03090174 (2) CITY OF CUPEWI'INO
BUILDING DIVISION PERMIT �',CONTRACTOI2�IINT'ORMVATIEONs
BUILDING ADDRESS: OLD COUNTRY ROOFING PMMITNO03090174
OWNER'S NAME: 125-B GROBRIC CT PERMTTISSUEDATE
IFNE: (707) 864-5557 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
+oa LICENSED CONTRACTORS DECLARATION lob Description
U 1 he y affirm that I am limnmd under provisions nr Chapter 9(commencing p
)p with 7001a)o(Division)of NC Businev and PrufcssinnsC de,and mylicense is /
n in full fnt and cfre
tie I �— Lle.a �� REROOF
^p Dalc - Cantreclor
FF7W ARCHITECTS DEC TION
I K< 1 understand my plans shall k used u p ¢mcoNs V
s its i Licensed Professional
3 OWNER BUILDER DECLARATION
<y I hereby affirm that 1 am exempt from the Contraetor'a License Law for the
00 following rcasnn.(Section 7131.5,Business and Pm(cramns Calc:Any city or county
5$� which requires a pemiii or construct,alter,improve,demolish,or repair any structure
-Zj, prior hs its issuance,also requires the applicant for such permit to file a signed statement
that he is licensed pursuant to Ne Provisions of the Comracmh Licenu law(Chapwr 9 Sq. Ft. Floor Area Valuation -
(commencing with Section 7000)0(Division 7 of the Business and Professions Cad d or
Net he is exempt therefrom and the basis for the alleged exemption.Any violation of 36616060 . 00
Section 7031.5 by any applicentto,a permit subjects the applicant to'rivil penalty of .APN NUmbCC. .. _ Occupancy Type
not mare than fives hundred dollars(15W). -— - -- P Y --- -
❑h as owner of the property,or my employees with wages u their sale compensation,
will do the work,and the tincture is not intended mcrifemd far sale(Sec.7044,Business
and Ptorensom.Codc:The Contractor's License Law does not apply to an owner of 307 — INSULATrV d Inspections
property who builds m improves thereon,and who daeatuch work himself or through his
awn employees,provided that such improvements am not intended ar offered for sale.If. 601 — ROOF TEAR OFF
however,the building or improvamenl is bold within one year or completion,Ne Owner-
builder
wnrnbuilder will have Ne burden of proving that he did not Wild or improve for purpose or 602 - ROOF PLYWOOD NAIL
sal`')' 603 - ROOF BATTENS
I,u t the p of Ne Sec.properry,am .elusively contracting with licensed contractors m - -construct does jetapply7oa4,wner ossand PmwoWids or i pr Contractor's Li 604 - ROOF IN-PROGRESS
rue Law coca not applyje an owner of property who Wilds or improves Neuron,and
whence Law,for projects with m conlrulor(q licensed pursuant to the COmncmh
License Law.
❑1 em exempt under sec. ,B&P C for this motion
Owner Data
WORKER'S COMPENSATION DECLARATION -. ..
I hereby afro under penally of perjury one of the following deelatations:
I haw and will maintain a Certificate ofConunuo self-mrsim Por Workers ComNn.
talion;u pmvided for by Section 37W of the labor Code.for the performance of the .
work for which this Permit is issued. ..
❑1 haw and will maintain Workers Compensation Insurance,as required by Section
7700 of the Labor Codc,for the performance of the work for which this permit is issued.
My Worker's Compeesalibn Insurance artier and Policy EXFPTNo.
ber rt: -s
Gamier; Policy RdMW KEl
J�( TIFICA OFSATIONIINN FROM WORKERS'
COMPENSATION INSURANCE
(This section wed not he completed if the Permit is for one hundred dollars($100)
mfors.)
