03090137 (2) CITY OF CUPER'fINO a vh *t " » "% ;."'
BUILDING DIVISION PERMIT CONTRACTQR�INFORMATION
BUILDING ADDRESS: OLD COUNTRY ROOFING PERMIT NO 03090137
OW Nlr�71 TAKE RPIRTIST9 QT
ER'S NAME: PERMIT MUE DATE
125—B GROBRIC CT
NE: SANITARY NO. CONTROL,N0.
(707) 864-5557
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
100 LICENSED CONTRACTOR'S DECLARATION
{u, I hereby affirm that 1 am licensed under provisions or chapter 9(commencing Job Description
.Z� with Section 7(0))af Diision 3afdte Business and Professions Code,and my license is
s<n Toruli force and cffcct� //v 1
>q= ucenxclas X REROOF O
F, Dam Can
u exctor
ARCHITECTS DECLA ATION
2 1 understand my plans shall be used u public rccnrds
lyp
yap:5 Licensed Professional
,5 - OWNER-BUILDER m Ce Contractors
ON
COOI berchy afford that 1 ore exempt from the Cxxions o Liccnx Lew Tar the
OO following E13L5,Business and oe(deoli Com:Any city or county
<3 which myuirct a permit m constmeL almG imprnsu demolish,or repair any amcture
PdonO its censed pursuanttssuance,also o theres the
avisda ant forsofthe men pormitmRic s Law sutemcnt
TEO that he isliccnsedpursuannnlhcPmviaiaaoftheContmctur'sLiccnxlaw(Chapter) Sq. Ft. Floor Area Valuation
2t- (commencing with Section7000)nl Division3orihe Business and Profusions Code)or
Nat he is exempt therefrom end Ne basis for the alleged exemption.Any vimidid.of 36654024 . 00
Section 7031.5 by any appfuntmr krermhaubjecis the applicemto&civil penalty or .APN Number -.-. OCCU 'ryI _.
not mom Nan five hundred dollan(5500). --' - Occupancy.Type --
❑L u owner.Rhe ft mom m my employees wsN wage a Nei((See.
co ,Box lion,
will do Professions Code;
and ft he Cont istor's Lndesoradosered ntapplyo aa, wnnw 305 - FRAME
end Professions Code:The Contractor's License Law docs not apply to an owner of Req wired Inspections
properly who builds or improves lhmen,and who does such work himxlfor through his 307' — INSULATION
man employers.provided that such improvements are not intended oroffiered or sale.If. 601 — ROOF TEAR OFF
however,are building or improvement is said within one year of completion.the owner
builder will nee burden of proving Nat he did not Wild or improve for purpose of 602 - ROOF PLYWOOD NAIL
sale.). ve he
C]1.as p
owner of the procny,am exclusively contracting with licensed contractors to 603 - ROOF BATTENS _ .-
construct the project(Sec.7Baa,Business and Professions Cram)The Comextori Li. 604 — ROOF IN-PROGRESS
cense Law does not apply to an owner of properly who Wilde or improves Uu mon.and
who commis for such projeeu with a conductorial Harmed pursuant to due Contractor's
License Lew. _
0 I ren exempt under See .B&P C for this recon
Owner Data
W ORKER'S COMPENSATION DECLARATION '
1 heraby affttm under penalty of pe jury otic of the following mutilations:1 have and will mainuin•Ceniricate of Cottsen(lo self insum fm Work esCompere
sation,a provided(or by Section 37M of the Labor Code,for the Penormance of the
work for which this permit is issued.
❑ I have and will maintain Worker's Compensation Insurance,as requimd by Section
3700 of the Labor Code.for the performance of the work for which this permit as issued. '
My`Walkker'e Coom/p�eastion Imvrana anicr end Polity stomper
CaTFt(4
L^f CERTIFICATE OF EXEMMOO MWORKERS'
COMPENSATION= ANCE
(Thiswedran need not beaomplcmd if the permit Is foram hundred dollars($ip))
of less.)
