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03100032CITY OF CUPERTINO BUILDING DIVISION PER �CONTRAC�TOR INFORMATION•{s�'y. BUILDING ADDRESS: OLD COUNTRY ROOFING PERMITNG. 03100032 OWNER'S NAME: - 125—B GROBRIC CT PERMIT65UEDATE NE: ) (707) 864-5557 SANITARY NO. CONTROL NO. ARCHITEC PI NGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description I hereby mri'm that I am licensed under provisions of Chapter 9 (commencing P with Section 70W) of Division 3 of the Business and Professions Code. and my license is and'fre Ga.413� L w a 93 REROOF -IN LF— Lieenu Clazs Lie. N - License r Dar Camrmmr ARCHITECTS DECLARATION— 0 gg 0 L003 I understand my plans shall he used as public records D DCU Licensed Profcssional OWNER -BUILDER DECLARATION I hereby Our 1 exempt from the Camas License Law for the G77 BUIL®IWG um Code: Any city or canny . sec 1. Co 7031.5,Business and Following amoa(rnsit Permit sur construct, abv, i Improve, Or rash any structure which requires t de ricmrolli t poor it, its issuance,rsuarequires ilia applicant for suchractora Eleasigned statement t t for such that LicenceLew(Cone) 9 the") dPSectio Sq. Ft. Floor Area Valuation 7in the Business and (commencingwith Section ofDivinmofthe the (commencingof Division) virCelle)ser 36654085 O on.An Thal he u exempt themtrom and tn< basis for the dlcgcd exemption. Any violation of And APN Number Occupancy Type Seo0on 7031.5 by any applicant for a permit subjects the applicant to a civil penalty, of not mon than five hundred dollen (SSW). ❑ 1, As owner of the property, or my employees with wages AS their $ole compensation, Egg Inspections will do Ne work. and the atrudu,is not Intended or offered far sale (Sec.]014, Business and Profeaslans Code: The Contractor', License Law docs not apply to an owner or property who builds or imprawa thereon, and who does such work himself or through his 307 - INSULATION Own employes, provided mat such improvements are not inundce Or offend for sale. If, 601 — ROOF TEAR OFF however. the building or impmvemenl is sold within one year of completion, the owncr- builder will have the burden of roving ren he did not Wild or improve for purpose of 602 - ROOF PLYWOOD NAIL sal`')' 603 - ROOF BATTENS contruiins with licensed Ccnnvaooss to exclusively meand ❑ 1, a owner of ct Sec.property. Business conswct BusinessandrtywhoomdsoriTheesthemon,an- 604 — ROOF IN -PROGRESS dproject(Sec.nan come law coca not apply je an owner of property who Wilds or improves Ihemon, and the Comra' men projects with acontrumrts)IicenseO pursuant to racm whocontractsLa .for License law. ❑ 1 em exempt under Sec. . B & P C for this rcuon Owner Data WORKER'S COMPENSATION DECLARATION I hereby aRrm under Primly of perjury One O( the following declaration: I hoe and will maintain a Certificate of Conserv to wlf.insum for Worker's Compen- sation, AS provided for by Section 37W of me Labor Code, for On performance of me work for which this Permit is issued. - ❑ I have and will maintain Workers Compensation Insurance, AS mquimd by Section J]W of the labor Code. far the Performance of the work for which this permit is Issued. " My Workers OmPeruatiomlamnncc cant Land Polity n ber am: Carrier. 4-;7PHX PolicyNo.:�?y CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not hecompleted if the permit la f hone hundred dullan (SI W I m less) I certify mu in Oc performance of the work or which this Permit is issued, I shall not . employ any pen on in any manocran AS to become subject to the Workers Compensation Laws of California. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers Compensation previsions of me tabor CNC. you must - forthwith comply with such provisions Or mix Permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby aMrm Out there is a construction lending agency for the Performance or me work for which this permit is issued (Sec. 3097, Civ. C.) . Lender's Name ///--- lendersAddress I certify mat I haw read this application and sure that the show i. rmninn is bonding I agree to comply with all city and county ntainansof and sou laws relating to building construction, and herby enthnrix meows of this city to enter upon me TPOWS. ehovcmcminnetl for inspection Purposes. t to save (We) Agmit a save, and expert and keep harmless the City accrue Cupertino againstHabil ts,the coauendofPemesmit. they in anyway accme eeeinsl said City / rT incoisequene of or This Permit. of the Aconsequence RSTAprand.g APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date SOU EGULATIONS. Re -roofs . 1a -3-o3 s e les ar a2nV�Cantncmr Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building Occupant more or handle hverdum material AS darned by do Cupertino Municipal Code, Chapter 9.12, and the Health and Safety code, Section All roofs shall be inspected prior to any roofing material being Installed. erss32(a)], ❑Ya If a roof is installed without first obtaining an inspection, I agree to remove . Will the applicant or future building occupant esu cyuipmem or devices which , havartlnus air contaminants at defined by the Bay Area Air Quality Management all new materials for inspection. xvict7 ^ ❑Ycs taiaetr I have mad me hamrdnus materials nommo enu under Chapter 6.95 of Oc Califor. tin Heohh 6 Safety Curie, Sections 255115,35533 and 25534.1 understood Out if the building ��-3�D� /7�L�/^�`�✓(/La—as does nalSurtcn0y haw a tenant, Our it u my responsibility at notify the occupant of the // L a's"� mqu' tEtewhyhmostlnmcldar1.ia...of. Ccnircamofaapaady. SignaureofApplicant Date ' ✓ /d-3-03 "B" All roof coverings to be Class or better dwrielf or au mnacnagent Date I Building Division ' 10300 Toren Avenue ' Cupertino, CA 950143255 Telephone: (408) 777-3228 Fax: (408) 777-3333 CUPEkT1N0 . Building Deparitnent 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 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 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 '/.' 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: k-)17 i W i c S c Address: l 1 1, b' I �11 e -r76 A)(, C OU A---T- Reroofing c,-r Reroofing Company Name: O L-�- C w nrr" d;F O o -,, „i G Applicants Signab=—F r �t�:� a.� �� Date: / 0 - a- O 25 • d� Joe Antonucci ` (Chief Building Official) 6/25/01 -CUPERJINO CITY OF CUPERTINO REROOF PERMIT APPLICATION FORM Qty. if Ant Ott. Frr DeeRrrintinn Fee Grout) BPERMFEE APN # G G 6 j Z O p J5- Date: I O- a_ 0,3 BENERGY Building Address: 11 Coil �/�3�'K 5�21�G BUILDING Owner's Name: = M) c1.1A � csc= Phone 5-6 31 BUILDING Contractor: Phone #: License #: BUILDING d�:7 C.ov1NT��I moor-t�� a X300 Plan Check Fee BUILDING Contact: Ph o a #: Cupertino Business License #: BUILDING 6—,R ?�3 00 8, —Type of Roof Covering: Existing: Proposed: ❑ Built -Up Roof ❑ Built -Up roof I ❑ Asphalt Shingles X Asphalt Shingles I Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other (Specify) ❑ Other (Specify) Number of existing coverings / ❑ Provide I.C.B.O. Report # To be Removed ❑ Provide Mfgr. Installation Specs. I Have Read, Understand and Will Com 1 With Cu erti%s Tear Off Pc Job Description: �{Eirl 09 c�X l s� t ,V L� cx o /Ns /J�L_ OS"5 5G,P 'mak d- y Residential 4 Commercial ❑ Fire Zone: Yes ❑ No ❑ Confirmed with Planning De t. if there are any restrictions: LJ Cost o o' t: aU Type of Construction: Occupancy group: Qty. if Ant Ott. Frr DeeRrrintinn Fee Grout) 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 I