02110009 CITY OF CUPER'1'INO
BUILDING DIVISION PERMIT CONTRACT,OWINFORMATION-
BUnafj(5a9 115sl 63 PARK VILLAS CIR OLD COUNTRY ROOFING PERM1TN(02110009
GWhl?AR4t0p:VILLAS HOA 125-B GROBRIC CT AFPLICATI1S`ZVhT1T/2002
Ak
lop TONE: (707) 864-5557 SANT"TARY NO. 77 CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
wOp LICENSED CONTRACTOR'S DECLARATION
.�cGi I hcrchy a0irm ren,1 am heca.d ander pmvishms of Chapter 9(commencing REROOF Job Description
wilb Section 9X011 of Division J of We dPmfemions Gide, dmylieCuseix
''ead infull(re aide yet. )ncsaun Z7�
CNo� iccntt Lie.p O
F D c � •• Cnnlrc,r [✓+� x� ��r�l� /ttA SCD
0-- ARCIII7L S ECLARATION utlar'-
< I understand my plans shall Puhlie records 2003
�w� JAN 0 1
waw
Licensed Prnlcxsicwl
=�5 OWNER-BUILDER DECLARATION
W`��'a S I M1crchy affirm'but I am exempt from tM Connector's License law for the $9000
S 0 o hillnwing ressr n.(Section 00111,Business and Professions Code:Any citynr maty BUILDING
x$ , which ayuires a pFmlil m codzruct,alter,improve,dcmnlish,nr repair any atrucmre
1D2" poor to it,issuance,also rectums the applicant fnrsuch permiuo file asigned statement
IS that he is licensed pursuanun the provisions of the Contractors Licemae law(chapter 9 ?g67.ff�6A10A Valuation
l5 0 (commercial,with Section 7000)of Division Sof the Business and Prolexsiuns Code)or
i $
that he is exempt therefrom add the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit xultjecu the applicant to a civil penalty of -3 UMyN_NTr7Rq= Occupancy Type
not moa than Eve hundred dollars(S51kD' 3 07 — INSULATION
❑1,as owner of the property,or my employees with wages as their vele compensation,
will do the work,and the structure is not intended or offered for sale(See.7044,Business p�g1T pT�0Cp 5s
and Professions Code:The Contractors License Law docs not apply to as owner,of 602 - ROOF. P IW V n1VHSLns
property who builds or improves Weaon,and who does such work himself or through his
own employees,provided Instinct impowerrcnrs arc not intended or offered for sale.If. 603 — ROOF BATTENS
however,the budding or improvement is.sild within one year of completion,the owner- 604 — ROOF IN-PROGRESS
builder will have the burden of proving Nal he did not Wild or improve for puipose of
sale).
1,as owner of the probeny,am exclusively contracting with licensed contractors to
construct the project(Sac.7044,Business and Profcalmm Cartel The,Contractor's Li.
ecrem law does not apply m an owner of property who builds or improves Iberenn.and
who Contracts for such projects with a ennuumr(s)licensed pursuant n be Contractor'x
Licene Law.
0 l am exempt under Sec. ,B&P C for this rcazon
Owner Dam
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑I have and will maintain seedless,of Consent tn.alf insum for Worker'x Comped.
ration,as provided for by Section Top of We[.We Code.far the Performarc<of the
work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance.as mounted by Section
3710 of the labor Code,for the performance of We work for which this permit is issued.
My Worker's GO tion InsuranCecranumM
Ca Si/R ftf= fhfl.t/� Pon Z —Q
CERTIFICATE OF EXEMPTIO FROMW RKERS'
COMPENSATION INSURANCE
G-his section need not M completed if the pmmil is foronc hundred dollars(5100)
or les)
I eerily that in the performance of the work for which this Permit is imued.I sball nil
employ any perms In any manner so as us become subject to the WorkersCompensation .
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,after making this Cenificate of Exemption,you should
become xubjca to the Worker's Com fie asation provisions of the Lohnr Code,you must
C O forthwith comply with such provisions or this Permit shall M deemed revoked.
z CONSTRUCTION LENDING AGENCY
[-. ,In. I hereby affirm Coal Were is a construction lending agency for the performance of
(y' 7 the work for which this pvoint is issued(Sec 31197.Civ.C.)
I] Q Fcndcr's Name
G Iendeis Address
U O 1 certify Our I have read this ir,licalin0 and.emu,that the above informalinn is t
L, P comen.I.,me(.Comply with all city and ummyoNinadces and sum laws relatingm
C) U building constnclion,and hereby authdrim abo momtives of Nix city to enter upon the
ahovc-mentioned property for inspection purposes.
a (We).,me or save,indemnify and keep meant the City of Cupertino against
liildlilicsjudgmeran,costs and expenses which may in any way wean against said City
U Z in conwyuence of the granting of this permit. v
'—� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON"POIIKr Issued by: Date
SOURCIRECOIM.A S. f�/—Q
� '///[// Re-roofs
Sig or pplicanUContmctdr
Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant sore or handle mo,ardous material
as defineU by the Capenino Municipal Code,Chapmr 9.12,and the health and Safety
Code.Section 25532LO.1 All roofs shall be inspected prior to any roofing material being installed.
❑Yes eer
Will We applicant or future building cca t use equipment or&vices which If a roof is installed without first obtaining an inspection, I agree to remove
pp gs pan yuip
mila? uxair cnnuminanlxasdelincJbythe Bay Area Air QualiyManagement all new materials for inspection.
District?
lOa&Safet Cose,Srd�m05.25 33amcrosuntkr ChaPmrfi CII
Iia s nolcu Safety Gve a wn ions255(15, my resnJ2551J. tt)nt)sunJ of ✓\J(i-If
Jrcs not cudcntly � v a mount.Wal 1(is my resgmsibillry m notify Ino. s'u� nl We '
requiamcn m va WaelpdoruimaanecofacerdficatenI "cy. - ignatureo Applicant Date
o aero(. mmi,edagen, Dam / All roof coverings to be Class "B" or better
Building Division
10300 Torre Avenue
Cupertino,CA 95014-3255
•` *' Telephone: (408)777-3228 CUPERTINO Fax: (408)777-3333
Building DepaAnent
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 and will comply with this policy.
Homeowners Name: ! h!s 1<
/ L
Address: V1 L L n-S C /lL GLS
Reroofing Company Name: � L--�// C'OU.y—'-t�
Applicants Signature�t � Date: '—al r o
• ' Joe Antonucci ^�
(Chief Building Official)
6/25/01