03040098 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT C0NTRACT'0W NFORMATION
�le`DT`f'"NDA ANN CT OLD COUNTRY ROOFING PERMIT NO,03040098
'S ffJI L AND ROBERTA T 125-9 GROBRIC CTPersMrISS EpA}8 8/2003
(707) 864-5557
ONE: SANITARY NOO.Y l CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
j00 LICENSED CONTRACTOR'S DECLARATION
i u 1 hereby affirm that 1 am Ranted under provisions of chapter v(commencing Job Description
with cti ]IXXlIarD'WEion 3 of Ne BusiwEfmW Profession Codi,and my license is
,Ll inr ands ieL—� ✓ ` 22a�� REROOF FINALE®
s q� Lieenu Clu Lie.a
3 Dam omlraclor G
A in SD uATION
blicromNs
_ d ran m plans m MAY 13 2003
cased do conal
7to OWNER-BUILDER DECLARATION
2 i I I hereby affirm that 1 am exempt from the Contractor's License Law I'ur(be BUILDING
OO following much.(Sccuon 7031.5.Business and Pro cati.n Code:Any city or county
f$E which requires a permit at construct.alter,improve,demolish,or repair any Elrucmrt
-ZT parr,to as iYuarct.alSu requires tie.pilieanlforeich mail.IIIc BEigned a181Cmen1
a^�
that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq. Ft, Floor Area 62�01g�IOn
r$ (,mm mincing with Section 7")of Division 3 of the Business and Prof $ession.Code)ser
sa, Nal ha u exempt thcmfrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for permftmbjecu the applicant to a civil penally of 3.A BT.M O�] 4efOO Occupancy
not more than five hundred do]].u(2500). AP Y Type
❑1,as owner of the property,or my employees with wags As half sole compensation,
will do the work and Nestruclu ,is not intended or offered Russia(See.7W.Business 305 - FRAME
and Profaasioru Cada:The Contractors Licence Law does not apply m an owner of Required Inspections
property whobuilds or Inflation thereon, ss
on,and who does work himself or through his 307 — INSULATION
own employees,provided that such improvements are not intended or offered for sale.If. 6O1 — ROOF TEAR OFF
however,the building or improvement is sold within one year of completion,the owner.
builder will have the burden of proving that he did not Wild or improve for p.,.of 602 - ROOF PLYWOOD NAIL
ul,J.
❑1,as owner of the property,am exclusively contracting with licensed Contortion to 603 - ROOF BATTENS , -
construct The project(Sec.7044,Business and Profemions Code:)no Contractor's L6 604 — ROOF IN-PROGRESS
cense Law does not apply to an owner of property who Wilds or int prove thereon,and
who contracts for such projects wit a contractor(!)licensed pursuant to the Contractor.
License laws
❑I am exempt under Sec. ,B,Y P C for this reason
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby aRrrn under penalty of perjury one of dm following declarations:
I hoe and will meintaln a Certificate of Consent self-Insum for Workers Camper
cation,u provided for by Section 37M of the labor Cada.for the Performance of the
work(or which Nis permit is ivued.
❑1 have and will maintain Worker.Compemuuon Insurance,as required by Sccuon
3700 of Ne Labor Code,for the pefformancc of thew which Ni.permit is issued.
y W rke�rraas,�Com mmlon Inwnnm Cartier and pfi number am: a Z�/
at: S' p F✓YI P Policy No.: I Y 9 S— U r�
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thch,ction need not he completed if the permit is forma,hundred dollars(SIM)
or less.)
1 certify Nm in the performance of the work for which Nis permit is issued,I shall not
employ any person in any manner sat As.s become subject to the Wo keri Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provision.of the Labor Code,you muse
z (oMwith comply with such provisions or Nis permit hdl W deemed revoked.
LO CONSTRUCTION LENDING AGENCY
I Mreby M.that Nem is a<oaswmion lending agoacy Iter the perform.nce of
X> Be.,it(ser which this permit is issued(Sec.3097,Co,C.)
A Lender's Name
z Lender's Address
J C) I cenify,that I have read this application And suite Net one above information is
Charlet,l&&rte to comply with all city and county ordinamret and state laws relating to
building construction,and hereby authome rclocnatadvis of this city to enter upon the
U ahovomentiuned property for ima, I n purge¢
ti G (We)agree to save,indemnify and tee leu the City of Caperlinm against
fA liabilities,judgmen 56 and CxpCnaCaw c ey in my way accrue against said City
J z in conseyoen the .ming of this
APPLIC UND STANDS D LL COMPLY WITH ALLON DINT Issued by: Date
O Re-roofs
Ignawri of Appiicantl nRDOUS MATERIALS DISCLOSURE Date Type of Roof
Will Ne app'am ser future building occupant store or handle haiardau s material
as defined by the operon.M_uryeip.I,Code,Chapter 9.12,and the Heahh and Safety
Code.Section 25532(¢)? .�y'QI All roofs shall be inspected prior to any fing material being installed.
❑Ya
Will the applicant kn.. .,pronsibiliyur
occupant use equipment or device,which If a roof is installed without first obtai g an inspection,I agree to remove
it m/nodaus air coommby the Bay Amu Air Quality Management all new mater'¢ inspection.
strict?
❑Yes
Ihave Ithe haraquirements under Chapter 6.95 of the Califor.
ria Health od S33 anJ 25574.Iundcrsmnd thel'fthc Wilding \
does rte ace a y rc.ponsibility m nod the cup of thi,
quite a mhmuar..d.Cold r c ;Signature'of App ' ant Dat
ncr ser authorir ogim D.le All roof coverings to be'Cla To or better
CITY OF CUPERTINO o 3 �e 0 v
REROOF
CUPERTINO . PERMIT APPLICATION FORM
APN # Date:
BuildingAddress:
,;Z
qq6 L I-✓A C_ 0
Owner's Name: 0 Phone-4:
Contractor: Phone #: License#:
O ����� /
LS C__O(A!L' e o i�ln t', ��- 5 00
Contact: Phone # 4-J Cupertino Business License#:
c%sS -�-F bN3 0 0 0"3 oQ 9
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
Wood Shakes :EC Wood Shakes
❑ Wood Shingles ❑ 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 t With Cu ertino's Tear Off Policy:
Job Description: Y1'EM 9 V G cc�X/STl i✓ L y efK-
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are an restrictions: i5
Cost of Project: Type of Construction: Occupancy group:
�p C? 000 CrI-Z, � !�
Qty. if
Applicable 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
Building Division '
10300 Tom Avenue
Cupertino,CA 95014-3255
`
go F= (408)M-3333Telephone: (408)777-3228
Fax: (408)777-3333
CUPEkTINO
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 Mim' +um of YV 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: _ L
Address: ate`{ S C 0('1(:;z
. Reroofing Company Name: D ��' o N nl_n-H a�o o <
Applicants Signature:'7--�/ U/t7k`-� Date:
Joe Antonucci
(Chief Building Official)
6/25101