03070104 CITY or curERTINO
Buamrvc DIVISION PERMIT CONTRACTQR INFQRMATION 'w
R a.tt, . ,xfir.-=3- •>s� xw c.:o,sdl a. .m b'
BU ILDING ADDRESS: MARCO ROOFING PERMITNO.03070104
• OWNER'SNAME: . 43230 OSGOOD ROAD PERMITLSEUEDATE
ONE: SANITARY NO. CONTROL NO.
(510) 656-6400
ARCHITECrrEN'GINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
LOO LICENSED CON'TRACTOR'S DECORATION
im C w 1 hertby affrm The,l am licensed under proviilou of Chapter Y(commencing Job Description
Z with temoff 7IXMB n(Division 3 of the Business mfeminm Me mYlieem '
in full fern and
a i License CI L L IEROOF n ga n
Dole Co no1Of T/O. SHAKES,PRESHEEP /WdN D30YR COMP . SHINGLES
,e FF ARCHITECT'S DECLARATION
y W< I undersand my plsm shall be used as public records
;LLrn Licensed Professional AUG 0 7 2003
G OWNER-BUILDER DECLARATION
i i f 1 hereby from that I em excmpt from Ihd Cmmraaor'a License law for be
E20following reason.(Section 7031.5,Business and Profmaiem Code:Any city or county BUILDING which requires mafter. mU/a Permit construct,ar,improve,demolish,or repair any structure YL 'V
primo is issuance.alsorequiresthe applicant forsuch Permit o File a signed statement
xxa that he is licensed p nsttotheprovisionoftheConractoriLicense Law(Chapter 9 Sq. Ft. Floor Area ValuatX845
(commencing with Section 7103)of Division 3 of the Business and Profesn sioCode)or
y that he is exempt therefrom and she buis for Ne alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally of 3g1�,$7pg1�er00 Occupancy Type
not more than five hundred della.(5500).
❑I,u Owner Of the progeny,or my employees with wages a their tole compenmtlon,
will do the work,and the structure is not intended or offered for sale(Sec.7094,Business Required Inspections
and Proefessions Code:The Contractor's License Law docs net apply to an owner of q p
property who builds or improves thereon,and who doeeeuch work himselfer through his - 305 — FRAME
own employee,provided that such improvements are not intended a offered formic.if. 307 — INSULATIONhowever,the building or improvement is sold within one year of completion,the owner"
builder will have the burden of proving the he did not Wild or Improve for purpose or 601 - ROOF TEAR OFF
rule,).
❑1,as owner of the progeny,am exclusively contacting with licensed Contacmd to 602 - ROOF PLYWOOD NAIL
continuer the project(Sec.7W.Business and Profusions Code:)The Conaeno'.Li. 603 — ROOF BATTENS,
cense Law does not appy to an owner or property who Wilds or improves summon.and, 604 — ROOF IN-PROGRESS
who contacts for such projects with a contractor(,)licensed pursuant to the Conm
tor's
License Lew.
❑1 am exempt under Sec. .B&P C for this recon
Ot
Owner Da
WORKER'S COMPENSATION DECLARATION
1 hereby aRrre under Penalty of perjury one of Ibe following deolaatiom:
1 had and will maintain a Cenifesm of Consent to self-insure for WorkeesCompen-
wion,aprovided for toy Section 3]000f Ne labor Cnde,for the performance of the
wed for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,a required by Section
31W or she Labor Code,for the performance Of Ne work for which this permit is issued.
My Worker's Compensation Insumna carrier and Policy number are:
Carrier. Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(Th6C'eriat raced not Wcomphmd If flocfermis is fsuoac hundred dolha(51(1(1)
or less.)
1 unify that in the performance Of the work for which this permll is issued,I shall not
employ any person in any maomr an as to become subject to the Worked'Compcmstlon'
Laws of Celifmnie.Date
Applicant
NOTICE TO APPLICANT:If,after making this Cenifcea of Exemption,you should
become subject to the Worker's Compensation provisions of the labor Code,you must
.J O forthwith comply with such provisions or this permit&hall he deemed mwked.
