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02110057 (2) CITY OF CUPEWUNO ^ ' BUILDING DIVISION PERMIT CONTRACTOR INFORMATION OU11443RI1sRAMPART AV OLD COUNTRY ROOFING PERMIT NO 2110057 1 W9-A9:RW1ELYN SEYMOUR 125-B GROBRIC CT APPLICAT Is55PUT02002 IONF.: (707) 864-5557 SANITARY NO. / CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 Op LICENSED CONTRACTOR'S Oisions AI]ON (Chap a F�,{ I hereby affirm Nm 1 am lith under provisions of Chapter 9(commencing REROOF b e r tai wi N Section]IMMB of Division Sof the ei ass and Pndessinnx Cole,and my license is �'N��unti� Eifullfore nd elf.. �n4 Liccmc -L ic.t� y'jt,� oZ— Ualc_/ 2 Cfn'�n'uuniccNCu_.1 CrsmnJmyple+nRshal Mulaf'sspubliRRATIO+N JAN 2 7 2003 'ui3t`r,D Licensed Prolessional BUILDING t is OWNER-0UILDIiR UECLARN'ION u�<2 1 herchy off.that I ma exempt from the Conuactm's Lineae Law fur the $10000 1 O O O 0 i 6 a O following mason.(Section 7031.5,Business and Professions Code:Any city or county 9 %2 which requires a permit to construe(,alter,improve,demolish,or repair any structure prior to its issuance,also requires the applicant for such permit to GIe a signed statement y+� £p£� tbut he is licensed mumu u.no the pmvisinns of the Carl...on',License Law(Cm,oc,9 3KI9061042AU Valuation S (commencing with Section 7000)it Division 3 of the Business and Professions Care)or — Nat he is exempt Breref ern and On basis for Ne alleged exemption Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to acivil penalty of PN N Occu ane Type otmnren.nBvenanareadNlattssa . 307 - INSULATION p y YP ❑I,as owner of the pro,oniq,or my employees with wages as their.anle compenadon, will do Be work,and Ne awcure is net intended or offered for sale(See.]044.Businessp(N�yy��,,��,,gg and Pmfessinns Code:The Contractor's License Law dors not apply o an owner of 602 - ROOF PL yYLV LYH1L nS property who builds or improves thereon,and who dors such work himself or through his Own employees,provided that such improvement are not intended or offered for We.If. 603 — ROOF BATTENS howeverthe building or improvement is sold within one year of completion,the owner. 604 — ROOF IN-PROGRESS builder will haus the burden of proving that he did not build or improve for purpose of sale.). ❑ I.as owner of she property.am exclusively contracting with licensed contractors to consuut the project(Sec.7044,Business and Professions Cods:)The Comme,tor's Li. wansa Law dors not apply o an owner of property who builds or improves thereon,and ho contracts for such project with a coniractor(s)licensed pursuant to the Contractors License Law, ❑I am exempt under Sec. .B A,P C for Nis reason Owner Dale WORKER'S COMPENSATION DECLARATION 1 hereby affirm under Penalty of Perjury one of the following declarations: I haw and will maintain a Cer ificam of Consent to W f insum for Worker's Compem 737M tion,as prnvidcd for by Section 371X)of the Labor Code.for the pernionown of the rk for which Nis permit is issued. 1 have and will maintain Worker's Compensation Insurance,as required by Section of Ne Labor Code,for the perfnrmenee of the work for which this permit is issued. y Workers Compensation Insurance carrier and Policy nu rtier: Sr/RT� F.,/VP Policy Nn.: 70 �- � CERTIFICATE OFEXEMPI'IO.ISIU p1.WORKERS' COMPENSATIONIN OR CE (This action need not he completed if the permit is for one hundred dollars 1$100) ,r IessJ 1 certify Out in the Performance of the work for which this permit is issued,1 shall not employ any person in any manner so as to become subject to the Workefi Compensation Laws n(California.Dam Applicant NOTICE TO APPLICANT:11,after..ski ng this Certilicum of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Cole,you must OO forthwith comply with such provisions or this permit shall be deemed revoked. z CONSTRUCTION LENDING AGENCY F+ � I hereby tuirm Nat there is a construction lending agency for the Performance of 6i On work for which this permit is issued(Sec.3097,Civ,C.) W� Q Lender's Name r7 z lender's Address U 0 1 certify that 1 have read this application and sum that the above information is f, coned.1 agree to comply with all city and county entrances and sum laws relating in O U building construction,and hereby au@n/hamle tiven of iscirytocntcropon the ahavcmentioneJ progeny fortio(We)agree o save,indemnify ac City of Cupertino against liabilities,judgments,costs and expensey way accrue against said CityU Z inennseyucncc ufth ting ofri, pAPPLICANT U ANDS ANDPLY WITH ALL ON DINT Issued by: Date SOURCERE // O Re-roofs Signature u IicaHAZA roc r Date IIAta US MATERIALS tstumo handle Type of ROOF ill y t applicant o ulum.ni,ip I Ccd occupant shmeorand the HeaNuu it Safety til u cd by the Cupmni n Munic;pal Curie.Chapmr 9.12.and the Health and Safety Code,section 25532U).1 ��XXAhn'ati'//,�i All roofs shall be inspected prior to any o6ng material being installed. p Yea Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obta• g an inspection, I agree to remove Ire mit hay.Nous air contaminants as defined by the Bay Area Air Quality Management all new ma a S Ins ectlon. istrin7 \ E]yes 7� Ihavc mad in haxallous materials q ire is unser Chapurb95of the C+Jifnry il l health&Sul• sun.2551 5. 25534.1 undermand Out if the building ors nm cu N sprnrfl hly o notify the hrcuput d yuircmen mh:n hnncme minim dacenmcamnrQcnp `y. nalureofAppli nt [e Ow pro anmoriaedogc a All roof coverings to be Class "B" or better y Building Division 10300 Torre Avenue Cupertino,CA 95014-3255 Telephone: (408)777-3228 coo CUPEI�TINO Fax: (408)777-3333 ' 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) 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: 1-19 (4 E t.JnJ -A�-Y',4 o U 2 Address: l 0 Reroofing Company Name: C L:�• Lo cn nJT-" r-?,,© A f ,JG Applicants Signature�_� Date: / / —G O Joe Antonucci (Chief Building Official) 6(25/01