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03110002 a CITY OF CUPERTINO BUILDING DIVISION PERMITCONTRACTOR,I,NFORMATION:t, BUILDING ADDRESS: OLD COUNTRY ROOFING PERMIT NOO U'2- 11592 SEVEN SPRINGS DR OWNER'S NAME: 125-13 GROBRIC CT PERMITLSSUEDATE LOUIS WANG 11/03/2003 IrNE: ('/U /) 864-5557 SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH jzz o o w LICENSED CONTRACTORS DECLARATION fClu Job Description I hereby affirm that 1 em of the cd under Provisions ofs Code. 9 my license is p FZ with Section7U711)of Division]of the BuainEesuM Professions Code.entl mylicense is <<pN (.fuss recta Ap/omen. ./" REROOF s q? Liaenso Clµ! C s.9 Lice 41 z z 3 of Dam i /��—Contncmr GQaiU FeFIN A fi FVO /�R LTS DEO RATION RO IN6 ArtD 31�.C 1 understand my plans shall he used as p.biic records f G Licensed Profesah,.&I DEC 1 2003 3 OWNER-BUILDER DECLARATION <y I hereby alium that I am exempt from But Contractor's License Law for the O O following reason.(Section 7031.5,Business and Professions Code:Any city on county $9000 � 5 m which requires a permit to Construct.&Iter,improve,demolish,or repair any structure $9 0 0 0 -Zmtprior h)its issuance,also requires the applicant for such permit to rile a signed statement FO that he is licensed pursuant In the provisions ofOnContractors License Law(Chapter 9 Sq.F[. Floor Area Valuation . $ (commencing with Section 7000)ofDivision 3ofthe Business and Professions Crvk)or 36654017 . 00 - That he is exempt themrum and t basis for the alleged exemption.Any violation of Section 7031.3 by any applicant for a Permit ubjects Be applicant to a civil penalty of ane APN Number Occupancy not more than fin hundred dollars($500). P y Type ❑1,&a owner of the propcny,or my employees with wages as their sole compensation, will do the work,and the structure Is not intended or offered for sale(Sec.70aa,Business and Profard.na Co.:The Contractors Lill.law does not apply in an owner of Required Inspections property who builds or improves thereon,and who doeuuch work himself or through his Own employes,provided Nat such improvements sae not intended or offered for sale If, however,the building or improvement is sold within one you of Completion.On owner- builder will hove the burden of proving that he did not Wild or improve for purpose of gale.). ❑1,as owtmr of the propeny,am exclusively contracting with licensed cormsetma to cou no(the project(Sec.70aa,Business and Professions Code:)The CommCLori Li curse law does not apply to an owner or property who builds or improv thereon,and, who contracts for such projects with a contractor(l)licensed pursuant o the Contractor's License Lew. 171 am exempt under Sec. ,B&P C for moon Owner Data WORKER'S COM PBNSATION DECLARATION 1 hereby atm under penalty of perjury ore of the following declarations: I ban and will maintain a Certificate of Consent to aclFinsum for Workeb Compere &.tion.as provided for by Section 3760 of the labor Code,for to performance of the work for which this permit is lasered. ❑I have and will maintain Workers Compensation Insurance.u required by Section 3700 of the labor Code,for the performance of ft work for which this permit is issued. My Worker's n nutign lnsunnee artiered Policy number are: Cm /U VN f1vN n Polipy .: I s(?z Z CERTIFICATEOF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need Out he completed Kthe permit is foronc hundred dollars B$IBB) less.) 1 certify Not in the performance of the work for which this permit is issued.1 shall not - employ any person in any manner se as m become subject o the Workers'Compensation Laws of Cal irons..Date Applicant NOTICE TO APPLICANT:If,after making this Certificate or Exemption.you should become subject in the Worker's Com pcu&tion provisions of the labor Codc.YOU must 7z fonhwi lh comply with such provisions or this Perm itsm hall w domed revoked, ti N CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the pcufurr awn of Y. Fes-, the work fur which this permit Is issued(Sce.3097,ON.C.) a7 Q Unders Name z LandereAddress Q 1 sentry that I bare read this application and roto that the above information is _ y F Curren.lagrce10Comply With All City and county ordinances and man laws Mintingto V building construction,and hereby&uthorin representatives of this city to enter upon the (Z) ahmveons,juenedproperty for inspection purpowhich ms. .� r gy (We)agree to save,indemnify and keep harmless the city or Cupertino against y liebilives,judgmenu,ensu add expenses which may to any way ettme against s.itl City inconsequence heg�rthisit.A PPLICA U DERI LY LTH ALL NON-POINT Issued by: Date sOURCER ATIO _ /y `?13 Re-roofs Sig ser AppoonvLomracmr Data HAZARDOUS MATERIALS DISCLOSURE Type of Roof .II the applicant or future building wcuputt nom or handle hayaacu a materi&1 defined by the Cupertino Municipal Cade,Chapter 9.11.and the Health and Safety ,aikLWc. ❑tYus 255320)lXn All roofs shall be inspected prior to any roofing material being installed. Will the applicantr(.lure building mcn.pant an equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove it horzrdmus air contaminants as dcfncd by ft Bay Area Air Quality Management all new materials for inspection. District? ❑Yes gNo _ I have mad the hmamoos materiels mq&tr u oder Chap ter 6115 ofthc CaIf., nio Hcnith&Safct YC ,Sccdou8305,1s53 a.l understand th&tifthchuilding - — - �! doas n. cumcutlyy(.t a e... tha tis s th m notify the occupant of the 1,213 rcquiremcn�Ilii tbc�p rlu e c tRc mor Occup %$i afore of Applicant Date (d �� } All roof coverings to be Class "B"or better Owner orircd agent m Building Division ' 10300 Toga Avenue Cupertino,CA 950143255 ` Telephone: (408)777-3228 Fen: (408)777-3333 ' CUPERTINO 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 obtainingall inspection Wand 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 0. 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 on reroofing and will comply with this policy. Homeowners Name: �-O a, �✓i4/t/o Address: 1.�9 ?_ �� VA V x/ /10ic s Reroofing Company Name: 0 L-� C c)U nrrd;F o c i•- G Applicants Signature— �t�:�, a.� �� Date: / 0 - a- o ') Joe Antonucci (Chief Building Official) 6/25/01 CITY OF CUPERTINO REROOF a 3 CUPERTINO PERMIT APPLICATION FORM APN # Date: Building Address: Owner's Name: Phone #: pC c7 cJ /Is Contractor: Phone #: b' License #: 047 C.00 t1Tci 1 (-,�opr-t,4G 6 as -4 �3 ! Contact: Ph o a #: Cupertino Business License #: `{ off r�;;k Go-0 8, —Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles ❑ Asphalt Shingles O Wood Shakes ❑ Wood Shakes ❑ Wood Shingles O Wood Shingles ❑ Other(Specify) O Other(Specify) Number of existing coverings O Provide I.C.B.O.Report# ❑ To be Removed ❑ Provide Mfgr.Installation Specs. I Have Read, Understand and Will Comply With Cu rtino's Tear Off Policy: Job Description: ' o j L,4 ye/G�O�S F+/ e.� �� 5 eeTe, A� ee-f/)/" CNo asl5 3p LB Fec d o ` a FG/� Residential Commercial ❑ Fire Zone: Yes ❑ No ❑ Confirmed with Planning De t. if therea an estrictions. lJ Cost of Pro t' Type of Construction: Oc pancy group: 3 Qt . if A0plicabld Fee ID Fee Description Fee Group BPERMFEE Bldg Permit Fees BUILDING BENERGY . Energy BUILDING BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING 2, 3667