03070018 (2) CITY OF CUPERTINO n8 ` �=a
BUILDING DIVISIONPERMIT �4"CON,tiUC ,01§ ATIION
BUILDING ADDRESS: OLD COUNTRY ROOFING PERMITN003070018
Dow' SNAME: 125-B GROBRIC CT PERMRLSSUEDATE
NE' (707) 864-5557 SANITARYNO. CONTROLNO.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
Sop LICENSED CONTRACTOR'S DECLARATION Job Description
I+r 1 Wrcby Affirm that I am licensed under rovistona of Chapter 9(commencing
n� with Secrio ]00�I)of Diviaion3of dae Busit v 'hofcuinm Code.and mylicemcis
n in full fooe effect. REROOF
p of Z LI nu 1 Lie. ,
°a can'" ORIGA02090147/ONE HALF OF THE FEES WAS PAID
ARCHITECT'S DWARATION
1 undcmand my plana shall be used as public records
U
y�G Licensed Pm(essmmil
3 OWNER-BUILDER DECLARATION
1 I hereby affirm that I am exempt from Ne Contractor's License Law for the
O O following Munn.(Section 7131.5,Business and Pmfessiou Calc:Any city or county
$ .which requires a permit ,,construct,alter,improv,demolish,ar upsir any structure
-ti prior to he issuance.also requires the applicant for such permit to Glc a signed statement
p � that he isliccnudpursuant tothe provisions ofiWComomum'sLicenseLaw/Charm,y Sq. Ft. Floor Area VaIU�gL1o_p000
d (commencing with Section 7")of Division 3 of the Business and Professions Carlo)or 'J
e Net he Is exempt therefrom and the basis for the alleged exemption.Any violation of
Sectlon 7031.5 by any applicant for apen.it subjects the applicant to a civil penally of 3 WbIT-0i (Ir0 0 Occupancy Type
not moo Nen five hundred doll..(5500).
O I,as owner of the property,or my employees with wages as their sole compensation,
will do Ne work and 0. net..is An,i.mnded or offered ronale(Sec.7004,Business Required Inspections
end Pofeuims Code:The Con male.Lt.Law docs not apply m an owner of 305 - FRAME q p
Poverty who builds or Improves daemon,and who doe,such work himself or through his
awn employees,provided that such improvements are not intended arafrered for sale.If, 307 - INSULATION
however,due building or imp mvmant is said within one Ser of cmpledon,the owner
builder will haw Me burden or proving that W did not Wild or improve for purpose of 601 - ROOF TEAR OFF
este')' 602 - ROOF PLYWOOD NAIL
❑L as ucttheOwner of the popery,,B sine siveely and
contracting Cid licensed ren croon L 6 0 3 - ROOF BATTENS,
construct the project(Sec.]004,Business end Profusions Code:)The Contracmla Li- '
cave taw does not apply m an owner of property who Wilde or improves daemon,and 604 - ROOF IN-PROGRESS
who contracts for such projects with a contraeor(s)licensed pursuant like Connector's
Lic—La-
❑I am exempt under Seo. B k P C for this moon Owner DauWORKER'S COMPENSATION DECLARATION
137M1 hereby affirm under penally of perjury arc of the fallowing declarations:
heve and will,u provided for by Section 3700 n(the tabor Code,(or the performance of the - �+... IEDi
for which this permit is issued.
ban and will maintain Worker,Compensation m u.nc its required by Section
of Ne labor Cade,for the perfo.....n(:o.,k for oh this permit I,issued.
arkefs Co ,so li..In.....carrier and Pali �a/rp� �'}�eat. S al. W) POI Icy No.: 2Z
CERTIFICA •OF INFROM WORKERS' 1
COMPENSATION INSURANCE
(This section need not bo completed Rthe permit is for one hundred dollars(SIM)
or less.)
L certify that in Ne perfosmamce of the work fa which this permit is issued.I Me)[ala
employ any person in any manner sal As to Wcomc subject o the Workeri Compernatlon
Laws of Catifomia.Date
Applicant
NOTICE TO APPLICANT:IL after meting this Certificate of Exemption,you should
become subject to the Worker'.Campenset[on provisions of the Labor Coda.you must
O forthwith comply with such Provision or this permit shalt be d¢mcd remkud.
