02110018 CITY OF CUPFR'1'INO
Bml.uwc orvlsu3N PERMIT CONTRACTOR INFORMATION-
Bull 114AP 4S 45 PARK VILLAS CIR OLD COUNTRY ROOFING PERMIT N(02110018
QWbP1AXWE:VILLAS HOA 125-9 GROBRIC CT APPLICATIln1s V1D%2002
]ONE: (707) 864-5557 SANITARY NO. CONTROL NO.
ARCIIDECnENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECII
L� 0
p 00 LICENSED CONTRACTOR'S DECLARATION
z.F Ihereby mB,mth.,l am liwmed made,provisions of chapter 9 aommenang REROOF ,Job Description
�?6 with Second 700ABof Division 3nl the Bmsinca and Professimm Gide.drd my license is
m full fnKc and ellccy�'1/�—I ice is �`.1�
Z O'a? Dan Cll ss C.- J-/ �8�ALsea
oz— Dmel�/-6�. conlrac o,
2 Hg ARCIIITECI'S DECLARATION
of H
< 1 understand di shall he coed m public read, 0 200^
uLicensed Pmfe<xiunal JAN 3
S
OWNER-BUILDER DECLARATION
<p I M1ereby affirm bar I am exempt from the Contractor License Law for IhC $9000
w 00 lidlnwing,canon(Sccuou 7031.5,Business and PrnfcOinns Code:Any city or county guILGING
u x x,� which requires a permit to construct,alcor,improve,demolish,lir repair any structure Yom/
pnnno its issuance.also requires the applicant forsuch Permian file a signed statement
1-za that he is licensed former,tothe If lisinnsif[the Contractor's License Law l&rmr9 3uTj6FY.Q BA109 Valuation
FFG (commencing with Section IlgM)of Division 3 of the Business and Professions Code)or
y
that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7051.5 by any applicant for aPermit subjects the applicant to a civil Penalty at '4PN-NTnTFFE` Occupancy Type
not mem than five hundred dollars($5110). 307 - INSULATION
1,as owner of the property,or my employers with wages as their stile compensation.
will do the work,and the siucmre isnot intended or mffered for sale(Sec.70al.Business �p�}{' g
and Professions Code:The Contractor's License law does of apply to as owner of 602 - ROOF P I IV V migAc�?_ns
property who builds lir improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended or offered for sale.If. 603 — ROOF BATTENS
however.the building or improvement is sold within one year or completion,the owner- 604 — ROOF IN—PROGRESS
builder will have the burden or proving that he did not build or improve for purpose til
salt.).
❑1,as owner of Ne property,am taclusively contracting with licensed contractors it,
construct the projal(sec.70,14,Business and Professions Code:)The Contractors Li-
cense law does not apply to an owner of property who builds or improves themod,and
who contracts for such projats with a enntracmr(s)licensed pursuant to the Cnnuacur,x
License law.
E] I am exempt under Sec. ,B&P C for this reason
OwnerDate
WOR K ER's COMPENSATION DECLARATION
1 hereby affian under Penalty of perjury one of the following dalarations:
1 have and will maintain a Cenilica a of Coastal,,,self-intoe for worker's Compel,
satin.,as provided for by Section 17(X1 of the labor Code,far be performs..of the
work for which this Permit is issued.
Fl I have and will maintain Workers Compensation Insurance,as required by Section
3700 of Ne LaMar Code,for the Performance of the work for which this permit is issued.
My Worleer'}Cor,'No"ttion Inalumbee carrier and Policy num arc:
icrZ{G fi e /'UAJ(:t Policy N .: r f Z
CERTIFIC OMPE SATION'IINN FR W RKLRS'
COMPENSATION INSURANCE '
IT section need nut be complced done Permit is for tme hundred dolims(SATO)
Iesa)
I,vitify that in the performance of the walk far which this TMrmil is issued,[shall mol
employ any Person in any manner so as In bcCam a subject 10 the Workers Compensation
laws of California.Date
Applicant
NOTICE TO APPLICANT:It,afrtr making this Cenifierm,of Esempion,you should
become subject to the Workers Compensation provisions of the tabor Code,you must
Q Z forthwith comply with such provisions lir this Permit shall he deemed evoked. -
z O CONSTRUCTION LENDING AGENCY
[-.'4 I hereby aRrm that there is a conslmetion lending agency for performance of
p: 7 the wort far which this Permit is issued(Sec.3097,Civ.C.)
W lender's Nam.
IL Icndcrs Address
U Q I cendy Ilial I have mad this.pphcminn and state that the above information is
la., P Comet,l agree to comply with all city and county ordinances and state laws refining 1. -
0U building Construction.and hereby authmie,representatives of this city to enter upon the
W aMrvomentioned property for inspection purposes.
G (We)agree to save,indemnify and keep brimless the City of Cupertino against
F N
liabilities.judgments,costs and expenses which may in any way scorer agmd'i mid City
U Z in eonsaaccence of the granting of this Permit
APPLICANT UNDP NDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date 47�
SOU0.CER G A
per- (F '1-0 Re-roofs
Signature n PliaanUComemor Date
IIA].ARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle hasard0us material
as defined by the Cupertino Municipal Code,Chapter 9.12.and the Ilcallh and Safety
CIWe.Section 25532001 All roofs shall be inspected prior to any roofing material being installed.
❑Yes
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
mil haeardous air contaminants as droned by the Bay Arca Air Quality Management all new materials for inspection.
Dintrinl
❑Y.
Inave real the Nomdous msec,ialsrequirements underChapter 6.95 ofthr Califnr
ni.Hcalth&SOIeIYCale.See6nns25A15.25533md25536.1undersandthatlfthe buildmg
does red cunendy have a Nnanl,that it is my rwlxmRihility In notify Inc rccupanl lit thC mz Z_Z��
requireme mu%Wmclp6onoisumccofacentOcaeofacupuey Ig ureofApplicant Dale
caner raumoriadagen, n,K All roof coverings to be Class "B" or better
Building Division
10300 Torte Avenue
Cupertino,CA 95014-3255
` Telephone: (408)777-3228
*CO. CUPEi�T�NO Fax: (408)777-3333
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 Ma'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 wincomply with this policy.
V
Homeowners Name: ��?�F� j L L14---s 1 014
Address: r/fi?2 K V1 LLn3 G (ILGLc�
Reroofing Company Name: 047:') G� U 2D01%
Applicants Signature:'-T� I� Date: / -3/
• Jo Antonucci
(Chief Building Official)
U25/01