03070105 CITY OF CUPERTINO �^ e' a ». x `•v�` a % ` `- � !»
BUILDING DIVISION PERMIT 'ON,TRACTDR�°INFORMA.TION.
BUILDING ADDRESS: MARCO ROOFING PERMIT NO 03070105
OWNER'S NAME: 43230 OSGOOD ROAD PERMfTISUEDATE
(510) 656-6400
ONE: SANITARY N0. CONTROL NO.
BUILDING
BUILDING PERMIT INFO
BLDG ELF.LT PLUMB MECH
no0 LICENSED CONTRACTOR'S DECLARATION
wp 1 hereby Often that 1 em licensed and pr0v.Aisms of ch 9 unman ring Job Description
IW wish Sool1on70fM)nrDivision3or NC Basi and pmfc m n .antl myl' seta
5nzin full force and eckx 9 EROOF
Llcenx .
^� DaT:�__COnwnor TSO. SHAKES, RESHEET/ADD 30YR COMP. SHINGLES
EE ARCHITECTS DECLARATION
>C U I undersond my plans shall be used as public records
ir Licensed Pmressinnat
L OatIameUILDER mptfroECLARATIDN AUG 0 7 2003
. 1 hereby marso affirm on 1 1. exempt from the Cssions o :Any c ty o for the
00 which following a Permit
to
703 1.5,Business imp Professions Code:Any city stratum roomy
x m which requires•permit oc emit t e,eller,impmm,h ermit t nr e a sig any tateme
pat it)he
ernadpursu mquime thovisioso mefor SucContraoni0oicense Law
stammem
that he it Bernard pursuant to the70kh)of Divisionfthe Cnmrumri Licenselsw(Code)r9 Sq. Ft. Floor Area BUILDINt2 alua["720
e€e (eat he Is
(commencing Saloon "it or Division3 of the
egeBusiness and ProfeainnaCMej Or
A.
$
that he b exempt them(mm and ate bail for the alleged eumplion.Any violation of -
Section 1031.5 by any Applicant far a But subjects the Applicant to s civil penahy of 31I1 gIg1 CJOQ Occupancy Type
not mom Nan five hundred dollars(S500). 1P SU"
1,u owner of the propcny,or my employees with wages at their sole companion,
will do me work,and Be sticture is not intended or offend fpr rale(See.7DN,Business
and Pmfesslons Code:The Contructora License Law does not apply to an owner of Required Inspections
property who builds or improves menton,and who Gas such work himxlfor tbmugh his 305 - FRAME
own employees provided ren such impmmments are not intended or offered for late.If. 307 — INSULATION
however.the building or impmmment is sold within one year or completion,the owner
builder will have he burden or proving that he did not build or improve for purpose of 601 - ROOF TEAR OFF
late.).
1—]1.as Owner of the property'am exclusively contracting with licensed contractors to 602 - ROOF PLYWOOD NAIL
LOalme the project(Sec.TOdd,Business and Professions Code:)The Contractors Li. 603 — ROOF BATTENS.
am law does not apply to An owner of property who builds or impmms themon,and, 604 — ROOF IN-PROGRESS
who contracts for such projects,with a contranorfs)licensed pursuant m the Contractors
License Law.
I am eaempl under Sec. B k P C for this moon
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hemhy Air,.under penalty of perjury one of the following declarations:
1 have and will maintain a Cenifelf,of Consent to aelfdnsum for Worker',Compen-
sation,u provided for by Section 3700 of the Labor Code,for the performance of the
work for which this peanut is issued.
1 have and will maintain Workers Compensation Insurance,a required by Section
3700 of the Labor Code.for me performance of he work for which his permit is issued
My Worker's Compensation Insurance carrier and Policy number art:
Carrier: Polity No.:
CERTIFICATE OF EXEMPTION FROM WORKERS' _
COMPENSATION INSURANCE
(ThIo xetinn recd not he mmpletcd Hthe Permit is An one hundred dollars(SRM)
or less.)
