03110002 (2) a CITY OF CUPERTINO
BUILDING DIVISION PERMITCONTRACTOR,I,NFORMATION:t,
BUILDING ADDRESS: OLD COUNTRY ROOFING PERMIT NOO
U'2-
11592 SEVEN SPRINGS DR
OWNER'S NAME: 125-13 GROBRIC CT PERMITLSSUEDATE
LOUIS WANG 11/03/2003
IrNE: ('/U /) 864-5557 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
jzz
o o
w LICENSED CONTRACTORS DECLARATION
fClu Job Description
I hereby affirm that 1 em of the
cd under Provisions ofs Code. 9 my license is p
FZ with Section7U711)of Division]of the BuainEesuM Professions Code.entl mylicense is
<<pN (.fuss recta Ap/omen. ./" REROOF
s q? Liaenso Clµ! C s.9 Lice 41 z z 3
of Dam i /��—Contncmr GQaiU FeFIN A fi FVO
/�R LTS DEO RATION RO IN6 ArtD 31�.C
1 understand my plans shall he used as p.biic records
f G Licensed Profesah,.&I DEC 1 2003
3 OWNER-BUILDER DECLARATION
<y I hereby alium that I am exempt from But Contractor's License Law for the
O O following reason.(Section 7031.5,Business and Professions Code:Any city on county $9000
�
5 m which requires a permit to Construct.&Iter,improve,demolish,or repair any structure $9 0 0 0
-Zmtprior h)its issuance,also requires the applicant for such permit to rile a signed statement
FO that he is licensed pursuant In the provisions ofOnContractors License Law(Chapter 9 Sq.F[. Floor Area Valuation .
$ (commencing with Section 7000)ofDivision 3ofthe Business and Professions Crvk)or 36654017 . 00
- That he is exempt themrum and t basis for the alleged exemption.Any violation of
Section 7031.3 by any applicant for a Permit ubjects Be applicant to a civil penalty of ane APN Number Occupancy
not more than fin hundred dollars($500). P y Type
❑1,&a owner of the propcny,or my employees with wages as their sole compensation,
will do the work,and the structure Is not intended or offered for sale(Sec.70aa,Business
and Profard.na Co.:The Contractors Lill.law does not apply in an owner of Required Inspections
property who builds or improves thereon,and who doeuuch work himself or through his
Own employes,provided Nat such improvements sae not intended or offered for sale If,
however,the building or improvement is sold within one you of Completion.On owner-
builder will hove the burden of proving that he did not Wild or improve for purpose of
gale.).
❑1,as owtmr of the propeny,am exclusively contracting with licensed cormsetma to
cou no(the project(Sec.70aa,Business and Professions Code:)The CommCLori Li
curse law does not apply to an owner or property who builds or improv thereon,and,
who contracts for such projects with a contractor(l)licensed pursuant o the Contractor's
License Lew.
171 am exempt under Sec. ,B&P C for moon
Owner Data
WORKER'S COM PBNSATION DECLARATION
1 hereby atm under penalty of perjury ore of the following declarations:
I ban and will maintain a Certificate of Consent to aclFinsum for Workeb Compere
&.tion.as provided for by Section 3760 of the labor Code,for to performance of the
work for which this permit is lasered.
❑I have and will maintain Workers Compensation Insurance.u required by Section
3700 of the labor Code,for the performance of ft work for which this permit is issued.
My Worker's n nutign lnsunnee artiered Policy number are:
Cm /U VN f1vN n Polipy .: I s(?z Z
CERTIFICATEOF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need Out he completed Kthe permit is foronc hundred dollars B$IBB)
less.)
1 certify Not in the performance of the work for which this permit is issued.1 shall not -
employ any person in any manner se as m become subject o the Workers'Compensation
Laws of Cal irons..Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate or Exemption.you should
become subject in the Worker's Com pcu&tion provisions of the labor Codc.YOU must
7z fonhwi lh comply with such provisions or this Perm itsm
hall w domed revoked,
ti N CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for the pcufurr awn of
Y. Fes-, the work fur which this permit Is issued(Sce.3097,ON.C.)
a7 Q Unders Name
z LandereAddress
Q 1 sentry that I bare read this application and roto that the above information is _
y F Curren.lagrce10Comply With All City and county ordinances and man laws
Mintingto
V building construction,and hereby&uthorin representatives of this city to enter upon the
(Z) ahmveons,juenedproperty for inspection purpowhich ms. .�
r gy (We)agree to save,indemnify and keep harmless the city or Cupertino against
y liebilives,judgmenu,ensu add expenses which may to any way ettme against s.itl City
inconsequence heg�rthisit.A PPLICA U DERI LY LTH ALL NON-POINT Issued by: Date
sOURCER ATIO _
/y `?13 Re-roofs
Sig ser AppoonvLomracmr Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
.II the applicant or future building wcuputt nom or handle hayaacu a materi&1
defined by the Cupertino Municipal Cade,Chapter 9.11.and the Health and Safety
,aikLWc. ❑tYus 255320)lXn All roofs shall be inspected prior to any roofing material being installed.
Will the applicantr(.lure building mcn.pant an equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
it horzrdmus air contaminants as dcfncd by ft Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes gNo _
I have mad the hmamoos materiels mq&tr u oder Chap ter 6115 ofthc CaIf.,
nio Hcnith&Safct YC
,Sccdou8305,1s53 a.l understand th&tifthchuilding - — - �!
doas n. cumcutlyy(.t a e... tha tis s th m notify the occupant of the
1,213
rcquiremcn�Ilii tbc�p rlu e c tRc mor Occup %$i afore of Applicant Date
(d �� } All roof coverings to be Class "B"or better
Owner orircd agent m
Building Division '
10300 Toga Avenue
Cupertino,CA 950143255
` Telephone: (408)777-3228
Fen: (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 obtainingall inspection
Wand 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
0. 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 Y"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 a, �✓i4/t/o
Address: 1.�9 ?_ �� VA V x/ /10ic s
Reroofing Company Name: 0 L-� C c)U nrrd;F o c i•- G
Applicants Signature— �t�:�, a.� �� Date: / 0 - a- o ')
Joe Antonucci
(Chief Building Official)
6/25/01
CITY OF CUPERTINO
REROOF a 3
CUPERTINO PERMIT APPLICATION FORM
APN # Date:
Building Address:
Owner's Name: Phone #:
pC c7 cJ /Is
Contractor: Phone #: b' License #:
047 C.00 t1Tci 1 (-,�opr-t,4G 6 as -4 �3 !
Contact: Ph o a #: Cupertino Business License #:
`{ off r�;;k Go-0 8,
—Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
O Wood Shakes ❑ Wood Shakes
❑ Wood Shingles O Wood Shingles
❑ Other(Specify) O Other(Specify)
Number of existing coverings O Provide I.C.B.O.Report#
❑ To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read, Understand and Will Comply With Cu rtino's Tear Off Policy:
Job Description: ' o j L,4 ye/G�O�S F+/ e.� ���� 5 eeTe, A� ee-f/)/" CNo asl5
3p LB Fec d o ` a FG/�
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning De t. if
therea an estrictions. lJ
Cost of Pro t' Type of Construction: Oc pancy group:
3
Qt . if
A0plicabld 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 Business License BUILDING
2, 3667