'Z " CONSTRUCTION LENDING AGENCY
M
"sew k for
rwhichrtm Natthere iu construction 3097.Co. ) l'm the Performance Or
Ri Ne work fur which This permit Is issued(Sec.3097. iv.C.)
U]A Lcndcfs Nemc
Z) z Lender's Address
U� 1 certify Nat 1 have reed Nis epplicatinn end sum Thu the oboe informuion is '
ser H bonding I agree to comply with y city and couoy ordtmncea and sum hot relating le
0U huildingetioned proend hereby purposes, mfiveinf this city memo!upon the
above-mentioned property for inspection puepnses.
(We)agree to save,indemnify and keep harmless the City Of Cupertino ageinsl
rh liabilities, udgments,cost.entl penscs soh ch may In any way accord against said City
U z in on Oce ser the ran' this per
APP ANT R A 5 A D L a PL WITH AL NON"POINT Issued by: Date r
10
/,) Re-roofs
Signawrc of
HAZARDOUS
APPlicaO u�
HAZARDOUS MATE RIALS DISCLOSURE Type of Roof
Will the a Cuorcm or future handing e,Chapter
store or handle Health andSafrmaterial
a defined by the Cupertino Municipal Code,Chapmr 9.12,and the Health and Safety
J�s
alc,Sccdnn 35532(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yct ❑No
win he applicant or mime banding Occupant use egaipmdnt ntaemas which
If a roof is installed without first obtaining an inspection,I agree to remove
It hamrdnus air ameminants u defined by the Bay Area Air Quality Menagcmcm all n0µ!materials for inspection.
nricl7
❑Yes ❑Nn
I have mad the Wormous materials requirements under Chapter 6.95 of the Califnr"
Huihh&Ssfmy Codd,Sections 25505,25533 and 25539.I undersand that if the Wilding .� C�mol nenlly hats s ren m it u m respemibllity m notify IhC acupant el Nc / Jtro nawhich st m pnaloi anceorgcenifatenraea.nay. Signature of Applicant Date
7 S All roof coverings to be Class "B" or better
,net Lir authorized in
I Dem
•• r
�` Building Division '
9 10300 Torre Avenue
f Cupertino,CA 95014-3255
CITY 0 Telephone: (408)777-3228
CUPEAPTINO Fax: (408)777-3333
Building Depait�nent
Subject: Reroofing policy for the City of Cupertino.
1. Prior to permit issuancd,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.
S. 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 I/"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:
s
Address:
Reroofing Company Name:
Applicants Signature:
Joe Antonucci
(Chief Building Official)
6/25/01
07/15/2003 20: 26 5105363262 LEGALITIES INK PAGE 04
I'✓1.Go
CITY OF CUPERTINO
REROOF
53 ,., 7CiT 1 °
�UPEI,TINO P RMIT APPLICATION FORM
APN# I q —� Date: 711 .510
/ , 3
Building Address:
Owner's Name: p Y �Ky Phone #:
Contractor-�"I2eJ hone #: License #:
/ QAZJ> . (Sod ios6-6 q0 V0,2 441
Contact: G / Phone # � Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
Q Asphalt Shingles > Asphalt Shingles
Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
O Other(Specify) y.A ❑ Other(Specify)
Number,of existing coverings_� __.� O Provide I.C.B.O. Report#
Jq To be Removed ❑ Provide Mfgr.Install&tion Specs.
J
wave Read, Understand and Wil Com 1 With Cu ertino's Tear Off Policy:
Job Description: _ro ,�,Py i, _ G�,oGQ 30 ,
yt �.
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ i Confirmed with Planning Dept. if
there are an restrictions: lJ
Cost of Project: Type of Construction Occupancy group:
7 _
Qty. if
Applicable Fee I'D Fee Description Fee Group
1
BPERMFEEBldg Permit Fees BUILDING
BENERGY:. Ener BUILDING
1 BSEISMICRE.` Sec Fee Res BUILDING
BSEISMICOMi _ Seismic Commercial BUILDING
BPLANCHK . _ Plan Check Fee BUILDING
BUSLIC Business License BUILDING; .
o