I ecniry Nat in the perfnrmoncc of the work for which this Permit is issued.I snail nut
employ any person in any mannenn as to become subject to the Wmada'Campeaation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If.oiler making this Cenifcete of Exemption,you should
become subject to the Worker's Compensation provisions of the Labe Code.you must
�O forthwith comply with such provisions or this permit shall be deemed revoked. - -
Z try CONSTRUCTION LENDING AGENCY
1 hereby affirm Nat there is a construction lending agency lot be Performance of
Y' the work for which this Permit Is issued(Sec.30117,Civ.C.)
Lender's Name
3. cr's
U Lending Address
1 ecniry that 1 have read this application and sac=het the show information is
1. correct,)agree to comply with all city and county ordinances and state laws palating to
SIJ buildingconstruction, fombyeuthonprposesenmtiws of Niscity to enter upon the
shove-(We)led Properly forinspectionfy aPurposes.
y
(We)agree m save,indemnify anJ keep hxmlcu the City of Cupcnino against
y liabiliticajudgmcnu.costs and expenses which may in anyway accrue against aid City
J 7 in croacuence of the graining of this permit.
r7 APPLI NT UNDERSTAND AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
S REGULATIONS// ff � ,.
(1 ttlJ A:� Aledaj y f14 3 Re-roofs
ign ore ofApplicamalcm ahead,or
HAZARDOUS MATERIALS DISCLOSURE Date Type of Roof
Will the applicant at future building Occupant store or handle harudous maxrial
as striped by the Cupertino Municipal Cade.Chapter 9.13,and the Health and Safety
Code,SPtrioesn 25532(.)? 3f+o All roofs shall be inspected prior to any roofing material being 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 maudaus air anuminanu as dcfncd by the Bay Arta Air Quality Management all new materials,for inspection.
isuict? /
LhavedetyC mad .Smdo materialsx33ud nu 4.l un Chapter uifNc Wilding `�;L / 1
nixHulth&SafctyCode,Seesoa 25505.25533 end 25534.1 undcpslaM Not i(IM WildingAgntum
/ i/1n/(g/'L-CO-�a/f
dao no am which
hew a¢pant Nat it is my see of a C rd c of
the acupant of themi nu wMch moat tt pdarta Tswana oracerdfc.te ser ocauancy. of Applicant Dale
w eroreuthori'rcdagent 'Dam All roof coverings to be Class"B" or better,
Building Division
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
i 4YO Fax: (408).M-3333
CUPEi�TINO
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 sheathfng 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: 'Iq N C-'S/-i
Address: _l l S I L.►�Xc% S'P2 i AIC C—
Reroofmg Company Name:
Applicants Signature: �- L? .-, J Date: `-
Joee Antonucci
(Chief Building Official)
6125/o1
CITY.OF CUPERTINO
REROOF o l3 7
CUPSRTINO PERMIT APPLICATION FORM
APN # 3 6 C Jz O Date:sy
Building Address:
[-d1 K&- 50ae?mg
wner's Name: one�,
�Nsf51k JC/-► �� / OF 5/ P C
Contractor: Phone #: c1 0 dQ tcense #:
CL, C o Li n1-r KA r t - 8'300 6 31
Contact: c Phone #: Cupertino Business License #:
T y o F Fa �s 0 9 0 ;5
Type of Roof Covering:
I
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
Asphalt Shingles D1' Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles O 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 ] With Cu ertino's Tear Off Policy:
Job Description: �C-M ° vc �'15'ri^� Ir:�)`l &W- Ver- C o,-n�
l N mit z-L Of- y o y.u. Co.-? r
Residential 14 Commercial ❑
Fi -one: Y ❑ No [:1 Confirmed with Planning Dept. if
�� there are any restrictions: LI
os of Project: \ Type of Construction: Occupancy group:
O PC C-too t=
Qty. if
A li abl 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
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