03080132 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACT-nRINFORMATIQ,N ?.
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BmLDINcnoohess: PERMIrr+o
OLD COUNTRY ROOFING 03080132
OWNER'S NAME: 125-2 GROBRIC CT PERMIT ISSUE DATE
NE: (707) 864-5557 SANITARY 0. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MEC"
o 0 0
.00 LICENSED CONTRACTOR'S DECLARATION Job Description
1 C I hereby erfl.that 1 am licensed under previsions of Chapbr 9(commencing P
i wit Sec' ]IXXnofDivisionJefteB�snOPro(c-ionsCoM.and mylicensei+ F��V�L.ED
s m in full fort cffc
n+ Lica a�a� a 3 REROOF p ,
FW Dab�dcrmandmyPlansshallheuseOa public BCLARAcoo
rd ` SEP 0 .2.2003
.a.
Dnp r^ Licensed Professional
1 3 OWNERexemptRDECeContrON BUILDING
2OS I hereby.(Sero that 1 oro exempt from the Contractor's License Lew for the
p o following mama.(Section IDnstr Business and Podseion+Code:Any city or county
5$� which requires•permit rat cnn+lruc6 elbc impmw,demolixh,or repair my structure
_I<
pd.,in its issuance.atm requires the applicant for such permit to +
file +igncdsum
leenl
that he is licensed pas.seam to the pmvisiou of she Contractor'sLicense Law(Chapter Y Sq. Ft. Floor Area Valuation
C (commencing with Section 90(10)of Division J of the B usineu and Professions Code)of
that he is exempt temfrom and the basis for Ne alleged exemption.Any violation of
Section 7071.5 by any applicant for a pennh subjects the applicant to a civil penalty of APN Number Occupancy Type
not more Nan five hundred della.($5007.
❑1,as owner of the property,or my employcu with cages u their sole compensation,
will do she workend the svunure is notimmindedm offered forsale(Sec.7W,Business 305 - FRAME
and Professions Cade:The Con owtors License Lew deo nos apply to an owner of Required Inspections
property who builds or Improves thereon,and who doessuch work himselfor through his 307 — INSULATION
own employees,provided that such improvements are not intended oroffered for-le.If, 601 — ROOF TEAR OFF
however,the building or improvement is wild within one yesf of compinion,the owner.
builder will have to burden of proving Nat he did nos Wild or improve for purpose of 602 - ROOF PLYWOOD NAIL
sale.).
0 I,as owner of to property em exclusively convecting with ltherud ix n owome to 603 - ROOF BATTENS
construct the project(SecJOaa,Business and Professions Code:)The Cenmxcbrb Lb 604 — ROOF IN-PROGRESS
cone law does not apply to an owner of property who Wilda or improves Oamon,and.
who concocts for such projects wit a conmuwr(p licensed pursuance to Committees
License law.
0l am exempt Obtain See ,B&PC for this..on
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby of on under Finally of perjury one or the fallowing declaostwor
1 haw and will maintain a Ceniriatc of Comm to sel6insum for Worker's Cumpco.
71;
ion,m provided for by Section 7]00 of the labor Code,for to Performance of doe
rk for which tis permit is issued.
1 have and will maintain Worker's Compensation Insurance,as required by Section
k)of doe lbor Code.for doe pcAormana o(doe work far which tis permit is issoed.
Workers Compen-tion Insurance carrier and Policy number am:
Pot' N
r CERTIFICATE OF EXEMPTION MWORKERS'
COMPENSATION IN ANCE
(fila section need not W completed ift c permh Is(more hundred drllan($100)
on Icas.)
1 caddy tat in she performance of the work for which this Permit is issued.I shall net
employ any person in any murder an as to become subject o the Workers Compcasation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption.you should
become subject to the Worker's Com pcuetion provision of the labor Code,you must
�O forthwith comply with such provisions or this Permit mail W deemed ranked.
„z„ 71 CONSTRUCTION LENDING AGENCY -
'rr I hereby affirm that there is a construction lending agency l or the performance of
a i to work for which tis permit Is issued(Sce.7097,Civ.C.)
Lg10 Lender's Name
= z lender's Address
U O I certify that 1 ban reed tis Application and sum dost to aW ire information is
ly P correct,I agree to comply with all city and county on inencu and stale laws relating to
0U building censbmetion,and hereby autorm:representatives of this city to enter upon the
r lLl above-mentioned property for inspection purposes.
C (We)agme to-w,indemnify and keep b-mleas the City of Cupertino against
M liabilities,judgments,cosuendexpemes which may in any way secure against slid City
U^ APPLLICA nceFine .and,of UNDERSTANDStbND WILL COMPLY WITH ALL NON-POINT Issued by:s ornit, Date 37
SOUR GULATIONS.
Re-roofs
not cof ApplicmVC.mRwmr te
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Well tc applicant or future Wilding occupant store or handle ha-Nous material
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Coda section255J2(an 11JJ All roofs shall be inspected prior to any roofing material being installed.
D Ycs y No
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
sit humplo a air contaminants as defined by to Bay Area Air Quality Management all new materials for inspection.
Writ,?
❑Yes . -k
I have mad to havaNsws materials requimroents under Chapter 6.95 of the Califor. ,/rs
nia Hcalt&SafctyCode,S¢deu25N)5.25533 W255Ja.lmwM dtatiftc Wilding IF J `A /via5`.o3
Attly hew a tenant Net it is my ms miMlity b nouly dobe xcupens orNe (/JV VVVnicmuse 'onowi-uenmexifCeNhcateofaetip thyignatur fApplicant Date
All roof coverings to be Class "B" or better
rived agent
Building Division '
10300 Tom Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
4cn Fac (408)777-3333
' CUPEkTiNO
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.
S. 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 minimum of VV 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's c' L-it/U
Address:
Peroofing Company Name: Ce--9r C.O(A 1)-T-4,,tl 0,0 r--,,,o G
Applicants Signature: Date: �'- Of 3
Joe Antonucci
(Chief Building Official)
6/25101
CITY OF CUPERTINO 0 3 o Z
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN# Date: a 5 O 3
Building Address:es
Owner's Name: Phone
os c:-- y &5� a sa a pk
Contractor: Phone #: Y 10 License #:
01-'? C oU NT -4-/w G -:� -4 3 )
Contact: Phone #: .-/oJJ' Cupertino Business License #:
__?- i'a X 3 0 O 3 b1
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ',f�f Asphalt Shingles
)ff, Wood 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 Dets-cription: MC-At c✓� X t S r� v �y r L o r- l+rshcr /�vsT�z� e s3•
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning DP - if
there are any restriction
Cost of Project: Type of Construct i Occupancy group:
11�) �D t��'l'L 0,0
Qty. if
Appli 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 I Business License BUILDING
7