04110111 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT C®NTRACT,OR I)VF�RMATION _ ------ -
- fl)»°h%S'ix3ke #. ,. T§Y.xsle rohars.3.w-x;- �.gui•�s; -3<:
BUILDING ADDRESS: OLD COUNTRY ROOFING PEIRMIr" 4110111
' 19720 DRAKE DR
OWNER'S NAME: PERMIT ISSUE DATE
MARGARET GRAVES 125-3 GROBRIC CT
_ 11 /17/2004
ONE: SANITARY NO. CONTROL NO.
(707) 864-5557
ARCHITECDENGINEER: BUILDING PERMIT INFO
_BLDG ELECT PLUMB. MECH
u00 LICENSED CONTRACTOR'S DECLARATION
w 1 bereby affirm that 1 am licensed under provisions or Chapter 9(curatorial., I0 rl 10
AZW with Scmionincirfer Division Jof NC Business and Professions CoM,and my license is — .M �� —_
,2ThI tau mrcc one effect a 3) REROOF /J�..1��
,a. lazs It Ile.g'
m-' Do '-31'02' ARCHI'IECTSDECLARATION _
'�% 1 undlersuind my plans shall W amid as public mersdat DEC 2004
JyU
u.G Licensed Professional
+$05 OWNER-BUILDER DECLARATION y _
d<Y I .. .(firm that 1 1. exempt tram Nc Contractors Licence Law co the I � ,O^+-41
o O which re matin.(Section t1nstr Business and w.Pondemolish.
h.or Any city no county _ _ N/A®•/-➢
sic m which requires
a Permit m construct,slug improve.Jcmnliffi,nr repair any stmcwm - ..
m-'^
prior it)its issuance.also reuims the applicant for such permit to Ole a signed suimmetn
that he is licemed final to the provisions of the Contractors License Law(Chapter 9 Sq. Ft. Floor Area Valuation - - —
�1-$ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or -
y On he is exempt therefrom and the haau for the alleged exemption.My violation of
Sactlon 703 1.5 by airy applinnl for a permit subjects the applicant to a civil penalty of 3a Occupancy Type
not mom dun Eve hundred dollars WWI. -
❑I,uowuer of ate pmpenY•mmy employrea with wgoaz their salt competiuuan, _ _
will do the work and the structure is not intended or offered for sale(See7W,Business Required Inspections -
and Professions Codc:The Contractors License Law does.not apply In an owner of q p
propcny who builds or improves thereon.and who does such wart himself as through his
own employees,provided that such Improvements art not intended or offered for sale.If,
howewt.the building or Improvement is said within one year ofcomplcuon,the owner-
builder will have the human of proving that he did not Wild or improv,for purpose of - - --- _
mile.).
I,as owner of the property,am asclusively contracting with licensed contractors to
construct the project(Sec.TOsa,Business and Professions Code:)The Conmcmr's Li.
cove law does not apply to an owner of goal who Wilds or improsv thereon,and _
who contracts for such projects with a contracuos)licensed pursuant m the Conuuters -
Lkcn a Law.
❑ I am exempt under Sec. ,B&PC for this mvun
Owner Dare
WORKER'S COMPENSATION DECLARATION
1 hereby alarm under Malty of perjury arc of the fallowing d,clmafiuv: -
I heN
re and will maintain aCeRctice of Consent a ent to self-tum for Walkers Compile'
salian,az provided for by Secuan 37W of Latin, rf
e Latin,Code,far the peom
rance of de
work for which Nis psmatt a issued.
❑I have and will maintain Workers Compensation Insurance.as equired by Section
3YW of Ne Ube,Code,for the perfmmmer of the work fur which this permit is issued.
My Workers/Com,,nsauon Insurance carrier and Policy number am:
Carrier:�/ F I-)RAicy No.:1JC_L�y�
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thusccdon need not W completed if the permit is fmonc hundred dollars(2100)
or ins.)
