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03080039 (2) •� CITY OF CUPERTINO (•� it '�� , BUILDING Dlv]SION PERMIT CONTRACTOR INFORMATION " ' BuagmcADDREss: OLD COUNTRY ROOFING - PERMIT N003080039 OWNER'S NAME: 125—B 'GROBRIC CT PERMIT ISSUE DATE DEL SECCO JOAN P TRUSTEE 11 .2003 NL. (707) 864-5557 SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 LICENSED CONTRACTOR'S DECLARATION 1m u 1 hereby affirm Nal 1 am licensed Onsjvr provisions of Chapter Y(commencing Job D05erlp[IO❑ s<i with Scaion70flo)of Divixion]o(mc Bust a rd PooRssinne Codaud my license is �'���am < in fu1 foam ffect. REROOF i Liccnu Clus Li , i r Dau - Cuter ARCHITECP 12¢ S E RATION' SEP Q 3 q 6 undcrsuth nd my plans W oaas public record.¢ O 2003 )yU Lirensed Professional S OWNER-BUILDER DECLARATION '� <f 1 hereby affirm Thal 1 am exempt from the Contractor's License Law far the BUILDING �m(0 following reason.(Section 7071.5,Business and Professions Codc:Any city memory which requires a m mit In construct,aper,improve,demolish,or repair any structure 814000 -Zto priarlrits issuance,also requires the applicant for such permit to rile a signed statement :zp that he is licensed pursuanuo the provisions of the Contmcmr's License Law(Chapter 9 Sq.Ft. Floor Area Valuation {� (commencing with Section 7")of Division 3 of the Business and Professions Code)or 3423 0024 . 00 that he is exempt mcrefmm and be basis for the alleged exemption.Any violation of Section]031.5 by any applicant for a permit subjects the applicant to a civil penally of APN Number Occupancy Type not more than five hundred della.(5500). P y yp ❑I,as owner of the property,or on,employees with wages As their sole compensation, will do me work.and the structure is not intended or offered for sale(See.7044,Business 3 05 — R � send Professions Code:The Convector's License Law Was not apply u an owner of 307 - INSULA'PeT'K�d Inspections property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are nal intended or offered for sale.¢ 601 — ROOF TEAR OFF however,the building or improvement is sold within one year of completion,the owner. builder will have tie burden of proving mat he did not build or improve.for purpose of 602 — ROOF PLYWOOD NAIL sale')' 603 - ROOF BATTENS ❑ i,as owner of the property,am exclusively contracting with licensed contraction tos L 6 04 - ROOF IN-PROGRESS construct the project(Sec.7W,Business and Professions Code:)no Correctori cense Law does not apply to an Owner of property who Wilds or improves thereon,and. who contracts for such projects with a conuactor(0 licensed pursuant o the Conuactoh License Law.- , ❑I am exempt under Sec. .B At P C far Nis... Owner Dam - WORKER'SCOMPENSATIONDECLARATION 1 hereby affirm under penalty of perjury acts of the fallowing declarations 1 have and will maintaina Cenifuau of Cemcnno ulpinsure for Workers Compete' subm,az provided for by Section 7700 of the L AWT Code,far the parformence of the work for which this permit is issued. I have and will maintain Workers Compensation Insurance,as required by Section 37W of the labor Code,for the performance of the work for which this permit is issued. My//Work��I¢I C mpensatign lnsumncc c//artier end Poi'y n.7umhcr am: QalriCr. f'CUI`I�I' 11))IDIR 1'1 fCPali o.: ' y "````KKKKKK..•///JJJ CERTIFICATE OFEXEMPrI FROM WORKERS' COMPENSATION INSURANCE otos action need nm W completed if rhe Ismail is fmonc hundred dollen(SI W) or less.) 1 sonify mal in the perfntmarca of the work for which dis permit is issued,l shall not employ any person in any manner so as In become subject o the Warkers'Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,alter making this Certificate of Exemption,you should y Wemom subject m the Worker's Campeasmion provisions of He labor Code,you as, Z .J forthwith comply with such previsions or dis permit shall he deemed revoked. ZO CONSTRUCTION LENDING AGENCY � I herb IBrm that dere is a construction lending-+ thereby gagcm:y for the performancc of GY.