03010143 (2) CITY OF CUPERTINO
nU117DING DIVISION PERMIT CONTRACTOR INFORMATION:...
BUILDING ADDRESS: GROMO ROOFING PERMIFNO,
10822 WILLOWBROOK WY 03010143
OWNER'S NAME: 121 W WASHINGTON AVE APPLICATION SUB DATE
ah JULIE CHEN 01/24/2003
OFIIONII: 740-8—F746-2075 SANITARY NO, CONTROL NO.
ARCIIIT C-UENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECII
0 0 0 0
�00 LICENSED COMBACTOR'S DECLARATION
at I hereby affirm that 1 am licenced under provisions of Chapter 9(commencing Job Description
{.ZZ with Section 7NX))of Division Sof the Business and Polliodnns Code,and my license is
b<w Lfull three andc cel 8 A® E�
zoq? License Cl a �,= Lica ]3�--:1 REROOF
ozr ast:, Dare Codirseaf��
W ARCIII'IECI'S UECLARATI6N
3i�Q I understand my plans shallbeused as Puhlie records J .l
aogu F G�
G Licensed Pu fcssimmd
ty- OWNER-BUILDER DECLARATION BUILDING
r l+<Y I hereby affirm Thal I am exempt from the Contractor's License Law for the
as 0O following reason(section 703 1.5,Business and Professions Code:Any city m county
a 2 which requires a Permit to construct,alcor,improve,demolish,or repair any structure
FZ< prior to its issuance,also inquires the applicant for such permit to file aligned srrouned,
Nm he is licensed pursuant to Ne provisions of the Comnclois License Law(Chapter 9 Sq. Ft. Floor Area $5➢'84Ltion
ar (commencing wi tit Section 7(091)of Division 3 of the B usinesr and Professions Code)or
that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 703 L5 by any applicant for a permit subjects the applicant to a civil penalty of Occupancy
not more than five hundred dollars ISM P Y Type
0 I,es aware of the property,or my employees with wages as their sole compensation,
will Jo the work,and Ne structure is not intended or offered for sale(See.7044,Business
and Professions Code:The Criat r'a License Law Jens not apply to an owner of 307 - INSULAff�ffed Inspections
property who builds or improves thereon,and who does such work himself or though his
own employees,prodded that such improvements am not intended or offered for sale.If. 601 — ROOF TEAR OFF
however,the building or improvement is sold within one year of completion,the owner
builder will have the burden of proving that he did not(mild car improve for purpose of 602 - ROOF PLYWOOD NAIL
sale.). 603 - ROOF BATTENS
0 1,as matter of for proprny,am exclusively contracting with licensed contractors to 604 - ROOF IN-PROGRESS
construct the printer(Sec.7044,Business and Professions Code:)The Conuscmr's Li.
cense Law does not apply to an owner of property who builds or improves thereon,and
who contracts for such projects with a contescoup)licensed Forward to the Confoulor's
License Law.
0 1 at exempt under Sec. .R&P C for this actions
Owner Dan
WORKER'S COMPENSATION DECLARATION
I hereby affirm under Penalty mf Perjury one of ifte following declentim er:
I
have and will mountain aCcri ficaac mf Consent m self inside for Workers Cit
un
ion,as provided for by Section Thin of the Labor Code,for the performance of the
rt for which this Permit is issued.
J9 1 have and will maintain Workers Compensation Insurance,as required by Section
of We Labor Code,for the Performance of the work for which this permit is issued,
y Worker's Compensation Insurance carrier and Policy numer am:
rrier: fTATF Policy Nu.: .7-T y
CERTIFICATE OF EKEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need nor W completed If the permit is limine hundred dollars(SIBIB
or less.)
1 cenify that in the performance of the work for which this permit is issued,1 shall not
employ any person in any manner sn us to hecome subject o the Workers'Compensation u
Laws of California.Date
Applicant
NOTICE TO APPLICANT:IL after making this Ccnifican of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
OO forthwith comply with such provisions or this Permit shall be deemed revoked.
zCONSTRUCTION LENDING AGENCY
[-. I hereby affirm that them is a construction lending agency for the Performance of -
the work for which this Peord is issued(Sec.3(197,Civ.C.)
Q
Led nocr's's Numc
z Lc derAddress
U 0 1 cenify that 1 ban mad this application and sum that the above information is
F-' coned,f agree to comply with all city and county ordinances and stale laws relating in
Q U building construction,and hereby authnriee opresenmtives of this city to enter upon the
BUJ show mentioned property for inspection purposes.
6. (We)agmc..an .indemnify and keep haemless Ne City of Cupertino against
F' (A liabilities,judgmrnn.ensn and expenses which may in any way acemr against said City �` O
U Z in consequence of the gaming of ibis Noraid. _ /)
'-' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCF.REGU NS. _— / / Z
Y�0 ;t Re-roofs
Signature l'ApplicrrUConuactor Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof _
Will the applicant or future building occupant store or handle h starduus material
as defined by Ne Cuptnino Municipal Code.Chapter 9.12.and the Hcahh and Safety
,MLCod,,, 25532a)7 gin All roofs shall be inspected prior to any roofing material being Installed.
Will the applicant or future building occupamuse equipment ordevices which If a roof is installed without first obtaining an inspection, I agree to remove
in havardnus air count inants tie defined by the Bay Arca Air Qual try M anagcmcm all new materials for inspection.
Dis"
❑Yrs �9 n
Ihave read Nc haraNnus materials requirements under Chaptcr695 ufthe Glifor.
iia Health&Safety Code.Secfixrx 5505,25533 and 255M.[understand that fine,haiding
does nm currently have a tenant,that it is my resrymsibility m nouly[be occupant of doe
requiremenN which must he mel prior to issuance of a Ceti ficare of Occupancy Signature of Applicant ale
owner rauthnnrcJagcm Dam All roof coverings to be Class"B" or better
„ t
Building Division
10300 Tom Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
CI 0 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
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 VV 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: J iI1 /60
Address: /oePL Z w/CGO �Q/zdv�� w y
Reroofing Company Name: G n O ha R ao i Ali C
Applicants Signature:
Joe Antonucci
(Chief Building Official)
6125/01