06010122 (2) ' CITY OF CUPERTINO
BUILDING DIVISION PERMIT aCUNfiRAC ;glt YN 'UIi1VIA"CTON,
BUILDING ADDRESS: OLD COUNTRY ROOFING PERMITNO.06010122
21806 HYANNI PORT DR
W NER'S NAME: PERMIT ISSUE DATE
WES SPARGIE 125-B GROBRIC CT 01/23/2006
NE: SANITARY NO. CONTROL NO.
(707) 864-5557
ARCHITECDP.NGINEER: BUILDING PERMIT INFO
BLDG
lL I� PLUMB
l� I�
3Gj LICENSED CONTRACTOR'S DECLARATION
4 1 hereby affirm that I am licensed under provisions of Chapmr 9(commencing Job Description
with Section 9000)of Division 3 of the Business and Pre(essium Code,and my license is
+� ifull(..ameff" yR 2L) T/O SHAKES . RESHEET OSB ADD 50YR COMP SHINGLES
DatenuClksa e L ,mens CLASS A OR B
'Q4F� {{ ARsh s�i
' < 1 undcraunJ my plana ah d pts me Tao {� p
g ted Uty Licensed Pmfcasionel I'.� yl
j OWNER-BUILDER DECLARATION Ittj—' PI'S.
E I hereby M.that I em exempt from du Clinometer,Lkeru law for the
ED
O o following moons.(Section 7031.5,Business and Professiuns Code:Any city or county
5$( which requires a permit to convect,alter,improve,demolish.or repair any structure
_ZI~ prior to its issuance,also requires themplican,for such Permit o role a signed summer,
Sy�Q mlalh
Feisllmrse11puRUNtmBM
Bmpl.Yism.of ConVKmrsLicense La.(Chapmf9 Sq.Ft. Floor Area I t - E Valu
9 recommencing with Section 7000)of Division 3 of NC Business and Professions Code)or
.- Nat he N exempt themfrom and the bub for due alleged exemption.Any vleladon of e t1 i — -
Section 7031.5 by any applicant for a permit subjects the applicant an a civil penalty of ��ppy7���i 7aN��i8Tb it pp�nJ7
not more than five hundred dol Ws(5500} 3M 01,I U 1 r(]Q `✓Zi/i l LM I O� GY Type
D I.u ownm ofthe property,a my employes with wages u their ole compensation, Illlli
will do the workend the eructule 4 not intendedmoQe lid fools(Sec.7094.Business
and Professions Code:The Conumemr's Liam Taw don not apply to an owner of Required Inspections
property who bei Id,a improves d ino m,and who does such work himsel f orthrough his
own employes,provided mat such improvements are not intended oroRcmd forsale.if.
however,me building or improvement is sold within one year of completion,the owner.
builder will have the burden of proving that he did ort build or Improve for pulp=of
sate.).
D 1.as owner of the property.am exclusively contracting with licensed contractors to
construct the pmjca(Sec.7099,Busineu and Professlrns Code:)The Conmcmr's Li.
emom law dos not apply to an Maar of property who build,or improves thereon.and,
who contracts for such projects with a comrmemr(a)Ikea ed Is...t as the CMmracurs
License Law.
❑I am exempt under Sec. .B&P C for this mason
wa Dam
WORKER'S COMPENSATION DECLARATION
I hereby aftlrm under penalty of perjury one of the following decimations:
1 have sed!will msinain•CeNfiate of Comes a elf-imam for WmkersCanpen-
.firm.sa provided for by Section 3700 of the Labor Code,for the Performance of the
work for which this permit is issued.
have and will maintain Workers Compensation Insurance,.acquired by Section
of the labor Code,for the Performance of the work for which this permit is issued.
My Wark�yr�/Compen.d-ot�Insurance artier ted Polity number art:
Cartier.!IN.�J �l/k1w�Qh Policy No.:ILI S 111
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Dib sectiat sad not hecompleted If the Permit Is forme,hundred dollen(SIM)
or less.)
