02110017 (2) CITY OF CUPERTINO a '." •....•Zk^_ *nk"
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
"W\1
Bu,l&1Bk5r 5s7 39 PARK VILLAS CIR OLD COUNTRY ROOFING PERMrrN(02110017
OWrFAIr2*pVILLAS HOA 125-3 GROBRIC CT APPLICATItp1J15trBtplI1r,2002
Ak
IMF ONE'. 707 864 -5557 SANITARY NO.
7 CONTROL NO.
ARCI IITIiCT/ENGINFER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECII
0 0 0 0
�00 LICENSED CONTRACTOR'S DECLARA'T'ION
rcU F 1 hereby altfrm that I stn licensed undq/pruvisions of ChaNer v(commencing REROOF Job Description
=u wile Scmi n]IXM17 of Divisioniof the❑tile anti Rofcssinns CsNc.and myliccntc is
nfull anti elle' '
Z O'a Z Liccn—f'•—"'--"-�hes.N
08�Z Da 'us O
!"-I-a IJ ARCIIITELTS LARATION �y
a 1 Professional
rofesion my plans shallMu.acd as public ranrdx Y �,� ar �S LE
a p 6 p IGh\V^Y lYISVk
u�LL 0 h LiccmeJ I'mfcssional
y OWNER BUILDER DECLARATION
d<x 1 hereby atlirm that I am exempt from the Contractor's License Law lit the JAN 0 1 2003 $9000
w i In 0 following reason.(Section]1131.5,Business and Professions Come:Any city or county
u%m to which requires a Permit m construes alter,improve,demolish,or repair any tWctum
m"^ pnorwas issuance.also requires the applicant forxucbpermit to file aligned statement
�Z9< bathe ixlicensed pucwanuo mepnwitiontoi the Contactor',Licene Law(&,or 9 �Ti&p�{J f@(1¢ 9 Valuation
Y�G (commencing with Section 7000)of Division 3(if the Fortune,anti Professions Gree)fir
y 3$ mat he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 71131.5 by any applicant for a permit subjects the applicant In a civil penalty of PNrN Occupancy Type
an mom man five hundred dnBart(S500), 307 - INSULATION
I,uownerof Nepmpeny,a myemployeeswiO"gesms cirmiccompe tion.
will do the work,and the structure is not intended or offered for sale(Sec.70aal,Business 681 �py� g
and Rnfessinns CoJc:The Concession's License Law data not apply to an owner of 602 - ROOF P ilV V nt2jns
property who builds or improves menton,and who dors such work himulfor through his
avnemNoyces,provided that such improvementsam notinlendedoroBered forsale.If, 603 — ROOF BATTENS
however.the building or improvement is sold within one year ofcompletion,me owner- 604 - ROOF IN-PROGRESS
builder will have the burden of moving that he did not Holm or improve for purpose or
sale.).
❑1,as owner of the property,am exclusively contracting with licensed contract.,.,to
concoct the pmjml(Sec.](44.Business and Professions Caul The Contractor's Li-
cement law does not apply to an owner of promeny who Wilds or improves thereon,and
who contracts for such projects with a contractor(t)licensed pursuant tome Contractor's
License Law.
I am exempt under See. .B&P C for this maxon
Down, Dam
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
1have and will maintain aCenificateof Consent to sell rourefor Worker's Compcn
sxtion,as provided for by Section 3700m the later Cole,forme peffmmance of the
work for which this permit is issued.
O 1 have and will maintain Worker's Compensation Insurance,as myvircd by Semon
370)of the labor Colli,for Ne performance of the work for which this permit is issued.
Wil Innssurance carrier end Pe, number am:ec 1Lc�"_�lq_{^(1�—Poli, No,��S—O
CERTIFICATE OF : EMPf10 FROM WORKERS'
COMPENSATION INSURANCE
This section need not bccompleted iftM permit is 0r one hundred dollars(S Ilgry
or less.)
1 unity that in the performance of the work for which this Permit is issued.1 shall not
employ any penton in any manner sit as to become subject to the Woro ns'Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT':If,after making this CerfEcrm of Exemption,you should
Mame subject to the Worker's Compensation provisions of the labor Cave.you must
O Z forthwith comply with such provisions or this Permit shall W deemed revoked.
z O CONSTRUCT ION LENDING AGENCY
[-. I hereby affirm that there is a eonmuction lending agency for the Performance of
ai 7 he work for which this Permit is issued(Sec.3197.Civ.C.)
D.1 Lender's Name
f.L Lcndcn's Address
VC) 1 unity that 1 have read this application and state that the above information it
!k. F weed.1 agree to comply with all city and county ordinances and state laws relating m
0 building concoction.and hereby authorim representatives of this city in enter upon the
r aWvomentioned property for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino agar nn
F" fA liabiliou.,dgmenu,costs and expenses which may in any way aurre againstsod City 1 /
U Z in consequence of the gracing of this Permit.
�-'- APPLICANT UNDERSTANDS AND WILL COMPLY WI A L NON-POINT Issued by: Date
S �URCE REO A Ops..
Re-roofs
Signamm Applium/Contnctor Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant Store or handle harandous material
as defined by the Cupcnimo Municipal Code.Chapter 9.13,and the Health and Safety
Code.Seeano 25532(a)' All roofs shall be inspected prior to any roofing material being installed.
I-]Yes pNn
Will the applicant or future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mit intentions air control forms as defined by the Bay Arca Air Quality Management all new materials for inspection.
Dicrinl
❑rx 3t.
l have read the hatardnus materials occiinmumvmder Chapter 6.95 of me Cald 0.
nix Health&Satuty Calc.Sanctions 35515.25533 and 25534. unce.urridmalifthe Melding /
tires not currently hays a tenant than it is my re,rymsi cityo marl;tM aeupa d of the
ruiremm�u hie un IPnnr In issuancenfaC,n4%L&U
itt nl Q'eupaney. .Slgnat of Applicant Date
is //-01-0 Z_
Owner m amt mired agent Date All roof coverings to be Class "B" or better
Building Division
10300 Toren Avenue
OCITYO
Cupertino,CA 95014-3255
Telephone: (408)777-3228
Fax: (408)777-3333
CUPEkTINO
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 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 onreroofingand will comply
with this policy.
Homeowners Name: pig K V i L /1 0
Address: IUUI ���2 K V� LLQ G 1lLCLv
IZemofmg Company Name:
Applicants Signature: Date:
Joe Antonucci
(Chief Building Official)
6/25101