03100031TTY OF CUPER'I'INO
, -K'
BUILDING DIVISION PERMIT
CONTRACTOR INFORMATION R'
BUILDINGADDRESS:
023 1 PAT 0 RQ
OLD COUNTRY ROOFING
PERMrrNo03100031
OWNER'SNAME:
125-9 GROBRIC CT
PERMIT ISSUE DATE -
NE:
(707)864-5557 '
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S P DECLARATION
1 affirm Thu 1 am IieenuO under previsions of Chapter 9 (commencing
Job Descri t161�'
P w w
wish Section 7000) of DiviaionJol NC Businasend Pmfcaio nCode, antl myliccnx is
ion70
,Y/Irl+
LE®
in full 4+rte and tree%
�1 3/
REROOF
License ase _
Contract.,
Dave O Cuntracmr �
NOV 1 8 ZO�J
ARCHITECT'S DECLARATION
I understand my plans shall W used as Puhlic records
BUILDING
Licensed Professional
OWNER -BUILDER DECLARATION
Law for the
1 hereby affirm that 1 RM1. exempt rrum dtc Cisions An,
follwhich regmnsoa m :
7031.5, Business and. mfewions Cnde:Anycity ror county
c
which requires Permit u+
Permit calor, improve, demolish, ror mash any structure
n quires the
Prior br its issuance, also nt to the Inc applicant for such permit m EIC s signed Chapter t
That he islicensedlit Pununm of theeBasinContractor's,.iccnulaw(Chopmr9
the")
Sq. Ft. Floor Area
Valuation
(commencingwith Section 71100)the brosion3
7of Division Pm(An,v
tof hIW,.dcateand
lad, aser
Nal he o exempt therefrom and the buil for the alleged exemption. Any violation of
35703022-00
ApN Number
Occupancy Type
P Y YP
Section 7031.5 by any applicant ror a permit subjects the applicant to a civil Penally of
not more than five hundred dollars (S500).
❑ I, as owner of the property, in my employcu with wages as their sole compensation,
305 - FRAME Required Inspections
P
will do the work, ad the structure is not intended or offered for sale (Sm. 7044, Business
and Professions Code: The Cmarr M1 License Lew does
not apply to an owner of
progeny who builds or improves 0mmon, and who does such work himself or through his
307 - INSULATION
own employees, provided that such improvements are not intended or offered for saw, If,
6O1 — ROOF TEAR OFF
however, the building or improvement is said within one yea of completion, the owner-
builder will have the burden ofproving that hedid not Wild orimprowfor purpose of
602 - ROOF PLYWOOD NAIL
sale.).
603 — ROOF BATTENS
❑ L as owner of the progeny, am exclusively contracting with licensed contractors to
construct the preject(Sec. 7044. Bainas and Professions Codc:) The Conmccrs Lt.
604 — ROOF IN -PROGRESS
curse Law does not apply to an owner of progeny who Wilda or improves Ihemon, and
who contracts for such projects with o contractor(s) licensed pursuant o the Contractors
Lima. Law.
❑ I am czempl under Sec. , B h P C for this reason
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the fallowing declarations:
1 haw and will maintain a Ceni fate of Consent to selbinmm for Workers Campew
anon, a provided for by Section 3700 of the LaWr Code, for the performance of the
work for which Nis Permit is issued.
❑ 1 have antl will maintain Worker's Comp nsatlan Insurance. as required by Section
37181 of the labor Cade. for the performance or the work for which this pumit is issued.
My Workers Cnmpe utin�n �(nsu/p eecariaand Policy numher art:
Cerriee 0s`^�t n Policy No.: f�
CERTIFICATE OF EXFMP ON FROM WORKERS'
COMPENSATION INSURANCE
,
Mir section need not I+ecomplemd If the Permit is fortune hundred dollen ($100)
or lcaJ
I eenify that in the performance of do work for which This permit is issued. I shall not
employ any person in my manner an as m Wcome subjoct to the Workers Compensation
-
Laws of Celifomia. Data
Applicant
NOTICE TO APPLICANT: IL after making this Ccnifmaw of Exemption, you should
become subject to the Worker's Compensation provisions of be Ichor Code, you must
forthwith comply wit such p rivisina or this permit shall he deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency fur the perforrimm of
'
the work for which this permit is Wind (Sec. 3097, Civ. C.)
