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05090145 (2)_00 to g0G �yoS YaCy y�LL _2> EFC w CITY OF CUPERTINO `EN§' €s m`°'` -i �. BUILDING DIVISION PERMIT @ONTRACTOR^INFORMATION v BUILDING ADDRESS: OLD COUNTRY ROOFING PERMIT NO.05090145 10553 FARALL N D OWNER'S NAME: PERMTf ISSUE DATE PAT TAKACSI 125-B GROBRIC CT 09/21/2005 ONE: SANITARY NO. CONTROL NO. (707)864-5557 ARCNITER/ENGINEER: BUILDING PERMIT INFO BLDG EIFCf PLUMB MECH 0 � 0 LICENSED CONTRACT'OR'S DECLARATION Job Description Chapter 9 mmmmenng 1 tertby affirm that I am licensed under provisions M ci with Section 7M)) of Division 3 of NC Business 4 Profusions Cede my icons is in full lame and a ate q �k •REROOF--T/O SHAKES, .RESHEEM 8SB�,A D 50 YR. COMP. SHINGLES o=gin r o ARCHHAS DECLARATION I undcmund my plans shall he used as public meords 2005 Licensed Pmfesxioaal OWNER -BUILDER DECLARATION e Contors License Law for the 1 hereby arm I ammexempt from Nom following rtumn. (Section ]U31.5. Business and Rvfresisw Code: Any city or roomyU which oxin. a permit In mnrmct, altar, minnow, demolish, ar repair any atrvcturc It.7j prior its issuance, also requirudm applicant for such pmol& m f Ie a signed aummem Sq. Ft, Floor Area — �.. ""s"Valua[ 80�0'0 Nat he is c licensed Purwmuo thec provisions of Nc Contmnurs Licence law (Chmmr9 (commencing with Section ]000) of Division 3 of the Business and Pmm cions Calc) or that he Is exempt dtarefrom and the basis for the alleged exemption. Any violation of ppNN tuber 5 Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant m a civil penalty of not more Nan five hundred dollars (35WL 3 6 9 3 9 34.00 ❑ I, as owner of the pmpmy, or my employers with wages u their sole compensation, Required Inspections will do Ne will and the ewcturt is not intended m offered for sale (Sm.]Os4, Business and Promsouns Code: The Convector's License Law docs not apply m an owner of q p property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements arc not intended or offered for sale. If. however, Ne building or improvement is sold within ane year of completion, the owner - builder will have the Wrdcn of pmving that k did not Wild or improve for purpose or .to L ❑ I, as Owner of One property, am exclusively controlling with licensed contractors to construct the project (Sec. ]D:A. Business and Professional Cade:) The Contractor's LI. eom law doe, not apply m an owner or pmpany who Wilds or improves themon, and. who contracts for such projects with a conoacmr(s) licensed pursuant o the Contractor's License Law. ❑ I am cmmpt ander Sec. . B & P C for this mason Owner Data WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: 1 have and will maintain a Cenifiam of Consent to self -insure for Worker'sComen- ution, as pmA&d for by Section 3700 of the labor Code, for the performance of the , work for which Nis permit is issued. I bout and will maintain Worker's Compcmvdon Insurance, as toquired by Section W of the Tabor Code. for the performance of she work for which this permit is issued. My Workoces Cohn,amoul'on Insurance canner and Policy number art: o IL n, l Cvmer.a + w`�`n, Palicy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thisseefion need nat Iccompletad if the permit is far enc hundred dollar (all (0) or less.) 1 cenifv thn in the performance of to work for which this permit is issued. I shall not mploy any person in any manner an as an Wcomc subject to the Workers' Compensation Laws of California, Date Applicant NOTICE TO APPLICANT: If. after making this Cenifam of Exemption, you should become subject to the Woher's Compemation provisions of the Iatho CMc, you mute (endwise comply wilt such movaimar or Nis permit shall be decmcd invoked. CONSTRUCTION LENDING AGENCY I hereby that there is o construction lendinagency ror the performance of ' the work furor wwhichich this permit is issued (Sec. J09'!, Civ. C.) Lender's Name , Lender's Address j I ccnify that I have rtad this application and sum that the about infoonuian is ' ' correct- I agree m comply with all city and county ordinances and sum laws mining m building construction, and hereby authmrme Toloommativcs of Nis city to color upon to ' above-mclmoned property for Inspection