03070111 s CITYOFCUPERTINOe ' � f::` " s ^"¢ '�� r,q.
BUILDwcDrvlsloN PERMIT ONTRA,C�T RINFOORRMAT-12
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UII.DINC AD0RFs5: MARCO ROOFING PERMIT N003070111
-IIIIDFIGWER 2T
uow E •s NAM (510) 656-6400 ONTR
E: 43230 OSGOOD ROAD PRRMIT ISSUE DAM
DNE: SANITARY NO. COL NO.
ARCHITPCMNGINELR: _ BUILDING PERMIT INFO
L'a. 9`fb3g
BLDG ELECT PLUMB MECH
y0o LICENSED CONTRACTOR'S DECLARATION Job Description
U I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing P
with Section?M))of Division 3 of NC Busi and Professions C e..nd my license is
In full force and c
z'y,z ,can. s .a REROOF
Data ARCH I SDECLARATIO T/O. SHAKES, RESHEET/ADD 30YR COMP. SHINGLES
-t 1 undeastand my palms atoll be used u Public record.
=a� FINALE®
o Licensed Professional
S OWNER-BUILDER DECLARATION
i�2 I heathy affirm that I am exempt from the Conuactm•a License Lew for the AUG
'1 O 900¢1
S 0 O following recon.(Section 7031.5,Business and Professions Code:Any city or county AUG 1 U L 3
X m which recount a permit Or construct,altar,impmw.demolish,or repair any struaun
prior in its issuance,also requires the applicant for such permit mile a signed statement
£ < that he is licensed pursuant to the provisions of the Comncmr's License Law(Chapter 9 Sq. Ft. Floor Area !1. w ua49
y�$ (commencing with Section 7")of Division 3 of the Business and Psofnssis.Coor)or BU�LD�N 4-a72O
that he is exempt therafrom and use basis for the alleged exemption.Any vlohtion of ,A,g7� �{., �s �/Y �wV
Section 7031.5 by airy applinnt fon Permit subjects the applicant to a civil penalty of 30'¢f i]YlY�9(;IOO Occupancy Type
Out more then five hundred dollar.(5500).
❑1,a owner of the pmptny,or my employees with wage.14 their sola compensadnn,
will do the work,and one arumure is not intended or offered for sale(See.7044,Business Required Inspections
and Professions Code:The Conuaetors License Law does not apply to C an owner of q P
property who builds or improve.thereon.and who deessach work himselfor thmugh his 305 — FRAME
awn employees,provided that such improvements art not intarmded or offered for Asia If,year 3O7 — INSULATION
however,Ne building or imm
proveent is mid ne within oof romplefiom lie owrcry
builder will haus the burden or proving that he did not build or Impress for purpose of 601 - ROOF TEAR OFF
❑1,a owner of the property,em exclusively contracting with licensed contractors to 602 — ROOF PLYWOOD NAIL
Optimal the project(Sec.7M4,Business and Professions Code:)The Contractor's Li. 603 — ROOF BATTENS.
cense Law does not apply to an Owner of property who wilds or improves thereon,and, 604 - ROOF IN-PROGRESS
who contracts for such projects with a Contractor'sr(s)licensed pursuant the Contractor's
License U-
0 l am exempt under Sec. Bk P C for this recon
Owner Data
WOR KER'S COMPENSATION DECLARATION
[ I hereby affirm under penslty of perjury one of the following declarations:I have and will maintain a Cenifieato of Conscn0o albin.um fm Workers Compere
.tion,.provided for by Section 3700 of the Labor Code,for the performance of the
work for which this remit is issued.
❑1 have and will maintain Worker's Compensation Incunned,As required by Section
3700 of the Labor Codd,for the performance of the work for which this permit is issued.
My Worker'.Compensation Insurance artier and Polity number rt:
Cartier: Polity No.: _
CERTIFICATE OFEXEMPTION FROM WORKERS' .
COMPENSATION INSURANCE
(TMs section need not be completed lithe Permit is for one hundred dollar(9HXB
nr less.)
