03070108 CITY OF CUPERTINO `" -
BUILDING DIVISION PERMIT �CONTRACTORINF�ORMATI®N:
pUiLDING ADDRESS: MARCO ROOFING PERMIT NO.03070108
owNER'S NAME: 43230 OSGOOD ROAD PERMrr Issue DATe
ONG: SANITARY N0. CONTROL NO.
(510) 656-6400
ARCHITECTENGINEER: BUILDING PERMIT INFO
BLDG ELELT PLUMB MECH
i00 LICENSED CONTRACTOR'S DECLARATION Job Description
I herthy affirm Nn 1 am littmcd under mviu.ns of Chap 9(commencing P
wUWU ithSutian]IXRl)nf Division3af the Basin no Profen' ntl mylie is
m mu mroe ane a3 ROOF
Dill License Cleve
- Dam om,anor TSO. SHAKES, RESHEET�ADD 30YR COMP. SHINGLES
ARCHI'T'ECTS DECLARATION
e.U I understand my Id....hall he used as public recants
W Licensed Pnsfelsinnal ®
`reg OWNER-BUILDER DECLARATION
<I 1 hereby affirm that 1 am exempt from dm Contractor's License Law for the AUG 0 7 2003
20 fallowing reason.(Section 7031.5,Business and Profession,Code:Any city or county
m which roquirea a permit to conpmet,alter,improve,demolish,or repair any structure
riy Friar to its issuance.also mquiros the applicant for such permit to file a signed subtotal
< that he is licensed pursuant o the provisions or be Contncmr',License Law(Chapter 9 Sq.Ft. Floor Area1 p�Valuat'V1430
ex (commencing with Section 700))of Division 3oftheIsusineoand ProfessionsCredc)or BUIL®INtj
k 5— that he is exempt themfram and d¢basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
.at more than fns hundred dollen($500. 3MN rwVI!P6CiOO Occupancy Type
❑1,as,owner of the pmpeny,in my employees with wages ad;their sole compensation,
will do the work,and the structure is not intended ea ofrered fo...I,(Su.7044,Business
and Professions Cade:The Conlnctm'.License Law does not apply m.a owner or Required Inspections
properly who builds or improve.thereon,and who donsinch work himself.,through his 305 — FRAME
own employees,provided that such improvements are nor intended or offend for tale.If, 307 — INSULATION
however,the building or improvement is cold within one year of completion.she ownar.
builder will hive the burden of proving that be did not Wild or improve for purpose of 601 — ROOF TEAR OFF
axle.).
❑I,as Owner of the property,am exclusively contracting with licensed contractors to 602 - ROOF PLYWOOD NAIL
construct the project(Sec.]044,Business and Professions Code:)The C.nractor's Li. 603 — ROOF BATTENS.
Oman,law docs not pply to an Owner of progeny who builtls or impmva thereon,and 604 — ROOF IN-PROGRESS
who contracts for such prejecta with iscontnnmp)licensed pursuant to the Contramula
Ltcena Law.
❑1 am exempt about Su. B At P C far this,coon
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby a011m under recently of perjury one of the following dedartlions:
I have and will maintain a Ceniftea c of Catboat o self-Insum for Worker's Compere
pian,a provided for by Seclum 3700 of the Labe,Code.fm the performance Of the
work for which this Permit is turned.
1 have and will maintain Wmkes's Compensation limon.,as required by Section
3700 Or the labor Coe,for the performance of she work for which this permit is bound.
My Workers Compensation Insurance caner and Policy number art:
Carrier: Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
pile stets need not be completed if the permit is far one hundred dnllan(SIm1
nr less.)
1 ecnify then in the perfnmmrec or the work int which this permit is issued,l shall not
employ any person in any mannerso a Ice become subject to the Worlecri Cnmpcnsallon
Lew.of California.Data
Applicant
NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should
become suhjut to the Worker's Compensation pmvisiom of the Labor Cade,you usual
.Jz forthwith comply wish such provisina or this Minor, hall the deemed revoked.