purposes. (We) agtae to save, indemnify and Ime, harmless the City of Cupenino gaimt j liabilities. judgmcnu, casts and expemcs which may in any way amus against said City n eom aluenee of the granting of this Permit. ' APPLICANT UND RSTANDS AND ILL COM LY WITH ALL NON -POINT �1 Issued by: Date Com( G p SOURCEREGU Is / Re -roofs Type of Roof a �7 Signature Ap,licm Contractor Dam HAZARDOUS MATERIALS DISCLOSURE Will he applicant or rut= building occupantmom or handle hvardaus material as defined by the Caperton Municipal Code. Chapter 9.12, and the Hallh and Safety ale, Section 255320)? All roofs shall be inspected prior to any roofing material being installed. ❑ Yes tgn� If a roof is installed without first obtaining an inspection, I agree to remove Will the aPPliermt or (marc building occupant um eyvipment or devices which it ha same; air contaminants as defined by the Bay Ama Air Doubly Management all new materials for inspection. Disuin? ❑secs Dil. Thal for - Cxldin, Nchaaardoons Chmmdtosif 25YiaHmyuirtmcnuundcr Safir o, ria Health&SafetyCode,SationsatII25513 md255J4.lunderatmd NmifNc Willing tlf tenan40 at it is re powhit y m unary Na nexmmt or Ne does not cAt -ZI miloimormn., nr armcnra ,ife.mpraayu.yy. Signature of Applicant Date All roof coverings to be Class "B" or better Owncror sate a Community Development 10300 Torre Avenue it J 1 Cupertino CA 95014 Telephone (408) 777-3228 CITY OF Fax (408) 777-3333 �UPEkTINO Building Department JOB ADDRESS: ldSS3 PERMIT # OSa�ol4s OWNER'S NAME: PHONE # S .-13 S GENERAL CONTRACTOR: O/ FAX # I am not using any subcontractors: O« ld S Signature Date Please check applicable subcontractors and complete the following information: Oner/ ontractor S gnature SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock The Date Oner/ ontractor S gnature SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock The Date Community Development Department Building Division City of Cupertino 10300 Torre Avenue CITY OF Telephone: (408) 777-3228 Fax: (408) 777-3333 C O P E Q I N O Building Department Subject: Re -roofing policy for the City of Cupertino 1- Prior to permit issuance; you must agree to comply with 1997 UBC -Standards - and manufacturers specifications on re -roofing. 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 re -roofing 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) Pre -inspection 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 a proper City inspection can be performed. 7. NOTE: If you call for a plywood nail inspection and the job is not ready, you will be charged a re -inspection fee of $176.18. The re -inspection fee must be paid before another inspection can be scheduled. IMPORTANT: 1. Flat roofs must have a minimum of 1/4 " per foot slope and demonstrate that there is no ponding. 2. An I.C.B.O. report is required to be on the job site at the time on inspection. I understand and will comply with the above stated policy on re -roofing. Homeowner's Name: �7� Job Site Address: ��SS3 nn7 a L () 0 - Roofing Company Name: plc l c iqp 1 Applicant's Signature: Date: Greg Casteel Building Official Revised 11 /2/04 CITY OF CUPERTINO -CCS- REROOF SCUPEkTINO PERMIT APPLICATION FORM Date: / APN # 3 (0 9 - 3 �i - 0 3 �' Building Address: 103-S-3 Owner's Name: Contractor: _ 0.A Phone #: l�p��2�z 4-3a� Contact: Phone #. s Qom` ..2.0 Type of Roof Covering: Existing: ❑ Built -Up Roof ❑ Asphalt Shingles ❑ Wood Shakes ❑ Wood Shingles ❑ Other (Specify) Number of existing coverings ❑ To be Removed 8 I Have Read, Un Job Description: Zone: Yes ❑ No ❑ Cost of Project: v l 2s �' Qty. if i� Phone #: F-65 —13 6,s;- License S License #: -6227-3/ -- - Cupertmo Business License #: Proposed: ❑ Built -Up roof Asphalt Shingles ❑ Wood Shakes ❑ Wood Shingles ❑ other (Specify) ❑ Provide I.C.B.O. Report # ❑ Provide Mfgr. Installation Specs. ,rtino's Tear 6 c$—ff , L'—� Type of Construction: Confirmed with Planning Dept. if there are any restrictions: LJ Occupancy group: Fee Group A licable Pee w / BPERMFEE BENERGY / BSEISMICRE BSEISMICOM BPLANCHK BUSLIC 1 Bldg Permit Fees Energv Seismic Fee Res Seismic Commercial Plan Check Fee Business License BUILDING BUILDING BUILDING BUILDING BUILDING BLZLDING