1 unify that in the performance of the work for which this Permit is issued.I mall not
employ any preon in my mercer m as an hecome subject o me Workeri Compounder,
laws of Calif Tris.Data
Appiiaml
NOTICE TO APPLICANT If,after making mb Certificate of Exemption.you should
become subject to the Worker's Compensation provisions of the labor Code,you must
z forthwith comply with such provisions or this pormiuhaff he decmcd revoked.
zCONSTRUCTION LENDING AGENCY
(—mom
I hereby anlrm that thea lar constuctlon lending agency for me performance of
14 the work for which this permit is issued(Sec.3091,Civ.CJ
Q Lenders None
z Lenders Address
U Q 1 ceAfy That 1 ave mad this application and,mete that the above information is
Iy collect.I agree to comply with all city and county oNiwues and sum laws relating to
building construction,erd hereby authorize repreaenutives of this city to cone,upon the
lIl ahove-mentioned property for inspection purposes.
gy (We)agree to save,indemnify and keep harmless the City of Cupertino against
ver(4 liabilities judgments,cents and expenses which may in any way am=against said City
Tsai in consequence of the Infidel,of oris permit.
APPLICANT DERSTA ODS WILL WITH ALL NO-POINT Issued by: Date
SOURCE LAW I
_ 27 81 Re-roofs
Signuum Mf AppliwnUConume Dane
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupam nom or handle mostodoes material
Imquironnems
nned by the Cupertino Municipal Code,Chapter 9.13,and time Health and Safety
.Section 2553z(a)7 All roofs shall be inspected prior to any roofing material being installed.
DYes LN--
Will
oWill the applicant or rutum building menton,um equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
ItIm"xm us.1,contaminants u dcOmd by the Bay Arta Air Quality Mergeme.I all new materials for Inspection.
el? ��
DYes &o
1 have orad the hxaard,u,mamriabmquiremenu unde,Capnerd.95 of me Calif.,.
ealth&Saleny Cede.Seedau25505.25533 and 25534.1 undersand tharifd,building
not currently haw:a tenant.that it b my maponsibility u notify the occupant or the '
moat be met poor stance of a Certirocam of Occuper . Signature Of Applicant Date
owners j Dam C 6 All roof coverings to be Class"B"or better
01/20/2006 13:56 7075287663 PERMIT SERVICES INC PAGE 02
JAN-20-2000 12:02 OLD COUNTRY ROOFING 4087828301 P.02
Community Dr44ment
10700 Torro Avagm
CUpaeoq GA P5014
TalepliFar,(404)777•}228
v Fax(403)777-3333
CUP£�T1N0 C.�/111�� - 7aSz - !�t�>m;�,
Building Department
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el P066Es�s_�V ,,�, S/Q02T 2�� PERMITa �O l o / ZZ
. 0'1 Wt ER'S NAIv_ s. i c�' " PtioNE o I a -T
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4r I sun not wing any aubconeraetor,j:
signature Date
Flessadu=c!c.io . ficaiazsuhconlra toraa.ndcompletetho. inl!owinginiormiHon-
S'ULiCONTR.ACTOR BUSINESS NAINITs BUSINESS LICENSE
— Cabinda &2viillvrork ^�
_Cement Fitlishint
.Electrical
Excaralion..
Fends
Fl;orin : Carpatins
l_noleisi/ Wood
. Glass/ Glatithg —_
Insulation
tandseaputs
�LathinF
OslurnentalSheetMetrtil
Piinhin_g/ 4Vn1IraPmr � �
Pturnbins .r... !
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. SUmatAIPtal __._
Slteat Rock
06"ner/Contractor Signature _ Hare
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
CUPEI�TIN®
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: r t v (�
Job Site Address: �7�� G Y�7nn4%� OA
Roofing Company Name: 0� t-t — I
J?Applicant's Signature: Date: /O 1
Greg Casteel
Building Official
Revised 11/2/04
Pnntod on Recyclod Paper
1 CITY OF CUPERTINO
CC ' tEROOF o
CUPERTINO PERMIT APPLICATION FORM
APN # 3 5 6 _ /3 _O / Date:
BuildingX1 s7 0
Owner's Nam e:� Phone#:
ContractorGY L n hone#: ��2License#�
-93� 227 3
Contact: Phone#: S _ Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ . Asphalt Shingles �Ic Asphalt Shingles
"1. Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings J ❑ Provide I.C.B.O.Report#
To be Removed ❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description:T/ Q 114 fa D S lg . GJ� d 7'7 Gf
Residential - Commercial ❑
Fire Zone: Yes ❑ No [T- Confirmed with Planning Det. if
there are any restrictions: IJ
Cost of P oject: Type of Construction: Occupancy group:
/�voo
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY _Yne�rgy BUILDING
1 BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
2- ��