1 certify that in the performance of the work for which Nis Permit H issued,)shall nut
employ any person in any manner an u to become subject o the Workers'Compemadmi
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Ccndleme of Bacardi., rm should
became subject to the Worker's Compensation previsions of the Labor Card,you most
�Q foMwilh comply with such provisions or this Permit shalt W deemed revoked.
Z� CONSTRUCTION LENDING AGENCY
I hereby affirm Nat there is a construction lending agency l'or the Performance or -
]: he work(or which this herrn is issued(Sec.3097,Civ.C.)
37 Lender's Name
z Lenders Address
J 1'nee Nat 1 have read this application and sow that the above information is
y U bonen.l onsi a comply with all city and county nNimncef and sow lawn r Urwng N
V "Ove-mentioned
ntioneclionand hereby aectioniaeoses.representatives of this city to enter upon lM1C
G eovc(We)are I.Sava for inspectionindemnity
akeep ha.
ti (We)agate 10 save,and ex,en and kith harmless the City Accrue
Cupertino s agoinsl
N incoitie;judgmcn cgmsindcxpcnsM which may in anyway eccmc agaiml said City
;J z in eonxgwnec a(Ncgmming of this permit.
^' APPLICANT NDERSTANDS ND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURC CATIONS.y an'�
Re-roofs
.9TSnauum,ddX,plicmVCanuacurr
HAZARDOUS MATERIALS DISCLOSURE Data Type of Roof
Will the applicant or future building Occupant stove or handle hazardous autumnal
as defined by the Cupertino Municipal,Code,Chapter 9.12,and the Health and Safety
Codc,Section 25532(x)? All roofs shall be inspected prior to an roofing material beim
❑yes p p Y g g installed.
Will the applicant or future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it haxordnus air coomminams as dcfiocd by the Bay Area Air Gamily Management all new materials for inspection.
forldc'?
❑Yes
Ihave mad theM Sections 25305lsre33 and 5534.1under Charter
comind met
of die Wilding
rias not Curr ntly haw
a tianamns255(t is M m9fion5534.1 M nodi nth a OcUip Willing /q��'�'A �^ �� ) 1
Jaws not currently haw a mnmt,that it is my rcspomibility w naulY the acupvil of the /./!r ✓ 6
mquirtm uh must Ix, arwiMaanaara Ca Ica al Qcu7 Sl�ture fApplicant Date
O rr((X4u��S1-`VC�VC//�,JJar;Sd ascot aa.•//1) ✓✓ D-�a+71e All roof coverings to be Class "B" or better
Building Division
10300 Torre Avenue
Cupertino,CA 95014-3255
` Telephone: (408)777-3228
CITY 0 Fax: (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 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/V'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: I'\\ �Sly l li-
Address q.$a3 Dy ve'
Reroofing Company Name: ! ntd 14h7"rL4 Lo`tvis
Applicants Signature: _L �4`b"`�-- Date:
�Joe Antonucci
(Chief Building Official)
6/25/01
CITY.OF CUPERTINO
REROOF
CUPEkTINO PERMIT APPLICATION FORM
APN # 3 G C l G OG
Buildin- Address: 7
-q- 3 1 o c-' �•c-� ✓
O ner's Name: Phone #:
05 L- / 4/ o P, 5 G85'
Contractor: Phone #: License #:
0L C o o n7T /door- ,nOG .14L 6? _ a-3 o0
Coq;act: 't Phne #: Cupertino Business License #:
-5s you ka- 83C)O ao3 d' 9
Type of Roof Covering:
Existing: Proposed: j
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
X Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
Cl Other(Specify) >f Other(Specify)M0N10rl- 461'T(nYr" -rjGL'
Number of existing coverings ❑ Provide LC.B.O.Report q�7 6
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Com 1 With Cu ertino's Teaz Off Polic
Job Description: �i'Ia✓� c xtsri Q wt kxoofer wer
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with P nning De t. if
there are an r trictions: `
Cost of ect: o Type of Consti_u Z, Occupancy oup:
tg-
Qty. if
Applicabor 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
i
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