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02110015 (2) CITY OF CUPERTINO - BUILDING DIVISION PERMIT CONTRACTOW NFORIVMATION: Buj"(99l 5/97 PARK VILLAS CIR OLD COUNTRY ROOFING PER MrTN®2110015 OWrgjzRKAE:VILLAS HOA 125-B GROBRIC CT APrucATlTTY"131TV2002 lopHONE: (707) 864 -5557 SANITARY NO. CONTROL NO. ARCHITECTyENGINFER: BUILDING PERMIT INTO BLDG ELECT PLUMB MIMI 0 0 0 0 w00 LICENSED CONTRACTOR'S DECLARATION �G I hereby affirm that I am licensed under provision of Chapter 9(commencing REROOF Job Description .t?� with Sectio I Bnf UivistinnJoftheBnin dNufcssioni Csxle.anJ mYlicens is in full fnmcCffsst �Z.Z z oo"vj 4 Liccnx��IyyaC C.... Lic.AA ' N_ hLm]_IL�Conusan F—�� v'YY ARCHITLCT'S ARATION ow a I understand my plana shall M uud es public rceoNx [� ®(gm� �® t LL o� Licensed Professional FINAL S OWNER-BUILDER DECLARATION P >' 1 hero,aflirm that I am cacmpr from the Comrannr's Liccnu Law lot the O 2U�3 $9000 Ce m o O Ibllowing reason.(Section 7031.5.Business and Professions Cade:Any city or County p4 L n'%$8' which mittio es a permit w construct.alter,improve,demolish,or repair any structure ere;^ joint its issuance.also requires dicapplicant fnfauch permiue lileasignedxtmcmcnt Ft—Z<. that he is licensed purmanl In the provisions of the Contractor:t License Law(Chepmr9 35rg66l.CF0o'b Valuation ve (commenciNnom g with Section71XXB of Division 3 of the Business and Profcsaione Cosidor BUIL D a $ at he is exempt therefrand the basis for Nl/ e alleged exemption.Any violation of Section 9031.5 by any applicant for a permit subjects the applicant to a civil penalty of l"NN Occupancy Type not mom than rive hondmd dollars fssBB). 3 07 - INSULATION ❑I,n owner of the property,cat,my employees with wages as their are compensation. will do the work.and the slructme is not intended or offered for sale(Sec.71q Business and Pronasions Cosh:The Contractors License Law does nm apply n an owner of 602 - ROOF P $$ n �c�iEns property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for sale.If, 603 — ROOF BATTENS however,the Wilding orimpuremcutissold within one year ofcompletion,the Owner- 604 - ROOF IN-PROGRESS Wilder will have the burden of proving Nat he did not build or improve for purpose of sale.). I,as owner of Ne property,am exclusively contracting with licensed contractors to constmed the project(.Sec11ss .74,Business and Professions Coded The Contractors Li cense law does not apply ,,an owner of property who huilds or improves themun,and who comma for such project with a contraction(s)licensed pursuant m the C.Cvwtor's License Law. I am exempt under See. .B A,P C for this mason Owner Dat WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have and will mointain a Cenificam of Consentto self-insum fof Worker's Compen- station,as provided for by Section 371X0 of the labor Code,for the performance of the work for which this permit is issued. ❑1 have and will maintain Workers Compensation Insurance,as"Ifired by Section 3707 of the labor Code,for the pefortm nce of Be work for which this permit is issued. My Wo/rkerCpcsatt caindPoariry nset CERI'IFICA'IEOFEXEMP`oON MMWORKERS COMPENSATION INSURANCE (Thissemirm need not Mcompleed if the permit is for one hundred dollars(i 100) or lea.) I certify that in the performance of the work for which this permit is issued.1 shall not employ any person in any manner so m ba Mcome subject n the Workers'Compensation Laws of California.Dam Applicant NOTICE TO APPLICANT:If,at making this Cc ni icate of Exemption,you should become subject to the Worker's Compensation provisions of the IaMu Code.you must OZ, forthwith comply with such provision Or permit shall W deemed evoked. z O CONSTRUCTION LENDING AGENCY p'4 I hereby aflirm Nat there is a construction lending agency for the performance of cd 7 the work for which this permit is issued(Sec.3197,Co.C.) Q IFnder's Name Addres 0 U 1 ilding emourvs /h V C) I sem y that 1 have read this application and stare that the ahuve infornation is U. P u+rca.l agree to comply with all city and county ordinances and state laws refining to Q U above-mennsuuctino,end hereby authonp rposes. tatives of this city to rentor upon the r CL ahnvc(We) nad gree in ertyave for inspection mnify an Imcp ha (s ju agree us Cast,indemnify and keep harmless the City accrue Carmen s against U42 N in consequence of the granting uind of this expenses which may in any wayaccmc against said city C.7 ,Z A APPLICANT of the RSTAN of this permit. ^t APPLICANT' N �RSTANDS AND WIh1.COMPLY WITH ALL NON-PO T Issued by: Date SOUR UI. O S. j/ A L Re-roofs aw rApphcanticomnmtror am HAZARDOUS MATERIALS DISCLOSURE Type Of Roof Will the applicant or future building slUcupant store or handle harardous material n defined by the Cupertino Municipal Code.Chapter 9,12,and the Health and Safety enae.Section z5532(a)'' All roofs shall be inspected prior to any roofing material being installed, �Ycs Nn Will IM1c applicant or future building Occupant use equipment or Devices which If a roof is installed without first obtaining an inspection, I agree to remove emit harandous air contaminants m defined by the Bay Arca Air Quality Management all new materials for inspection. Dinrin? / ❑Yes have read the harallous materials requirements under Chapmr Su��)ryryry'''BBdmmmmmmc Califnr- niu llculth NSafcry Cmx�.Sccdnns25505,25533 and 155?A.l undceemn u�jf the M1uildlny \✓Xv/rill does not Curren IY h'vc' tcmam,that it is my responsibility I malde iyufl0 ll Nc mgmrem n nth I heoml r;oftnissaMCC Ifacerfull l�/m/p d` arc SignatuD of Applicant Date owner 0f lori'md agcnl v Dale All roof coverings to be Class "B" or better Building Division 10300 Torre Avenue Cupertino,CA 95014-3255 Telephone: (408) M-3228 CITY 0 Fax: (408)777-3333 CUPE�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 withoutfirst 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) pproval3) 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 1/4,"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 on reroofing and will comply with this policy. Homeowners Name: PFrr<K I L L14---s 1401-1 Address: © 93 / �� It �/ L�({3 C. I lLC-LL Reroofing Company Name: �- ' CD U 2001%yuc Applicants Signature:e � Date: • Joe y1 Antonucci (Chief Building Official) 6/25/01