02110014 CITY OF CUPERTINO •�"��- - �
BUILDING DIVISION PERMIT CONTRACTORINF.ORMATION:-
,
4
BUI011T(1A1)I 3s$ 15 PARK VILLAS CIR OLD COUNTRY ROOFING PERMrrN(@2110014
ox,IFAR*LM :VILLAS HOA 125-B GROBRIC CT APPLICATITN Yb3)1TV 2002
IONS (707) 864-5557 SANITARY NO, / CONTROL NO,
ARCHH'EC 11INGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
n ea, LICENSED CONTRACTOR'S DECLARATION
��� Ihereby affirm that Iammenwdunder p fChapter9mommen`i"g REROOF Job Description
with Sced� 07�XBof Divi.,xm3of NCBusincYa/JPrnfessinns Crdc, nJmYliccnw is
F7in in I.uHxb,F`3bJe IT. Lic,ll (')z��3
F�raZ LicenwC a.
�t°y Dale co .me �ONA LE®
yy ARCIIIITICT ORATION 6`•G
y< 1 unJccd;md mY plans shell be used public rccorJs
OyU
s-LL0� LiccnwJ l'rnlcainnal 03
g that I am
RDECLARATION JAN 0 12003
as u6o'j 20 I hereby motio al Bim that 11. exempt frim the Contractors Co Liam law for my $9000
w a p o followingmotion.a.Permit
ti]1131.5.Business and improve.
der ali h,or Any city or runty
xm� which d.iss a permit ac,him,ter alter.improve,demolish,or repair any strwimm
that hnitsiensedp pursuant
n:to the aosoin crofthf CoApermiuoble icense gne f&Pvccm
that he islicensedwit pursuant 7000)(if Diviu(s 3 the Cttrinessnd Proflaw.%Coda)9 3�g6F3t.U�cb33A VaIUBUOn
yrs (cat he
xempthomfiro7XX)of Division)of the Business prion.Any violation
GW:)of
y�$ @a0 he is exempt therefrom and the massa for the allege)exemption.Any violation of
Section 703 L.5 by any applicant for a petit subjects the applicant to a civil penalty Of PPFN Occupancy Type
nor mom than me hundred dollars 1$500), 307 - INSULATION
0 I,as owner of the prnpcny,or my employees with wages as their sole compensation,
will do the work,and the swcture is not intended or offered for sale(Sec.7044,Business ��u{ ggmT {�q
and Professions Coda:The Contrac'tor's License Law does not apply r,an Owner of 6 0 2 — ROOF P $'IPV nWAcpLns
property who builds or improves thereon,and who doessuch work himself or through his
own employees.provided that such improvements arc not intended or offered for aale.l6 603 — ROOF BATTENS
however.due Inififing or improvement is sold within one yew of completion.the owner- 604 — ROOF IN—PROGRESS
builder will have the burden of pmving Wt he did not hold or improve for purpose of
.Jr.).
0 1,as owner of Ne propvat.am enclusively contracting with licensed contracmrs to
consumer the project(Sea 744.Business and Professions Code:)The Contractor's Li
cense law Jens not apply to an owner of property who builds or improves themon,and
who contracts for such projects with a contracmr(s)licensed pursuant o the Contractor's
Liecnx 1.w.
0 1 am exempt under See. .B&P C for this reason
Owner Date
40 WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of peOury one of the following declaration
0 I have and will maintain a Certificate of Comenua self maim for Worker's Cumpcm
suit.as provided for by Section 3700 of the IabOf Code,far the performance of the
work for which this permit is issued 0
0 1 have and will maintain Wurkcr's Compensation Insurance,as required by Section
37x1 of the Lahr Code,for Ne performance of the work for which this permit is issued.
My Wnrkc_ Co pcnsatinn lnsu. ce corset and Policy nu beram: 1
C'
he Policy Na: S z -O
CERT FICA]E OF EX EMfTION TWORKERS'
COM PHNSAI'ION I NSU RANCE
T his section need not be completed if Ime perm it is for one hundred dollars 1$100)
or loos.)
I eerily that in the performance Of the work for which this permit is issued.I shall not
employ any prawn in any manner to as u,become subject o the Workers Compensation
Laws of California.Date
Applicant
NOTICG TO APPLICANT:II,after making this Ccni Ecalm of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code.you must
0 Z forthwith comply with such provisions or this permit shall he deemed revoked.
Z O CONSTRUCTION LENDING AGENCY
(r — I lie reby affirm that there is a nmabuclioo lending agency l Or the re,hommot,Of
(17 the work l or which Ihis Fermi(is issued(Sec.3097,Civ.CJ
f11 Q lender's Name
Z Lender's Address
U 0 1 certify our 1 have read this application and slam that the above information is
{T. P Coneet.I agree to comply with all city and county ordinances and sore laws relating to
0 U building construction.and hereby adhorim mpmwnutivcs of this city to enter upon the
above.mentioned pmpcny for inspecuan pu antes.
�" a (We)agree to save,indemnify and keep harmless the City of Cupertino against
N Iiabi lilies.judgment%,costs and expenses which may in any way acrme against sold City
U in son. ufthe gramingof this permit (�v
.. APP, ANT UND STANDS AND WILL.COMPLY WITH ALL NON-POINT Issued by: Date
50 ER' LoNS ..Q/L
l/-l. Ih9_O,yt ! �4 Re-roofs
Si�gnafure of AppLcanvcontmctor ' Dm)
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant arfmu ci in s rwcupam cafe or handle harmJous material
as dcfncd by the Cupertino Munii I CnJc.Chapter 9.12 and the Health and Safety
Coda section 25532a)? All roofs shall be inspected prior to any roofing material being installed.
0 Yc% Na
Will the applicant ser future h ldingavupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mit hvarJoux air mnmminanu as efncd by the Bay Arca Air Quality Management all new materials for inspection.
District?
❑Yes
Ihase mud the haraNOus muwriats myuircmcros unJcr Chupmrfis)Sul mCali for tis//
nitsllcalth&Sultryh Scninns2.$.HI.i 2myreNiJ25534.1 un der. J oil c 'Jing (��/(/ y// J�LJ f — C
Jms nm currcnJy have u rant Nm it is my rapmelbiliry to n, I w p' n J
casinrck% n mclparbii..uanaofaCertificat pee Slgnatu of Applicant Dale
o ivedagcat Date All roof coverings to be Class "B" or better
Building Division
' 10300 Torre Avenue
Cupertino,CA 95014-3255
` Telephone: (408)777-3228
&cnyo Fax: (408)777-3333
CUPEkTINO
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 Y"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: 1 �7�t< I L
Address: G IILc—L4
Reroofing Company Name:
Applicants Signature: t�/ nate: -31- °
• Jo ^_
Antonucci
(Chief Building Official)
6/25/01