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02110013 r CITY OF CUPERTINO - ter- i w BUILDING DIVISION PERMIT i "CONTRACTOR INFORMATION: Bre 0RS410S3 PARK VILLAS CIR OLD COUNTRY ROOFING PIiRM]rN®2110013 ow9.ARWE:VILLAS HOA 125-B GROBRIC CT APPLICN'ITIJ1SIyfakt/1TIa2002 Ahk vp ZONE: (707) 864-5557 SANITARY NO. /� / CONTROL NO. ARC[11TECf/ENGINET:R: BUILDING PERMIT INFO BLDG ELECT PLUMB NIFEll 0 0 0 0 Lao) LICENSED CONTRACTOR'S DECLARATION re1r Incmby,aOkmthatIamBcen.ed�rprovisionsofChapter9(commencing REROOF Job Description E whirsmin 7 B ur Di0e,hm3ofthe Busr J ^fc�.cainns Cafe. lid/ ,license is in full lam eReats — ( G2 7 I , License C� Lic.N M,y'❑ Dam CupA t<"—aCt-� ARCf11TECT' CI.ARATION ?r K�Q Jeeaoadnry platusball be usedaspuhlicreanda IA LED �wU w 3u LiccnmJ Pndcssinnal s_=0S OWNER-BUILDER DECLARATION JAN O L ZOOS Ha n y 1 hereby affirm Thal 1 am exempt from the Cimmnrs Lignac Law for the 9 O O O a-00 following reason.(Scctinn 7031.5,Business and Professions Code:Any city or county x a a which requires a permit m construct,alter,improve.dcmnlivh,or mpoir any structure I "t—IA priors its issuance,also requires the applicant for such Permit o file asigned statement 7 that he is licensed pursuant mthe provisions it[the Contractors License Law(Choplcr1) Valuation at (commencing with Section)IXAryof Division 3ofthe Rmin,a and Pmfesxians Code)nr a 3$ that be is exempt Incmfmm and Ne basis for the allcgcd exemption,Any violation of Section 7031.5 by any applicant for a permit subjecu the applicant")a civil penalty of PPIT NTnWWE Occupancy Type not more than ave hundred dollars(1500). 3 07 - INSULATION ❑1,as owner of the property,or my employees with wages as their sole compensation. will do the work,and The stmcmr,is not intended or offered for safe(Sec.704,L Business �Z qp& and Professions Code:Th,Contractor's License Law does not apply m in Owner of 602 - ROOF P S1VlJ nWTcjinns property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvemcnu arc not intended or offered for salt.If. 603 — ROOF BATTENS however,the building lir improvement is sow within one year ofcompletion,The owner 604 — ROOF IN-PROGRESS builder will have the burden or pmvi ng Inas he did not hand or improve for purpose If sale.). I � ❑ I,as awncr of the prupeny.am exclusively conuuting with licensed contracmra to construct Ne project(Sec.701,.Business and Prufcssions Code)The Contractor's Li- t cense Law does not apply to an owner or property who builds or improves Merton.and who conuacu for such projecu with a contraaor(s)licensed pursuant to the Convenor's License law. I am exempt under Sec. ,B&P C far this..,In Owner Dols WORKER'S COMPENSATION DECLARATION 41 1 hereby eliom under Penalty of perjury one of The following declarations: 1 have and will maintain a Cenificam ofGmmnt m sel6insum for Worker'sCompcn- ration,as provided for by Section 3710 of the labor Code.for The performance of the work for which this P r mit is tamed. 1 have and will maintain Worker's Compensation Insurance,as required by Section COX)nfth Labor Code.to Belciformanccof the work for whichmis permit is issued. My Wr'r [,5�G1nW scion Insurance carrier end Policy no r am C r. ✓t /U Policy N ..iG�f�=A?S—� CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This motion aced not be completed if de Permit is Throne hundred dolls I(Slap or leis.) 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 subjeeno the Workers Compensation Laws of California.Dam Applicant NOTICE TO APPLICANT:1t.after making this Certifies,of Exemption,you should became subject to the Worker's Compensation provisions m the"No Gide.you mesa O O forthwith comply with such provisions or this Permit shall be d,cmed revoked. z CONSTRUCTION LENDING AGENCY E'^ Z) I hereby allirm that there is a coreametion lending agency for the Periormance of (Y, 7 the work for which this permB Is issued(See.3097,Civ.C.) lel QLcndcr's Name c. ndcrs Addmss V p 1 ceniry Our 1 have read this ii,rimatinn and sum tThe e alcove inforrlstsion is t LL Fcorrect.I agree 10 Comply with all city and county ordinances and such,laws relating m DU building construction,and hereby auNnrim mpmicnutives of Nix city to enter ulam Nc ,r above-mentioned property for inspection purposes. (Wc)agree les save,indemnify and keep harmless the City or Cupcnino agama '141 1 nF+ Hhard itics,judgm,nu,ensu and expenses which may in any way acerae ugmno said City {'/ / U Z inconmqu,ne,ofthegrarom fthisperZ"' iIL 4 ^` APPLICANT UNDF S"TA SAND WILL COMPLY WITH ALL NONPfCJT Issued by: Dat SO�UyCE UN NS. L A ( � Re roofs Signal of APD can✓Commcmr Data IIA"J.ARDOUS MATERIALS DISCLOSURE. Type of Roof Will the applicant or future building taeupanl store lir handle hrowdous material as defined by the CuNnoo Municipal Code.Chapter 9.12,and the Trial and Safety Code,Section 2s532r)7 ❑Yes No All roofs shall be inspected prior to any roofing material being installed. Will the applicant or future building resu t use a m,nt m J,wcea which If a roof is installed without first obtaining an inspection, I agree to remove pP b pan quip emit hazardous air conmminanu as defined by the Bay Arca Air Quality Management all new materials for ins c District? ❑Yes ourmat Ihave read NchvarJTanv erials...3 emcnuundcrderstarlibut95 h Ne Calding doesione e:nmy Gale, mansork .2myresld25s36,l understand lenatth,huil the Jtes roI c emly c n I nuns,that it is my reslwnsihil'ny In nntil'y the rx'cupum nl'Nc - regnnt h last pnmmiamanceofaCeniocate v a cy. gat lure ofApplI ant Date / I Dan orauth rmiligem Dai, All roof coverings to be Class "B"or better ' Building DiV ioa 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 1/a'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 onreroofingand will comply with this policy. V Homeowners Name: ! f77�l< / L- LA--st!� 0 Address: / ��K V 4,LLt--- Iger o ofing c-$eroofng Company Name: �-� CO U N /<z 001%— Applicants Signature• —3/- Date: • Joe Antonucci _ (Chief Building Official) 6125101