Lenders Name
Lender's Address
1 certify that I have read this application end slew that the shout information is
'
corm I agree to comply with all city and county ordinances and some laws relating to
Wilding convection, and hereby authorim npraenutiwa of this city to error upon the
above-mentioned property for inspection purposes.
(We) agree to save, indemnity and keep harmless the City of Cupertino against
liabilities, judgmeno, casts and expenses which may In any way scenic against aid Ctry
in consequence of the granting of this Permit.
it
APPLIC UNDERSTAND AND WILL COMPLY WITH ALL NON -POINT
Issued by:
so U GULATIONS.
��"•'i'D
A.Ai /�iei,.�
Re -roofs
-rh/i
Signori to ta(ApplimmVCon rmwr Dao
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will the applicant or future building occupant atom or handle havuduus material
a defined by the Cupenino Municipal Code. Chapter 9,12. and the Health and Safety
We Senior 255320e)7
All roofs shall be inspected to an roofing material beim installed.
❑Yea ®+f
prior
P P Y g g
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or (luau building occupant use equipment or devices which
it hnvardnm air cnnomirnno a defined by the Bay Area Air Quality Management
all new materials for inspection.
uicli _/
;
v
❑Yes Lyivu
I hew maJ the haallousmawriols requirements under ChnPwr695 of the Califory
rota licnith & Safmy Codc, Sections 25505,35537 and 35534.1 understand that if the building
does ngt (urcndy how a tenan4 that it to my respunihility m nodl'y the mcupal of the
re�q/u�t7.�Emd�nuwhwit �To/y�,{.,�Met pdonutauanceoraCeniricalc IOccupancy.
Sign Ura4 aofApplicant Date
VV VdA,/`kC�l�1 )—) -3-o3
All roof coverings to be Class "B" or better
Ow
erarawhmimdagent Data
•
0
Building Division
10300 Tort Avenue
Cupertino, CA 95014-3255
Telephone: (408)777-3228
Fax: (408)777-3333
Building Depa ritment
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 VV 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: C-1-1 rle 1,3-r1 N/a
Address:/09/1 i1q,(_0
Reroofing Company Name: CV u rreti d--3 Oo r „r G
Applicants Signature:�J ��a, , �1 Date: -LO a- 0 3
• Y
Joe Antonucci
(Chief Building Official)
6/25/01
CUPEkTINO
NV
CITY OF CUPERTINO
REROOF b J
PERMIT APPLICATION FORM
APN #
Bldg Permit Fees
Date:
Building Address:
Energy
10311 Z_o VI'n —)4 orq�
BSEISMICRE
Owner's Name:
BUILDING
one
I IST /t//1 �04Z,11,S 0 N G
BUILDING
p
0 / tt -
Contractor: Phone #:
License #:
01-:0% C,000-rA� (:?,O,OPtAG h'a 300
Co
Contact: a #:
Cupertino Business License #:
'`Pho
T' O
F�(3 09
Q
Type of Roof Covering:
Existing:
Proposed:
❑ Built -Up Roof
❑ Built -Up roof
X Asphalt Shingles
)< Asphalt Shingles
❑ Wood Shakes
❑ Wood Shakes
Cl Wood Shingles
❑ Wood Shingles
❑ Other (Specify)
❑ Other (Specify)
Number of existing coverings
❑ Provide I.C.B.O. Report #
'd To be Removed
❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and WillCom 1 WitCu
ertino's Tear Off Policy:
Job Description: r?, CIM o ✓c _ )41 ST/nJZ
L eq -1 En- o r- Gumma
tis-, /-;t e -L 3 0.4 re 4- -+ s,D
CD,-"
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑
Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project: Type of Construction: Occupancy group:
� o ,o0 +'Zc oo
r- R--3
Qty.
Aoal' ably
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
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