03010020 (2) I CITY OF CUPERTIN0 "` ': •
BUILDING DIVISION PERMIT xONTRACTORINFORMATION:`,.
BUILDINGADDRFSS: OLD COUNTRY ROOFING PERMIT NO,
21123 CHRISTENSEN DR
OWNER'S NAME: 125—B GROBRIC CT APPLICATION SUB DATE
LEAL MILFORD A AND DORIS J 01/06/2003
toHONE: (707) 864-5557 SANITARY NO. CONTROL NO,
ARCHITECfIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
OrcZ u0
LICENSED CONfstSDECLARATION ms I heathy affirm that I em licensedd undorunder provisions lco of Chapter Y(commencing Job Description
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with Sermon Hlit of DivisiunJnf UtM B/xiness end Prnfcssin sCndc,end myliccnsc is
�&I i11ml rceandeff0, ✓]0 �Oa�e]� / REROF
z5gz c `I LL�'[[gr¢¢Tv nG T/O SHAKE INSTALL OSB 30# FELT &
�N; s , ARCHITECT}'KCLARATEA
omV IunderaxndmyplansshellMusedaspublicrecords ELK 40 YR. COMP. SHINGLES FUNALE®
3LL Licensed Pml'essianal 1G
.t=0 OWNER-BU ELDER DECLARATION
u�<y I hereby affirm Nal 1 am exempt from the Contractor's License Law for the JUN 5 2003
o.E 00 following reason.(Section 7031.5.Business and Pmfcmions Code:Any city or county
$9� which requires a permit to construct,alcor,improrx.demolish,or tepair any sroctma
at
�3e prior to its issuance,also requires the applicant for such Permit to rile a signedstatement w..,
ppxx that he is licensed pursuant m Ne provisions of the Connector's License Law(Chepher9 Sq.Ft. Floor Area LDIN&tlon
yF� (commencing with Section7(MMp of Division 3 of the Buaim.ruid Professions Cade)or �w
tuy Nal he is exempt Ihenerrom and the basis for the alleged exemption,Any violation of
Section 7031.5 by any applicant for a Permit subjects the applicant to a civil penally of APN NumberC Type
not more Nen five hundred dollars(55110). y yp
❑I,u owner ofthe property.or my employees with wages es their sole compensation,
will do the work,and she structure is not intended oroffered ec
fortune(S .7044,Business
and Professions Cade:The Contractor's License law does not apply to an owner of Required Inspections
Propeny who builds or Improves thereon,and who does such work himself or through his
own emptones.provided Nat such improvements se not intended or offered for We.If, 305 — FRAME
however,the building or improvement is sold within aro year of completion,the Owner.
builder will have the burden of proving that he did not build or improve for purpose of 3 07 - INSULATION
wile'I' 601 - ROOF TEAR OFF
C]1.as owner of the progeny,am exclusively contracting with licensed contractors u 602 - ROOF PLYWOOD NAIL
consuuct the project(Sec.70 ,Reindict and Profeumns Code:)The Cannot U.
cense law does not apply to an owner of property who builds or impmm thereon,and 603 - ROOF BATTENS
who conuacts for such projects with a rou
ntractor(s)licensed pursuant the Contractor's
License Law. 604 - ROOF IN-PROGRESS
❑ I am exempt under Sec. ,B&P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affum under penalty of perjury one of the following declarations:
1 have and will maintain eCer iftuare of Consent self-insure for Worker's Compete
730700.1'
tion,as provided for by Section 3700 of the labor Code,for he Performance of the
rk for which this Permit is issued.
I have and will maintain Workers Compensation Insurance,as required by Section
the labor Cede,for Ne pcifomnance of the work for which this permit is issued.
y Woron''s mppnaafi Iyn_su�rar�ce carrier end Polity mark,are:
` zf . IPulicyN}U CERTIFICATE Op EXEMPfIOWORKERS'
COMPENSATION INS RANCE
(Nis section need raw Aecomplered itaM permit is for one hundred dollars(SIGH)
or loss.)
1 cenify the in The performance of the work for which this permit is issued,I Asti not
employ any penton in any manners¢as to become subject to the Workere'Compcmadon
Laws of California.Dam
Appteam
NOTICE TO APPLICANT:IL after making this Ccnifcale of Exemption,you should
hcsvmc Subject to The Worker's Compensation provisions at the labor Code,you must
O O forthwith comply with such provisions or Nan
is Permit shall be demand revoked.
z ^'t CONSTRUCTION LENDING AGENCY
E-. .N.. I hemhy affirm Nai them is a construction lending agency]arts Performance of
�i
the work for which This permit is issued(Sec.YEAH.Civ.C.)
aQ Lender's Name
z Lenders Addmss
U 0 1 witty Nat I have rad this application and state that the about iolmoradon is
F coram.l—----comply with all city and county on finances and sate laws relating to
DU building construction,and hereby authnri:rpreumativms of Nis city to en¢r upon the
aMvc mentioned properly for inspmoon put s.
LL (we)agree m rave,indemnify and p armless the City of Cupertino against
EVE liabilities,jud U."maa aaJ expenecaw symmy wayaccaue against:id City % 7/
) is coattail c is granting of this Pm Issued by: Date
.•77 APPLE NDERSTANDS AN ILL COMPLY WITH L OINT
SOUR ULATIONS.
Re-roofs
gnsure o(Appli IIAZARDOUhach"S MATERIALS DISCLOSURE Dare Type of Roof
Will Ne ap imam or future building occupant store or handle huerdous material
as defined by the Cumnino Municipal Cods,Chapter 9.12,and the Health and Safety
Code,Section 255R(e)?
❑tics All roofs shall be inspected prior to any roofing material being installed.
o
Will the applicant or future building occupant use equipment or devices which If a roof is installed wit first obtaining a action,I agree to remove
mit haaardous air cmaxmin.4 M defined by the Bay Area Air Quality Management all new materials for i e tion
Dian ct?
❑Yes Nu
Ihavemad the Im: materialsrequiremen r Chapter 6.95 of Or Cubn, / ,S
ma Health&A_Lns2.5.A15.25533 an 34.E undersand that ifda building [///
does act cur .Na 'smy ihitity m ratify the rccuPant o crequimmentst - rmI oralat'YU¢7f -W,
r Signature of Applicant Date
Owner or anmadvmdn ,ta All roof coverings to be Class "B"or better
1
Building Division
10300 Torn Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
Fax: (408)7n-3333
CUPERTINO
Building Deparitment
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 on reroofing and will comply with this policy.
Homeowners Name: rr 1 LF02 7 d- C-0,2
Address: a 11 a3 C-14 2 I S T�=MS c=� X21 V c5-
Reroofing Company Name: O LO vi A4-r2 c, /Z 0 o F r Cr
Applicants Signature: Z Date:
Joe Antonucci
(Chief Building Official)
6/25/01