnify and keep harmless the City of Cupcnino against
Esu r0.q liabilities.judgments,cots and exp•ses which may in my way accede against said City
U Z in consequence of the Starting of this permit.
APPR813'=
ICANT U ERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCEREGU A 91ta���a
Re-roofs
Signature of Appli ontnc Date
F3 ZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building Occupant store or handle havardous material
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
ode,Sc Yes]5532(a)? All roofs shall be inspected prior to any roofing material being installed.
Yes )00
Will the applicant or future wilding occupant use equipment or devices whim If a roof is installed without first obtaining an inspection,I agree to remove
it bemldnos air conuiminamu as defined by the Bay Arco Air Quality Management all new materials for inspection.
District
❑Ycs itO
1haveread IWm,a .sma¢rialsmquimmentsunder Chapter6.95ofineCaliror-
niaHnlN&SafctyCadc.ScntMnM5.MS33md2534.lundcrsumd Nuirmc Wilding
don rent currently hone a lemon short is my responsibility m madly do occupml of t e
mlommentswh mustiamel .ortuIssuance ofaCertificate efoccupancy. Signature of Applicant Date
owner pr lamaap ge11 Dare IAll roof coverings to be Class "B"or better
Community Development
11 10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
�UPERTINO
Building De artment
JOB ADDRES PERMIT #
`7 7 - o f c/2 -T
OWNER'S NAME: CPHONE # VO -,(Q 7j
-
GENERAL CONTRACTOR: GFAX # W9 7,7-3-
I
,3-I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
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 (gyp 3 %6 02
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Con • for gnature Date
Community Development Department
Building Division
City of Cupertino
�•+ 10300 Torre Avenue
CITY OFt Telephone: (408)777-3228
U P E RT I N O 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.
7. NOTE: If you call for a plywood nail inspection and the job is not ready,
you will be charged a re-inspection fee of$176.18. The re-inspection fee must
be paid before another inspection can be scheduled.
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: U , J✓G
Job Site Address: 3 7 rP//J CiY�0[/
Roofing Company Name: ro
Applicant's Signature: Date: b6—QS
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
-1 CITY OF CUPERTINO
��d" REROOF 03� 1 ��
CUPEI�TINO PERMIT APPLICATION FORM
APN # D Ito 614 Date:
Building Address:
l / 9) • v2 1J, aQ�
Owner'sN e: Phone :
O Ln oUr Yof 916- Q2U
Contractor: ho #: License #:
Contact: Phone#: Cupertino Business License#:
V Zt Z
pe of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles >d Asphalt Shingles
;' Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings / /ku9-/ ❑ 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:
r �) Ae ck,L 30 r c X
Residential _Commercial ❑
Fire Zone: Yes ❑ No� Confirmed with Planning Dept. if
there are any restrictions: 15
Cost of Project: Type of Construction: Occupancy group:
Soo
Qty. if
Applicable 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
# 3 r ��