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03090175 (2) CITY OF CUPERTINO BUILDING DIVISION PERMIT VCONTRACTOR INFORMATION: BUI I.DING ADDRESS: OLD COUNTRY ROOFING PERMIT N003090175 OWNER'S NAME: 125-13 GROBRIC CT PERMITISSUEDA]E TEVE Sp NE' (707) 864-5557 SANITARY NO, CONTROL NO. ARCHITEC(ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 ±00 LICENSED CONTRACTOR'S DECLARATION 'Ms with In I hereby affirm that I am licensed under previsions of Chapter 9(commencing Job DescriptiOFI Yw�ALE0 Sceim.7M))of Division 3afthe foi.msvand Precision,Code,and my license is r full fan's and effect LicenseLl License ma 71 3 REROOF -Fo Date Q-2A)_J Convenor I A DEC 2 9 2003 ARCHITECTS DECLAION f,4 u. I understand my plans shell he unit as public records cog Licensed Professional SJUILDING OWNER-BUILDER DECLARATION 'v M 0 1 mason. .(Sere on 1 1. exempt(rum 0a Convenor's License c Law for Bre .... .. w o following mason.(Seniun 7101.5.Business andimprove ve dcrons Critic:Any tiny or courtly <m which requires a pcalsore cnmWet,alma improve,demolish,ri erepair gany ummem YZY that hpoor e its lensed .osur,to theres prevision of Barthe sucContractor's micense Lawned(Chapter :Z< thommen ingwJpursuanunthcpmvivinion3al neBusa as ndProfsawlCode)or Sq:F[. Floor Area Valuation r1-0 (cat be (Commencing Screfromon XIMand of Diaiiion)nf gleed exempton.Ayv Code)or $ that he is exempt therefrom end the basis for the alleged exemption.Any violation of 32613125 . 00 Section 7031.5 by any applicant for a permit suhjecu the applicant to a civil pane penalty of APN Number .. Occupancy T - . non mare than five hundred callers(5500). -- P Y YPe --'-- - ❑I,a owner of the property,or my employees with wages As their sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044.Business — gg and poetess ons Code:The Contramr9 License Law docs not apply to en owner of 307 - INSULAT � d Inspections property who holds Of improves thereon,and who does such work himself or through his awn employees,provided that such improvements are not intended or offered far ale.If, 601 — ROOF TEAR OFF however,the Mi lding or improvement is sold within one year or completion.the owncr- builder will have the burden of proving that he did not build or Improve fur purpose of 602 - ROOF PLYWOOD NAIL Cale')' 603 - ROOF BATTENS I,a owner of el pm.70,1 ,Business exclusively coircmia g with:)Mixd canvattots i- ._._. arias La does not apply.o i n ancoaoprty who Wids Code:)Mix Canueman.Ll- 604 — ROOF IN-PROGRESS crimwho contracts such apply with aofproperry whosedporimprow fireman.and who comracu for such projccu with a comracmrp)licensed pursuant to me Conuanofs Liccnu Law. ❑ Tem exempt under Scc. ,BhPCfar this moon Owner Data WORKER'S COMPENSATION DECLARATION 1 hereby Arian under penalty of perjury ane or the following declarations: 1 have end will maintain a Cenificae of Conant to ulbinsure for WorkcriCumpcn- cation,as provided for by section 3700 of the labor Code.for the is rformanm of the work for which this permit is issued. ❑1 have and will maintain Worker's Compensaion losunnce,u acquired by genion _ 3700 of the Labor Code.for the pedrmmsnce of the work for which this pemtil is issued, My Works m alai InWom caainand Policynu loam: Carrier: _t�.--i PolityNo.; —�v CERTIFICATE OF EXEMP 1 ON FROM WORKERS' COMPENSATION INSURANCE (This xctiun need not heetsmplead If the remit is fmoac hundred dollars(S IIXn or less.) 1 certify that in the performance of the work for which his Permit is issued,I shall not employ any person in any manner An As to become subject to the Workers'Compcmauon Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Cei iftaam of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must .D 0 forthwith comply with such provisions or this permitshall be deemed revoked. Z�y CONSTRUCTION LENDING AGENCY I hereby affirm Net Nem is a eonatraf inn lending agency room performance of x the work for which this permit Is issued(Sec,3041,Co.C.) QLender's Name 33. z Lender's Address J Q 1 certify that I have read this application And stare that the above information is j, (✓ Correct.I agree la Comply with all city and County ordinances and Stale laws relating to 7building construction,and hcmhy awhOtiM represcntativcs Of Nis city to enter upon the NU ahme-mentioned property for inspection purposes. ti (We)agree Ir ave,indemnify end keep harmless the City of Cupertino against IA liabilities,judgments,costs and expenses which may in any way accrde against aid City ..3z me0 fib thclo""Ogof this permit. APPLI A UNDERSTAND AND WILL COMPLY WITH ALL NON-POINT Issued by: Date 50 REGULATION ([4Q✓ /)�doY✓ i a3-03 Re-roofs S nal reof Applican/Contractee Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building Occupant store or handle hazardous material as defined by the Cupertino Municipal,Code.Chepmr 9.13.and the Health and Safety CW..Section All roofs shall be inspected prior to an roofing material being installed. [3 y}/ Win the applicant Or future hu iding Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove it haardrua it contaminana dcfincd by the Bay Arta Air Quality Management all new materials for inspection. iatrmo ❑Ycs No I have mad the hvardtms materials requirements under Chapter 6.95 of nM Califoo- n �� .is Health K Safety Code,Sections 25505,25533 and 25534.1 undcreard tha if the IWilding /7J� Juts' d rely have•Wheat, tit u my responsibility to nou Iy de oh:cupant of the rcyJip�s to which must0 ct riorwissuancc ofaCcrufcaa:of O (/Jrqupmry. SI attars of Applicant Date own ed agent •L.V-._i/1 Date All roof coverings to be Class "B" or better Building Division 10300 Tom Avenue Cupertino,CA 95014-3255 Telephone: (408)777-3228 &CITYO Fax: (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 obtaining all 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 3) Final inspection approval. a) Spark arrester installation • 5. If plywood is installed,a plywood nail inspection is required:6. Any roofmg 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: S7C% I/&- Address: /&-Address: O-W d' �' I S -A Ki1/v�` �?L✓ Reroofing Company Name: CO tiitlTn oP c% , .7 G. Applicants Signature Date: 0/— o?3- 9 3 Joe Antonucci (Chief Building Official) 6/25/01 CITY.OF CUPERTINO REROOF CUPERTINO PERMIT APPLICATION FORM APN # �a 6 r 3 I a� Date:��JJ Bnil`linv Address: v I S'TA N o,(-L. 61, Owner's Name: Phone #: -v& �/or �3o Contractor: Ph on License #: 04.0 CIO(AK)IT-el G5?00i�I 1,6 )O W6Z 6 3 t Contact: "t h #: Cupertino Bt�si(nness`3Lic�nse#: 01 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: i2 c---,,44 O✓(; C,X!5' t^I nls i_ 04)�S> 3 0 rz1-cr- of noa Residential 14Commercial ❑ Fire Zone: Yes ❑ No ❑ Confirmed with Planning Det. if there are an restrictions: LJ Co of Project: TAP of Construction: Occupancy group: 0 P� �L if A lic l Fee ID Fee Description Fee Gro u 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 23233 7,