N CONSTRUCTION LENDING AGENCY
(~ Ihereby4f1rmthetthere is a counuctinn lending agency for the performance of
C the work for which Nu Permit is issued(Sec.3097,Civ.C.)
W Q Lender's Name
z Lender's Addmas
U Q 1 certify that I have teed this application And tum that the above information i, -
D.H correct.)agree to comply with all city and county ordinances and stale law,relating to
0U building conswction,end hereby authorize mmesenmivea or this city to enwr upon the
W above-mentioned property fin impecdon purposes. z1z;2�4
gyr
(We)agree son,ave,indemnifyandkec0 hay in at he city or Cupertino against City
[A inconso,ut e.Of th,commend of this expenses which may In anywry accrue against said City
U in conseynence Of the granting of this permit.
^ APPLICANT UNDERST NDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SQUa REGUL -_S..
Si . rev " far 1/2 ";, Re-roofs
Data
ARD
MA RIALS DISCLOSURE Type of Roof
Will McapplicMn,m1uumbat ng uccupantnorcorhandlchanrdoumamriat
As defined by the Cupertino MurA I Cade.CNpmr 9.13,and the Hea[da and Safety
nuc,Section 35531(a)7 All roofs shall be inspected prior to any roofing material being installed.
Year
Will the applicant or ramM I. ne"upent usecyuipmcnt or devices which If a roof is installed without first obtaining an inspection,I agree to remove
It hnordnua sit c.numinants u cfood by the Bay Arca Air Quality Management all new materials-for inspection.
ovist?
❑Yes
I have read the ha ardour materials requioments under Chapmrii.95 of the Califor.
nue HcalthB:Safely Code,Sections 75505.25533 and25534.I underamM thuirthe aiding \Y'O
Jou not cuncntly have a ren the)[I is my rnpnfb il' m nntily theqq¢aac.panl of ds 5
rc uiremcnuwhim dprior In issuance of a Cc roof Oceans Signa�ure of Applicant _ Date
0
Done,or ,clog Date All roof coverings to be Class"B" or better
t r
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
�UPE TINO
Building Department
Subject: Re-roofing policy for the City of Cupertino
1. Prior to permit issuance,you must agree to comply with 1997 UBC Standards
and manufacturers specifications on re-roofing.
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 re-roofing
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) Pre-inspection 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 a 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 on inspection.
I understand and will comply with the above stated policy on re-roofing.
Homeowner's Name: jar b Wl oyt 4L_11�
Job Site Address: l S��� Y) h S d'
Roofing Company Name: I ��h') �^ ��C C�l P721
A ",ant's Signature: Date:
eel
Greg t
Building Official
Revised 1/30/03
Printed on Recycled Paper
Com -# , 2 Jc
CITY OF CUPERTINO � �
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN# 3 / / F/ o�/ Date: .
Building Address:
Owner's Name: Pone#:
23 JZ9
Contractor: Phone#: License#:
rd dr z�= *ZX-Z RS C-C7
Contact: Pho #: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ 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 Comply With Cu ertino's Tear Off Policy: ❑
Job Description:
Residential ❑ Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are anrestrictions: LJ
Cost of Project: Type of Construction: Occupancy group:
Qty. if
Applicable 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
C
2,2-36S
e CITY OF CUPERTINO - ' -
euH DING,DIvrs1ON ' PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: : ... .. PERMIT NO.