I cenify Nal in the perfearriu ,of the work for which this permit a issued,l shall not
employ any person in any manner so u to become subject to the Workers'Compensation
Laws of California.Dae
Applinnt
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Campcvad me provisions of the Labor Code,you must
.J z forthwith comply with men provision or this permit shall W deemed revoked.
zO CONSTRUCTION LENDING AGENCY
[- I bemby alarm Nat them is a constitution lending agency for the performance of
f3: the work fur which this permit is issued(Sec.3097,Civ.C.)
Lenders Name
= z fenders Addmu
U C) 1 cenify that I have read this application and sNIC that the above information is
U, F Comcct.[agree to comply with all city and county ordinances and suite laws relating to
pU building construction,and hemby authorize mpoWnutives of Nis city to enter upon the
r La abovomenlioned property for inx ccfion purposes.
F 4. (We)ogee to use,indemnify and keep harmless Ne City of Cupertino against
rn liabilities,judgments,eases and expenses which may in any only accrue against mid City
U Z in consequence of Ne granting of this permit.
AP9PLICA UNDERSfAN SAND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOU EGULATIONS.
O/LJ OJ ✓✓l�CI � ��- at/ Re-roofs
Signal, of ApplicanUContmcmr Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or fume building occupant store or handle hazardous material
az eerincd by Oc Cupenino Municipal Cade.Chapter 9.13,and the Health and Safety
ode.S ]Tees 25532(.)? �� A`, All roofs shall be inspected prior to any roofing material being installed.
Will the application ar fuwm building occupant tic cyuipmcm at devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit Is,00dous air contaminants u defined by the Bay Area Air Quality Management all new materials for inspection.
Disaict?
❑Yes Nu
Ihoic&Sdro L thchv 6o m Ni5,255 3i d25sundcr dcm=h.95ofthe Cali L
ni Health&Safyteiva,Secuuv255115.355JJanJ 25534.1unders�ndthmifthebuilding
docs nr rtently hare a come the'it is my msprvihility w nntily the rccuparn of the � �����/
\ mqu, Iswhich must ,prior muss. ce of a certificate of Occupan�ty. Signature Of Applicant Date
�//ham /142h1r A-/q-�Y'
owne a .athorbcdagent Date All roof coverings to be Class"B"or better
Community Development
10300 Torte Avenue
s Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
SUPEkTINO
Building Department
JOB ADDRESS: PERMIT #
tl o ) An- KL, Q)/ -- OSSllaoI
OWNER'S NAME:r-, 1t,9 JAG nt-,2(S T- O 2t-q ✓L-5 PHONE # 4,0 o-
X300
GENERAL CONTRACTOR:QL C p ( FAX # V o 8 3 0 /
I am not using any subcontractors
Signature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
&w=/Contractor Signature Date
Community Development Department
BuiJding Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
$ CITY OF Fax: (408)777-3333
UPEkTINO
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: IS IL-I G /S-1-9 ✓c_�
Job Site Address: 9+a 0 rz--n K C 3)K--I V tom/
Roofing Company Name: Q L-- ) Co fA N Iy/ 2 D 0 1--1/i/G
A ph I's
Signature / Date: 7- J — O Y
` \A/�61NDLXI
GregJteel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF
CUP RTINO PERMIT APPLICATION FORM
APN # Date:
� �- �5- -may
Building Address:
1 9 O --!) (Z-n 1< L) VZ
Owner's Name: Phone#:
M n r*�; G n R(s G rz-n- ✓ 63 qO�-' a05a Fg--_�O
Contractor: Phone #: J License #:
0
Contact: Phone #: Cupertino Business License #:
cs c/ -0P- 1 V� 3 001 0 3
Type of Roof Covering:
Existing: Proposed:
❑ . Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles 1< Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
A Other(Specify)C-6 GAKi \5N1g1Ccl ❑ 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: i < t%r" OV L�, kS 11A/G 10 Q F
-3O _ -�._ L'o �
Residential] . .-. Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Det. if
there are any restrictions: LJ
Cost of Project: Type of Construction_ Occupancy group:
1 O 000 oo - 7S Fr__ /,Z - 3
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