02110010 (2) CITY OF CUPERTINO ..� >; z ,
BUILDING DIVISION PERMIT CONTRAC-TOR INFORMATION:
BDIIftr6^9l173 PARK VILLAS CIR OLD COUNTRY ROOFING PERMrrNT2110010
Gw Ik4(4EVILLAS HOA 125-B GROBRIC CT APPLICAnggsLYggy2002
IFZONE. (707) 864-5557 SANITARY NO. CONTROL.NO.
ARCHITECTIENGINHER; BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
m00 LICENSED CONTRACTOR'S DECLARATION
icar l bench,alfunt mal l non licensed anderprovision:or chapter 4 rcoonni"g REROOF Job Description
In Scam 74X8 nl Divixiun 3nl the B��usJJ'��csx trod Pntfcssinns CnJc,andntyl,wo,co
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ARCl11TECP:`y,,[{�.CLARATION
y< 1 code rsmnd., Lina shall M u i,ohlio records
HO'
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t�st31,_� Licensed l'rolcx,Ooml
OWNER BUILDER DECLARATION
s"�a£ I hereby affmt that 1 am exempt from the Contractor's License law(cur the $9000
m K 0 o following reason.(Section 7831.5,Businem and Professions Gins:Any city or county
e.X'm which requires a Permit n)c,mtruct.alter,improve,demolish,or repair any structure
1e—°+ prior it)its ivance,alit)requires the applicantfor such Permit to rile a signed statement
that he is licensed pursuant o the provisions of the CummIur's License Law(Chapter Y Valuation
¢=$ (commencing with Section7kXB of Division Sof the Business and Pmfoodons Code)or
i 3— Nal he is exempt therefrom and the basis for the Wleged exemption.Any violation of
Smtion 7831.5 by any applicam for a permit subjects me applicant to a civil Penalty of PNN Occupancy Type
not more man Bw hundred dollars($5(101. 3 07 - INSULATION
I,as owner of the porb,try,or my employees with wages as their role eompeaation,
will do the work,and Ne structure is not intended or offered for sale(Sec.7064.Busieeu 681 ReeF ppT�( ITN"?_ns
and Professions Code:The Contracmr's License law does not apply man owner of 602 — ROOF P S R'V ITN�i Ln5
property who builds or improves thcrcun.and who does such work himself or through his
mvn employees,provided but such improvements arenot intended orolfered Imitate.If, 603 — ROOF BATTENS
however,the building or improvement is sold within one year of completion,the Owner 604 — ROOF IN—PROGRESS
builder will have the burden of proving that he did not Mild or improve for pmpruc of
wlc.l.
I,as owner of the property,am exclusivdy contracting with licensed contractors to
conmoct the protect(Sc.7(WBusiness and Professions Code:)The Contractor's Li.
a Law docs no,apply to an owner of property who builds or 1,nuu the Conproves thereon,and. FiIV ►LED
who contracts for such notices with a contraons,licensed pursuanor s
aclo
License Law,
0 14M CXCMPI under Sec. .B A P C for this reason
Owner Dae JAN 0 12003
WORKER'S COMPENSATION DECLARATION p
1 hereby affirm under Penalty or perjury one of the following declarations: BUILDING
0 I have and will maintain a Cer ifate of Cunscm Ioselfnsur
-ie for Workci SCompcm B
sation,as provided for by Section 3700 of the labor Code,for the peAormance of the
work for which this permit is issued.
C)I have and will maintain Worker's Compensation Insurance,as required by Section
37(X)of the Alvor Code,for the performanm of one work for which this permit a issued.
My Worker'snmPensalinn Ins...,e c.nm,1 it Policy a IjCr ��Q
CERTIPIC OMPENSATION'IINNF AN WORKERS'
COMPENSATION INSURANCE I
(This section need monectoodcred Else permit is throne hundred dolls ($119)
or Icss.) _
1 eenily that in the perfurmance of the work for which this Permit is issued,I skull not
employ any p,c on io any manner so as it)hecnme subject to the Workeri Campcnsutom
Laws of C.1door ia.Dole
Applicant
NOTICE TO APPLICANT:It,after making this CeritiiA c of Exemption,you should
become Subject lit the Workers Compensation provisions t)r the Labor Code,you must
Oz forthwith comply with such Provisions or this permit shall M deemed revoked.
z O CONSTRUCTION LENDING AGENCY
Pl here by motion mm there is a construction lending agency for the performanac of
Led 7 the work for which Nis permit is issued(Sec.3197.Civ.C.)
W Q Lenders Nam.
L. 1<nder's agreeI
UU z I certify that I have read this application and stare that Be above information is
(•" conen.l agree to comely with all airy and county ordinances and site laws relatingm
0 U Building construction.and hereby authoda repmsenuews or this city to cuter ufatn the
} 0 ahnvomemioned pnapc costs
for impactioneeexpenses
which
ms.
6. Doc)agree to save,indemnify and keep haomlca the City of CuPcnino against
Fh liahilitics.judgmcns,ntss and esPcnscs whicM1 may in any way same agmina aid City
U Z in consequence or the granting of this permit.
Issued by: Date
APPLICANT UNDER. ANDS AND WILL COMPLY WITH ALL NON-POINT
SOURCE RG L '10 Sall
Re-roofs
lkqnatti AppllantoConomaoo Dutc
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the appliam or lumre building occupant smrC or handle moiadous mmerial
us defined by the CuPenino Municipal Code,Chapter 4.12.and the Health and Safety
Code,omCS 2SSQo a All roofs shall be inspected prior to any 'roofing material being installed.
Will me a ficant or future bailam•t><•a t as.a rent ord.vmea croon If a roof is installed without first obtaining an inspection, I agree to remove
Pr g pan quipm
mihatatdous air contaminants as delined by the Bay Arca Air Q agemeot 1 new materials for inspection.
Dislri3O
O Ycs labra
I have mad thclusaNnus maerialsreyu;mmcnu unJcr Chap r fthc H
niallealO&Safety C(k.Sm8om25A)5,25533and25534.1ury - th !IM tiding
doesnmcum.mly haves ren. ,thmitomy.Ponailiflymnod! t . P tof t
requirement' Oak I m1 a eofa Cemtiamm Per d 5' nal re o Applicant ate
owner or as ri,ee ascot
All roof coverings to be Class "B" or better
IC
Building Division
10300 Torre Avenue
Cupertino,CA 95014-3255
` Telephone: (408)777-3228
&CITYFax: (408)777-3333
CURTINO
Building Depadment
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 minimum of r/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 of inspection.
We understand the above policy onreroofingand will comply
with this policy.
V
Homeowners Name: 1 l 1< 1 L- L�s 110,4
Address: ?-o6 5 � K I/ KJ:5 C 12CL�=
Reroofing Company Name: U
Applicants Signature: Date: d -3/
Joe Antonucci
(Chief Building Official)
6/25/01