11673 SEVEN SPRINGS DR OLD COUNTRY ROOFING 090147
,OWNER'S NAME: Y 1 SUB DATE
RAYMOND. CHAN 125-B GROBRIC CT 09/20/2002
0 NE - .. SANITARY NO. CONTROL NO.
s408823fi'7941, SUISUN CA 94585
ARCHITECT/ENGINEER: PHONE p - BUILDING PERMIT INFO
+'• BLDG ELECT PLUMB MECH
REROOF
a INSPECTIONS DATE INSPEC. TO ARRANGE INSPECTION JOB DESCRIPTION
�i PFS CALL 717-3228 MONDAY-FRIDAY 24 HOURS RESIDENTIAL:
zv, FOUNDATION/PIERSMDS
BEFORE REQUIRED INSPECTION.JOB ADDRESS
. . . Q DWL KITCHEN REMODE
Fz S - AND PERMIT# W0 A 0 ARE NEEDED WHEN PHONING. p ADDITION PLUMBING RE-PIPE
L hp MULTI-UNIT []STRUCTURAL
g�c q 6 LIFER GROUND
PAD/SBT BACK-CERT` ' RESIDENTIAL_COMMERCIAL—OTHER_ MODIFICATION
u0 3
' ABS/PREGUNITEu CARAGESLY - p INTERIOR ❑CHIMNEY REP
AIR
HAZARDOUS FIRE AREA IMPROVEMENT C SWIMMINGPOOL
SNS POURNO CONCRETE'UNTIL ABOVE HAS BEEN SIGNED ❑ BATH REMODEUREPAIR❑ DEMOLITION> o I!yc+-I undanJ that a CIu+Ap
moaouearbly is required. 11 OTHER
zm PLUMPING
p NO Initial �„ I C B.O.#
3$ DONOT POUR FLOOR UNTILABOVE HAS BEENSIGNED. `EXISTING ROOF COVERING - - . COMMERCIAL:
'PLUMBINGt Cl NEW BLDO/ADDITION O DEMOLITION
Number of existing coverings ,C.TENANT 0 FOODSERVICE
MECHANICAL " •
__ _ .. __ . . ._.IMPROVEMENT .._._ ... -
'ELECTRICAL To be removed To be retained 0 OTHER'-
FRAMING VENTS
p'INSULATION:I "' " ' '• -
�'wy.gC. PLACE NO SURFT-GOR UNTIL ABOVE HAS BEEN SIGNED TYPE OF ROOF COVERING ,
'.:ROOF SHEATH/DIAPHRAM - EXISTING: -- - -PROPOSED:
PLUMBING ,° p Built-Up Roof ❑ Built-Up Roof
-TUBS'&SHOWER PAN" - ^' El Asphalt Shingles .... p Asphalt Shingles .._.. ... . . _
MECHANICAL 0 Wood Shakes p Wood Shakes
-ELECTRICAL/POOL BOND ---- _ ❑ Wood Shinglei - ElWood$M1irigle'st(
p Other(S cif -
-FRAMING/STAIRS/E EGRESS ._ .. pe yl ❑ OlheiYSpec
i
INSULATION/VENTILATION Provide I.C.B.O Report No
pVFR'NO WORK UNTIL ABOVE HAS BEEN.SIGNED _ : Provide Mfgr.Installation Specs.
,. .'. .-EXTERIAL'SHEAR/HOLD DOWN.
INTERIOR SHEAR/HOLD DOWN
..SHEETROCK/SHEETROCKSHEAR INSPECTION SPECIAL INSPECTION REQUIRED El DATE INSP
_EXTERIORLATH/,W-SCREED -
y:, `
-SHOWER LATH C:.11 .,. - .' � t• _ "'• ..
NOTAPE:OR PLASTER UNTIL ABOVE:HAS BEEN SIGNED- - • -" " ' "" - '
SCRATCH COAT ..
,SEWER/WATER,;
.:TEMPORARY APPROVALS '
:-OCCUPANCY - -- -
4tonr'..FINALS' '.' . .o ..
Z. ..PLANNING'777 3308 1
.•:-GRADE TRW-777-3354)
it -EIDE:._ .- ... . .. . :r, '
. EXPIRED
HAND ..
U'ZH
_ . _.
C!U:0 ELECTRICAI�,,
-.MECHANICAL
:, ✓y -ENERGY:-.P),::.
V .
BVI§UAL'FINAL
.=OCCUPANCY'OF BUILDING IS NOT PERMITTED
UNTIL77,UILDING.FINAL IS SIGNED BY BUILDING
CERTIFICATE'OF OCCUPANCY.0 - - -
INSPECTOR. ,t 'a ..
PRE-INSPECTION: -' PLYWOOD: IN-PROGRESS
INSP. '� �_ DATE INSP. DATE INSP. DATE
.: ''NEAR OFF'INSPECTION: BATTENS: ' FINAL: - - -
! INSP. DATE INSP. DATE -INSP. DATE
NOTEi OSHA APPROVED ACCESS.TO ROOF SHALL BE PROVIDED-FOR.INSPECTION
_ - APPLICANTS POSTING COPY - "'