1 eenify mal in the performance Of she work for which this permit is laxed I shall not
employ any person in any manner An As in become subject to the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker'a Compensation provisions of the Lahm Code,you muter
.JO (crawl th comply with such provisions or this permit shall M deemed revoked.
z CONSTRUCTION LENDING AGENCY
I hemhy atlrm that here is A construction lending agency for the Performance of
f17 me work for which this permit is issued(See.3097,Co.C.)
W A Under'a Name
z Lender's Addntss
V Q 1 certify that 1 have reed this application end mote that me abom information is
Ie.E. coantn.I agree to comply with all city and county ordinances and sure Iowa relating to
p U building conswetimm and hmehy autimm.repmsenmw ivof his city care,upon the
�4 abnve-mentinned property for inspection porpoises.
(We)agree to save,indemnify And keep notthe City or Cupertino against
Hh liabilitlw,judgercno,caaoand rape s which mayor any way acme against said Ci Ly
U z in conx9ue or the gra i permu.
APPLIC UND A S D 1 0 W TH ALL NON-POINT Issued by:9 Date
SO I
Re-roofs
Sigawm of
HAZARDOUS
AppliaO Datc
HAZARDOUS MATERIALi DISCLOSURE Type of Roof
Will the applicant
nefuwrcbuilding
e.Chaptstarenr and the
Health
and
As defined by the Cupertino Municipal Code,Chapter 9.12,and the Hwhb end Sorely
Code,screen 25532(a)?
0Yca ❑No All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant use equipment nr devices which If a roof is installed without first obtaining an inspection,I agree to remove
it hazardous air conterminous a dcfncd by me Bay Area Air Quality Mamvarom all new materials for inspection.
isvict1 /J
C]Yes ONO
1 have rtaJ he hnwNrws materials fey'rcmcnts under Chapter 6.95 of the Cali for
ria Hwlth&S ty Code,Sadoa 3.25533 25534.1 understand thuif me building 1 C a
arcs not c tly Nm m il6 my r mmiliy ad nndry the�cuputt of me
N, C1 °r pdrty' Signature of Applicant Date
!Mho_
�S�t All roof coverings to be Class "B"or better
Owner or euthori'rcJ agent Dae '
{Vk
Building Division '
10300 Torre Avenue
`E Cupertino,CA 95014-3255
CITY O Telephone: (408)777-3228
CUPEkTINO Fax: (408)777-3333
Building Department
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
'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 approva.L
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'K"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:
e
Address:
o
Reroofing Company Name: s
Applicants Signature: �o
Date: /
Joe Antonucci
(Chief Building Official)
&25101
07/1.5112G_iG_U 2a: 25 51052F3262 LEGALITIES INK PAGE 03
t
(�` CITY OF CUPERTINO
REROOF o3
&UPERTiNO PORMIT APPLICATION FORM v u 0
APIv #
Building Address: //6 ,25-
Owner's Name:ee C Phone#: Z4 Z-3 Z 2 3
Contractor: a Phone #: License #:
S/o� �s6 -6q00
Contact: G Phone 11 a'rrv� Cupertino Business License #:
_L6u ` '
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles X Asphalt Shingles
X Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
Q Other(Specify) ❑ Other(Specify)
Number of existing coverings 1? ❑ Provide I.C.B.O. Report#
A To be Removed ❑ Provide Mfgr.Installation Specs.
Wave Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: -fp 3o)*i q"_ ;
Residential Commercial ❑ `' �}'
Fire Zone: Yes ❑ No ❑ _ Confirmed with Planning Dept. if
_ there are any restrictions: L(
Cost of Project. ' Type of Construction: Occupancy group:
S72o . _ — --
Qty. if
A licable _ Fee i Fee Description Fee Group
/ BPERMFEE Bldg. Permit Fees BUILDING
BENERGY Energy BUILDING
1 BSEISMICR Seismic Fee Res BUILDING
BSEISMICOM< Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
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