02110016 CITY OF CUPERTINO yr
BUILDING DIVISION PERMIT t'CONTRAC QWINF,ORMATION:•
uul T(IA17 qsg 21 PARK VILLAS CIR OLD COUNTRY ROOFING PFRMITN®2110016
ow@-AsR*E:VILLAS HOA 125-B GROBRIC CT APPLICATTh!_sYBT1T1Y2002
NIF IONS: (707) 864-5557 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECII
Op
LICENSED CONTRACTOR derp DECLARATION
,yup Iberchyantromat1amIOt,Il dryodNolensarcbade,q(eammead"g REROOF Job Description
%<i mons Scninn 71XX17 nl Uivisioninl the❑u�sxa JProlcxonns CnJv.0 Jmyliccn.m ix
��?pDa1u11 ftKcpnd rcit.� CC r`j zz 73 i Ip�y� IIIl
ZOnK I.iccnsc a FO! sFJALIE®
F'=t-w, ARCIIITECTY11t'ZI.ARATION ®�
.ote� understandmyplansxM1allWuudaspuhliereenrJs JAN 0 12003
pyU
3 e l- Licensed Prnlensional
F-u.O I OWNER-BUILDER DECLARATION
re <y I herchy alfrm that 12M exempt from the Conuanor:s License law for the ,,pe $9000
00 rollowmg.,an.(Such,n 7031.5,Business and Professions Code:Any city or county BUILDING
a'%$� which requires a permit era construe,alar,improve,Jemellxb,or repair tray storcmrc
prior to its issuance.also requires the applicant for such permino file a signed statement '�C�
Ibar he is licensed pursuant In the proveomas-ofmc Contractor's License Law(CAaparY +.g6Bt.4II�mOA1@� VaIDal10❑
y�p (commencing with Section 70f))of Division 3 of the Business and Professions Crde)or
i 3$ that he is exempt interest and the basis for the alleged escmption.Any violation of
Section 7031.5 by any applicanUor a permit subjects the applicant to a civil penally of PNN Occupancy Type
n.I mom than five hundred dollars(S5110I. 3 07 - INSULATION
O 1.as owner of me parpeny,or my employees with wages is their sole compensation,
will do she work.and the suoctum is not intended or offered for sale(Sec.7044.Business mf r
and Professions Code:The Contractors License wner Law does not apply to an oof 602 - ROOF P=T]V nWAgiRns
part who huildsor improves Orman,and whodoessuch work himsdfor though his
employees.provided mat such improve sots are not intended or offered for sale.If. 603 - ROOF BATTENS
Forwent.the building or improvement is solwithin one year of completion.he owner- 604 — ROOF IN-PROGRESS
builder will have the burden of paving that he did not Wild or improve for purpose of
Ole.),
❑ I.as owner of the progeny,am exclusively contracting wit licensed convectors to
con5wm the project(Sec.7044.Business and Professions Code:?The Convacmrs Li-
cense Law does not apply to or owner of property who Wilds or improves lW rean,and
who contracts for such projects with a mmlraclor(s)licensed pursuant o the Contractor's
License Law.
❑I am exempt under Sec. .B&P C for this reason
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the fallowing declarations:
❑1 have and will maintain a Cenificate of eed eit br self-insu¢for Workers Compere
motion,as,provided for by Section 371X1 of the labor Code,for the performanr,of the
work for which this permit is issued.
I have and will mainuin Worker's Compensation Insurance,at required by Section
37M of the labor Code.for she performance of the work for which his permit is swed.
CMWrker's anfigsabion laxmunce carrier
d P ocy'num r
O`yas Z
CERTIFICATGOFEX M NFROM WORKERS'
COMPENSATION INSURANCE
This section need not W completed if the Bannit is Iorone hundred dollars 1511X1)
less.)
1 crony that in the pertormance of the work for which this permit is issued.I shall nal
employ any worm in any manner so set or WcamC whjeel to he Workers Compensation
Law s of Califemis.Date
Applicam
NOTICE TO APPLICANT.11,after making this Ccni ficale of Exemption,you should
Wcnna subject to the Workers Compensation provisions M the Labor Code.you musl
OO forthwith comply with such provisions or his permit shall W deemed revoked.
z CONSI'RUCFI ON LENDI NO AGENCY
'r.14 I hereby affirm mat here is a construction lending agency for the performance of
Sat 7 he work for which his permit is issued(Sec.3097.Civ.C.)
W Q Lender's Name
z Uncut's Address
U O 1 sonify that 1 have read this application and sus that be above infomlatiun is
W F Correct 1 agree to comply with all city and county ordinances and state laws relating to
0 building conswctlon.and hereby amhorw representative,al his city or anter upon the
r W ahewementioned property for inspection purposes.
(We)agree as save,indemnify and keep harmless he City of Cupertino against
Fw rq liabilities judgments,costs and expenses which may in any way accede against said City VA'11)
Uz inctmuyucnccnlthe arcingofthis f<rmit
'—' APPLICAN DF. TA DS AND WILL COMPLY WITH ALL N POINT Issued by: Date
Sou K LATI
ZJkZ Re-roofs
ignawre (opl¢aHAZARDOUS MATERI DISCLOSURE tractor Date
Type of Roof
ill l6capplicatnnrfeurehuilh eupnnl nitre fir handle hararders material
m defined by the Cupenin,Munici bele.Chapter 9.12.and the Ileallh and Safety
Code.Scninn 255320)'r All roofs shall be inspected prior to any roofing material being installed.
❑Yes
If a roof is installed without first obtaining an inspection,I agree to remove
Will the applican fir(marc hd ng occupier use equipment or devices which
I thaerdous air conbminami fined by the Bay Area Air Quality Management all new materials for inspection.
Diarinl
❑Yes No
IhavcreaJ vSNnusmaariels 533ad255u1.1aabapmr695 of the Caldid,
mail cry Qdc.Scgjinns25511515533 and 25535.1 unJcrsund Our if ht Willing !/
does net eurren�tlC h 'e len al it is my apmsihility 1st m dry the occupant or he
rcyviremC / aulr el �,R, lnRmeaaarQe'rplky'cr' Sig sours o (pplicant Date
r"Imlb indagent Dale All roof coverings to be Class"B" or better
Building Division
10300 Tom Avenue
Cupertino,CA 95014-3255
` Telephone: (408)7n-3228
CUPEI�TINO Fes: (408)7T1-3333
Building Depa ritment
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: p�7�iK j L LA--s /4 0,4
Address:
Reroofing Company Name: C-0 U 4?—( W�" 2001%VV(;
Applicants Signature: t ti�.t� Date: / d —3/-
Joe Antonucci
(Chief Building Official)
6/25/01