02110012 ( CITY OF CUPERTINO -
RUn.DING DIVISION PERMIT CONTRACTOR INFORMATION:
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Bu10@f7A 1 p9;s7 75 PARK VILLAS CIR OLD COUNTRY ROOFING PI:RMrrN(0211OO12
owbRAR*r:VILLAS HOA 125-B GROBRIC CT AP1`LICATITN15Ygygy2002
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NONE: (707) 864-5557 SANITARY NO. CONTROL NO.
ARCHI'1RCn9NGINEERt BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
omZ
�00 LICENSED CONTRACTOR'S DECLARATION
ae.F I hereby million that lam licensed under provisions of Chapter Y(commencing REROOF Job Description
�<E with Sc n 7aNp of Diviainn3oflhc Busiue,,,r dPn,IcasinnsC Jc,and my license is
to full In and of t. Z
Liccni�s - Lic.4 G. .[-.L 1_
oiF� Dam ///�CUn r
--��(( ARCHITECrSDECL TION
0zf sfiTe
� stanJmyplansmallheasedrop ¢reeomx
oats
IW-LL`O.1 Licensed rromasional
S OWNER-BUILDER DECLARATION
cotil' <Y 1 hwaso .]firm that 1 am exempt from the Cnmmctnr's License law lar the $9000
w 60 o following mason.(Section 7031.5.Business and Professions Codi Any city or county
e%$� which myuircs u permit m construct,alter,improve,demolish.or repair any structure
W'v, prior.its issuance.also re4vires the applicant Bn.ech permiuo file.signed smlemenl 'y(q 11�.t'rm� !]t�
the,he r,licensed puauantl,, heProO,,ionsofth.ContownW,LicenscLaw(&Imcr9 $FI6R.0FDoh6AIi Valuation
a�O (commencing with Section 74XXhol Division 3nl'the Business and Professions Cude)nr
i that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil Penalty of pNN Occupancy Type
notmmethan five hunmeddmma(ssfa). 307 - INSULATION
1,as owner of the property,or my employees with wages as their sole compensation,
will do the work.and Ne structure is not intended of offered for sale(Sec.7044,Business �Y�r �qg
and Professions Code:The Contractor's License Law does not apply e,an owner of 6 0 2 — ROOF P 3.� nip xyC�Qns
property who builds or improves thereon,end who fires such work himself or through his
we employees.provided that such improvements am not intended or o0ced for sale.If. 603 — ROOF BATTENS
however.the building or improvement is sold within One year of completion.the owner- 604 - ROOF IN—PROGRESS
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
1,as owner of the property,am exclusively contmeting with licensed committal,m
cnnsuuct the protect(Sec.TM.Business and professions Code:)The COmracturs Li
cense Law does not apply to an owner of property who builds or improves themon,and
who contracts for such pmjecu with a contraction(s)licensed pursuant to the Contractor's
Lice.Law. FINALE
I am exempt under Sec. .B&P C for thu mason
Owner Date
WORKER'S COMPENSATION DECLARATION JAN 0 12003
1 hereby afam,under Penalty of perjury one of(he following declarations:
O 1 have and will maintain a Cenifcam of Cmtsenuo self-mons for Worker's Compen- p��
unon.as provided far by Section nowm
al of the labor e, ,the pciformarm,of the B U I L W TVG
work for which this permit is issued.
1 have and will maintain Worker's Compensation Insurance,as vyuired by Section
37x1 of the labor Code,for the peformance of the work for which this permit is issued.
My Workcis`Com�`namit Inaurvncc y'artier and Po'b��c�y[,R/t
Cam :STG T'L' Fu,v(,l PatiCYNjK-m cr are:
CERTIFICATE OF EXEMPTION FROM WORKERS'
/ COMPENSAT1ONINSURANCE
(This section need not he completed if the permit is for one hundred dollars(S lap
all less.)
1 certify that in the Performance of the work for which this permit is issued.1 shall not
employ any person in any manner so as to become subject o the WorkersCompensation
Laws of California.Dale
Applicant
NOTICE TO APPLICANT:If,atter making this Ceniticam of Exemption,you should
become subject to the Worker's Compensation prrAisions OI the lahor Code,you muss
oZ forthwith comply with such provisimsor this perm llshal l be deemed revoked.
Z D CONSTRUCTION LENDING AGENCY
PI hereby affirm that there is a construction lending agency for performance of
C > the murk fur which this permit is issued(Sec.3(N7.Civ.C.) t /\
laza Q 1 ender',Name
0 Z L nJcds Address
V O 1 certify that I have read this application and iunc that the above information is
f•' coned.l agree to comply with all city and county ordinances andxtae laws relating to
0 U building construction.and hereby auturite mmescrifumes of this city to enter upon the
r alx,ve-mentioned property for inspection purpmes. )
(We)agree to w,indemnify and keep harmless the City of Cupertino again V V
F' paj Iiubiblies,pid,menu..,,I,and e,Nnscs which may in any way accmc against add City 1/ I
V Z i n conseyuenee of the gran( gol(his perm it. {/G
.-t APPLICANT D RST NDS AND WILL COMPLY WITH ALL NO POINT Issued by: Date
SOUR E LA
F' Re-roofs
Si oma Apphc..VC uacmr Dam
HAZARDOUS MATERIALSOISCLOSURE Type of Roof
\ ill the upplicam nr future hmlJi cupam store rehandle harwdoo mimrial -
as defined by(hc CUPcninn Muniaip odes Chapter 4.12,and(he Ilcallh and Safety
Code,Section 25532(a)' All roofs shall be inspected prior to any roofing material being installed.
0 Yes
Will theapphca) Ilu buildingoccupan(ueequipmentordeviceswhich If a roof is installed without first obtaining an inspection, I agree to remove
emit h....don,air conmmiw as Jmined by the Bay Area Air Quality Management all new materials for inspection.
Dianic(p
❑Vcs ❑No 1 //
In wmad the anrJnusmomrials rtyuimmem under Chapmrb95 of the Califnry Z
nixs no, &SafetyGxk.Scc(itm 25NI5.2S533 and 25 b I 1 untbamnd Noifthebuilding
ares num culmntla ha a te nt, al i(i,my respmsibili(y m m,dfy(M ta'cupant of the
UA�
rcyuimmentsw is .at be nd.nni nano uracemream ofoccuponey. G Sign re of Applicant Date
-�
orantb n.ed.,cut Dale All roof coverings to be Class "B" or better
Building Division
10300 Torre Avenue
Cupertino,CA 95014-3255
` Telephone: (408)777-3228
Fax: (408)777-3333
CURTINO
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 V4,"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
{reeroofing and will comply
with this policy.
V
Homeowners Name: 1 �7�K , L- L1 0'1
Address: Ogl � /•< V/ L L'f" s C f lLC_L4
Reroofing Company Name: L_� C
Applicants Signature: � �' l� Date: / O —3i- o
Joe Antonucci
(Chief Building Official)
6/25/01