Z'O CONSTRUCTION LENDING AGENCY
IberehyAMM that then is a conssructinn lending agency rar the performance or
ai the work fur which this North Is issued(Sec.3097,Civ.C.) _
W 0 Lender's Name
= z Under's Address
V 1 cenify that 1 have read this application and state that Ne above inrannarion is
14 F coned.)agree to comply with all city and county ordinances and stare laws relating to
(]„ building construction,and hereby autharin representatives of his city 10 enter upon the
W above-mentioned pmpeny for inspection purposes.
G (We)agree m ave,indemnify and keep harmless the City of Cupcnina against
r
V) liahilidOijudgments,costs and expenses which may in any way scout against aid silicon
V z ore nures, cc.f the granting of this ,mit /\
APPLICANT ERSTA S WILL C PLY WITH ALL NONPOINT Issued by: Date
SO onI LATI
'112Re-roofs
Signature of ApplieantlConmetor IData
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building Occupant store or handle havudous material
a deftnctl by the Cupertino Municipal,Code.Chapter 9.11,end the Health end Safety
Code,Section 255320)7
ElY.,. [:1 N. All roofs shall be inspected prior to any roofing material being Installed.
Will the applicant or future building occupant use equipment a,devices which If a roof is installed without first obtaining an inspection,I agree to remove
ill haardnux air cnatamibants a defined by the Bay Arca Air Quality Management all new materials for inspection.
uin7
❑Yet 0N
I havered the havudnissmaterials rtyuirtments under Chaptarl.95 ofthe Gldin ejrE% (i�C
eia Health KSafcry .M,Suuom25505 Sl3 aJ 25531.1 undcrppW thuifthc building ) /-.[.-Aw— t
dtu not cutmn ass a moa that t y resp. ility mpnufy dm occupant of the .l J
revaire rat t e1 or .a a .c nraa x Signature of Applicant Date
All roof coverings to be Class"B"or better
Owner tar aphmiasd agent Dm
r
Building Divisioa '
' 10300 Torre Avenue
x , Cupertino.CA 95014-3255
C17Y 0 Telephone: (408)777-3728
CUPERJINO Fax: (408)777-3333
Building .
Subject: Reroofing policy for the City of Cupertino.
I. 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 1/"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 %t-aM�sv.a
Address: —1�� ZU LL,)
Reroofing Company Name:
� S
Applicants Signature: � � s
Date:
Joe Antonucci
(Chief Building Official)
6/25/01 -
07/15/2003 20:26 5105303202 LEGALITIES INK PAGE 01
Ful
CITY OF CUPERTINO
&UPER,TINO
C(�- REROOFJo kRMIT APPLICATION FORM 3
APN # . Date: ? /15 03
{ . l
Building'Address`.
Owner's Name: Phone#:
` . ►^ p 34/3_j96 9
Contractor:� Phone#: License #:
�yl � S�o� loSL -6 foo . 's<o�
Contact: Phone# Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
0 Built-Up Roof 0 Built-Up roof
Q Asphalt Shingles >( Asphalt Shingles
A Wood Shakes it O Wood Shakes
U Wood Shingles 0 Wood Shingles
0 Other(Specify.) O Other(Specify)
Number of existing coverings . 17 .-�. ❑ Provide I.C.B.O. Report#
fQ To be Removed o Provide Mfgr.Installation Specs.
" Have Read, Understand and .-till Comply With Cu ertino's Tear Off Policy:
Job Description: _r10 „ ,; _ -,.0-dd 30)61
Residential jTg r Commercial ❑
Fire Zone: .Yes ❑ No ❑ i� Confirmed with Planning Dept. if
there are any restrictions:
Cosi of Project:
"type of Construction: Occupancy group:
b �Sl X30 • u„p
Qty.,if.. t .
Applicable Fee � _Fee Description Fee Group.
/. BPERMFEE _Bldg Permit Fees' BUILDING
BENERGY, Energy BUILDING
I BSEISMICRF� Seismic Fee,Res BUILDING
_
B$EISMICW4. . I Seismic Commercial BUILDING
BPLANCHIC`,. Plan Check Fee BUILDING
BUSLIC Business License BUILDING
� 60