> me work for which this permit is issued(Sec.3097,Civ,C.) W Q Lender's Name = z Lender's Address V Q I terrify that 1 have read this application and sum that Ne above information is Hcorrect.l agree to comply with all city and county ordinances and sure laws relating to QC.) c building coronation,and hereby amhorize repmaemadina Of this city m enter upon the W ahovmentianed property for inspection purposes. (We)agree I.save,indemnify and keep harmlcu IW City of Cuperlino against w%] liabilities,judgments,coats and expenses which may in any way accrue against said City CJz in consequence of the graining of this permit. " APPLI ANTUNDERANDS A D WILL COMPLY WITH A L NON-POINT Issued by: Date SOUR _ _ UL A TISTN s ahh[ �xv -11-D Re-roofs nature ApPAU cVComrmotr t Data HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will me applicant ser future building occupant store or handle harsedous material az dclecd by the Cupertino Municipal Code.Chapter 9.11,and the Health and Safety odo, section ss53zan ❑Yes o[Na All roofs shall be inspected prior to any roofing material being installed. Will the applicant or future building account on equipment or dealers which If a roof is installed without first obtaining an inspection,I agree to remove tit hazardous air contaminates as defined by the Bay Arca Air Quality Management all new materials for inspection. latent? Fl Yes No I have read me hwarduus materials rerequirements under Chapter 6.95 of the Cxlifttr. ria Hcalm&Safety Calc,Sccduns 2M5,25533 And 25574.1 undcrsund thmifmc building 4 P �ndoes nOt cu aptly hove a tenant,that it is my reaperewbillty m noddy de Ormomm of ma \K/./1 / ��(-�/'a✓/tY/l/L'(��"' %�!l mquim tywhich mull be mel riot�In(issuance of aCcnifcauo GO Tri Signature bf Applicant Date -GLiG- vKd I)✓ d l�`D owners aatharixadAgent Date All roof coverings to be Class "B" or better Building Division 10300 Torre Avenue 4 Ctipmtino,CA 95014-3255 Telephone: (408)777-3228 coo 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 Cityinspection can be performed. IMPORTANT: 1. Flat roofs must have a minimum of 3."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: o Ian1 DC'L S EC-C- 0 Address: as / a r-"*? re D 1,,V1 4,1Q4/r' Reroofing Company Name: © L CouNTzc,� /moos cNG Applicants Signature: �� /� a-�� Date: p- P �3 • Joe Antonucci (Chief Building Official) 6/25/01 r CITY OF CUPERTINO �, 3 REROOF CUPERTINO PERMIT APPLICATION FORM APN # Date: 3 00 o0? Building Address: b° /4 4rINC Owner's Name: Phone #: 1/ O aP o/kn7 "DC, �CGc o a5 -x/33 Contractor: Phone#: License #: 0&,� 7� 4?-a moo &ate 3i Cont ct: Phone #: 0 Cupertino usiness License #: ��' ECOO 0(0 0 to 9 Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles ,>( Asphalt Shingles XWood Shakes ❑ 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 1 With Cu ertino's Tear Off Policy: -� Job Description: t��rn0✓a �XI rlZZ L-r4-1 O�- 0 r m7rt )L.F InzT-4-u 0 ^� 10 VV ��-LR' -t 4CE:4c VOYA- Came' I O " SN,J TC1eVJ1=LA) Residential 10 Commercial ❑ Fire Zone: Yes ❑ No ❑ Confirmed with Planning Det. if '\ there are an estrictions: lJ Cost of Project: Type of Constructio :. Occupa group: 0 O t2L%2DOt= M -3 QtY• i A c b e Fee ID Fee Description Fee Group BPERMFEE Bldg Permit Fees BUILDING r BENERGY Energy BUILDING BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING � asTs"" •