02110011 I
CITY OF CUPERTINp •• - ^' 3,:.;.
BUILDING DIVISION PERMIT .CONTRACTOR4NFORMATION '
BuB 6(5%5 C3S3 61 PARK VILLAS CIR OLD COUNTRY ROOFING PERMITN(02110011
owq.AIR*E:VILLAS HOA 125-13 GROBRIC CT APPLICATI(pN1SYtIgg�2002
41 ZONE: (707) 864-5557 SANITARY NO. CONTROL NO.
ARCDITECDENGINEER: BUILDING PERMIT INTO
BLDG ELECT PLUMB MECN
µ0O LICIiNS1iD CONTRACIDR'S UECLARA'1'ION
a.cri Ihereby affirm Nat lam fieenwed mnder,I'nvishms of Chapter 9(commmicing REROOF Job Description
�;w with Soft n7fXX))of Division3nftbc Busincyand Professions Gude.and my license is
„ inlnll candeBr't._ A] 162273
�o�= Liven..
ON—p Dames '�Cnntractyyr
F—� ARCIIITI:CTS`kjIpLARATION
y ;),;;KundcrxIam1 my plans shall M uscJdSS public records
DaU
63 — Licensed Professional
=oma OWNER-BUILDER DECLARATION
r a S 1 hereby affirm that 1 am exempt from the Contractor's License,Law fur the $9000
e. a O following re si n.(Sccfinn 7031.5.Buono s and Professions Code:Any city or county
x m�i which requires a Permit at construct.alter,improve,demolish,nr repair any structure
w'� prior in its issuance.also requires the applicant lir such permit o file a wignedstummem
that he is I caused pursuant to the provisions of the Contractors License Law(Chapter9 .�g6t•]t.O dAIQ9 Valuation
ySFO (commencing with Section 7000)of Uivi.tion Jul the Busi nes and Prof ession.¢Coda)or
od 3 that he a exempt therefrom wad the basis for the alleged exemption.Any violation of
Section 9031.5 by any applicant for a Permit subjecu the applicant to a civil Penalty of 3 UAiPN_NTnRFEOccupancy Type
hot...than Eve hundred delta.(s500). 307 - INSULATION
❑1,as owner of the property,or my employees with wages of their sole compensation.
will do Ne work.and the swcture is not intended or offered for sale(Sec.70,14,Business p��
and Pmfesiont Code:The Contractor's License law does not apply to an owner of 602 - ROOF P V6 n�Acttns
progeny who builds or improves thereon,and who dors such work himself or through his
own employms,provided that such impmvemenu we not intended Or offered for Sale.If, 603 - ROOF BATTENS
owever.the building or improvement is wild within one year of completion,the mvner- 604 — ROOF IN—PROGRESS
Wilder will have the burden of proving Nal he did not build or improve for purpose of
saii,)
❑1,as owner of the propcny,am exclusively contracting with licensed contrncurs to
construct the project(Sec 70a4.Business and Professions Code:)The Contractor's Li-
cense Law docs not apply to an owner of property who builds of improves thereon,and
who contracts for such projects with a contractor(s)licensed pursuant to the Contractors
License Law. FINALE®
I am ade
exempt under Scc. .B& Brom.P C for Nis rtun
Owner Date
WORKER'S COMPENSATION DECLARATION JAN 0 12003
1 hereby aRrm under Penalty of perjury one of the following declarations:
❑ I have and will maintain a Cenolem,of Consent In self-insure,for Workers Corepch
Saffron,as provided for by Section 3700 of the labor Cale,for the performance of the BUILDING
work for which this permit is isucd.
I have and will maintain Worker's Compensation Insurance,as¢'sired by,Section
3]10)of the Labor Gyle,for the performance of the work for which this pmmit is icsucd, i
My Worker'sFr m nsatioyn�Insurance a cr wnd Poli y number arc:
�'er:SrGe YLtN/ Pnrc n:_/��
CC:RTImCATF.OF E%EMPI'1 FROMWORKERS'
COMPENSATION INSURANCE
(This section need nm be completed if the permit is formic hundred dollars(5101)
,it less)
1 victory that in the performance of the work for which this permit is issued,I shall not
employ any person in any manner m as to become subject to the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:IL after making this Cenilicam of Exemption,you should
Oxford e suhjeet to the Worker's Compensation provisions of the Labor Cada you must
OZ forthwith comply with Such provisions or this permiuhall he deemed revoked.
z O CONSTRUCTION LENDING AGENCY
[-.4 1 hereby affirm Nat there is a cunstractinn lending agency for the Eerformance of
m 7 the work for which this permit is issued(Sec.3099,Civ.C.)
W Q Lenders Namc
C I<ndcr's Address
U O 1 cenify Nat 1 have read this appliwation and sum that Ne about information is
W F correct.1 agree to comply with all city and county ordinances and state laws relating to
OU building construction,and hereby airman m representatives of this ci ty to coma upon'he
} W aMrve(We)a ive to tarySave.
for inspection kwp ha
(We)agree to save,Indemnify and keep harmless the City of C almost
against q J
r N liabilities,judgmencs,cosss m
and expenses which may in any way acec against said City
U Z in emisc'sence of the goc in6 of this permit.
*APPLICANTERS NUS AND WILL COMPLY WITH ALLLL NON.POINT Issuedby: DatelF7`� Re-roofsndcanow Date
IIA'LAR, rl Mk FR1ALSDISCLOSURE Type of Roof
Will the applicant of future building oceripam store or handle hammous material
ass defined by the Cupertino Municipal Cotte.Chapter 9.12,and the Health and Safety
Code.Section25532r)111 All roofs shall be inspected prior to any roofing material being installed.
0 Ycs
Will the applicant nrfuture building occupant us,equipment ofdevice swhich If a roof is installed without first obtaining an inspection, 1 agree to remove
'mit brew mals air cnmaminants as defined by the Bay Area Air Quality Menbecment all new materials for inspection.
District?
❑yrs
I have read me hvallous materials mquirem res under Chap r _Snf T Ifor
iia llcalNgt Sufmy G4c,5«Bnns 25NI5.2551J and 255U.1 unders h Ilding l
duct not cam. I huse a tuna the itis my responsibility m nm t of
er
requirements h' than or toisssancenfaCcnifiremt cu c. nature Applicant Date
owner err atrmmr Jagcnt D All roof coverings to be Class "B" or better
Building Division
10300 Torre Avenue
� • Cupertino,CA 95014-3255
` Telephone: (408)777-3228
CITY O Fax: (408)777-3333
CUPERTINO
Building Department
Subject: Reroofing policy for the City of Cupertino.
1. Prior to permit issuance,you must agree to comply with 1997 USC 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 Y4,"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.
V
Homeowners Name: f f71z K r' L { 0
Address: ?-O G;' C/Th2 C- (/LC-LL
Reroofing Company Name:
Applicants Signature: / ZDate:
Joe Antonucci
(Chief Building Official)
6M/01