1 cenify,that In the perrmmancc of the work for which this Permit is issued.I.hall not
employ any person in any mannet an As to become Object to the W himos'Cmmpcn.tion
Laws of C.lifomis.Dau:
African,
NOTICE TO APPLICANT:If.ager making this Certificate of Exemption,you should
become subject to the Worker's Compensation previsions of the Latour Code,you must
.J O forthwith comply with such provisions nr this Permit be deemed revoked.
,zs r-m CONSTRUCTION LENDING AGENCY
I hereby affirm that there its construction lending Agency lm the performance of
(Y.> the work for which this permit Is issued(Sec.3097,CO.C.)
mal Lender's Name
z Undcr's Address
V Q I cenify that I have rad this application and soon that the above information i.
u. Canada.I agree to comply with all city and county on inances and state laws raising to
building conmuction,and hereby authorise repaesentativss of this city to enter upon the
,rat above-mentioned partially for inspection purposes.
(We)agree to save,indemnify and keep harmlea the City of Cupertino against
rA Iiabibiles,judgments.costs and expenses which may in any way acame against said City
Uz income, coftha grant isix-
APPLIC UNDE AND WI COMELY WITH ALL NON-POINT Issued by: Date
S U E � N
Re-roofs
Signature Df Applican✓Contncho Dan,
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle hara dour material
to defined by the Cupertino Municipal Code,Chapter 9.13,and the Health and Safety
Cute.Swoon 25533(¢)? All roofs shall be inspected prior to an roofing material beim
❑Yes ON. P P Y g g installed.
Will the applicant or(auto building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it haardous air contaminants As defined by the Bay Ana Air Quality Management
Wrict7 all new materials for inspection.
❑Yes ❑No Cding '�Ca
I have mad the hazardous materials requirements under Chapter 6.95 of the Califni, ;72GC�mQ/+/ Yi.//!i/Jw__�•��.
Intos nothk SntlyCrack,howa tenannshat it i my exnd75534,1 Indammndthal eOccupantilm orthe 7�fs not curtendy huts a tenant,Nat it is my responsibility m nnfily the occup.m of Nefuircmcn hichmust mO missuan ofaCcnificasnfOcc panty. Signature of-Applicant Date i
1$ b� All roof coverings to be Class "B"or better
Ow aur.umbo m yen,
Data g
. K4VVll� Building Division
S • a'+" 10300 Torre Avenue
Cupeaino,CA 95014-3255
C]TY 0 Telephone: (408)777-3228
CUPCkTIh O Fac: (408)777-3333
Building Depa ent
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
completed.
approval shall be obtained from the building inspector when the reroofing is
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
S. 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 .
I City inspection can be performed.
IMPORTANT:
1. Flat roofs must have a minimum of /V'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: C-C-
Address:
10
Reroofing Company Name: Cfnr-.--_�_,
Applicants Signature: —
Date: Z /
Joe Antonucci
(Chief Building Official)
6/25/01
9'x''15;299° 29: 26 5195=S2262 LEGALITIES INK PAGE 96
i r m tL1,(.O
�� CITY OF CUPERTINO � '� L6
REROOI+
SUPCITEkTY
INO PERMIT APPLICATION FORM
APN# Date:
Building Address:
Owner's Name,. C � Phone #: 2-ZZ _32,2--3
Contractor: Phone #: License #:
h1 _?S 1�5L-6 ' 00 �fO.zRGI
Contact. G Phone #6 Cupertino Business License #:
3
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles )i( Asphalt Shingles
X Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) _` _ _ ❑ Other(Specify)
Number of existing coverings ' ❑ Provide I.C.B.O. Report#
To be Removed ❑ Provide Mfgr. Installation Specs.
Have Read, Understand and W(11 Com I With Cu ertino's Tear Off Policy:
Job Description: "Tl0 ,�,�,; _ _ zzdd 3o y�i ( - 4 u4 , , [b
Residential V Commercial O
Fire Zone: Yes ❑ No F1 Confirmed with Planning Dept. if
1 there are any restrictions:
Cost of Project: Type of Construction: Occupancy group:
5710 • l3�
Qty. if
Applicable Fee ID _ _ Fee Description Fee Group
BPERMFEE i v Bldg Permit Fees BUILDING
BENERGY Energy BUILDING
1 BSEISMICRE, Seismic Fee Res BUILDING
_ BSEISMICOM Seismic Commercial BUILDING
BPLANC_HK _ Plan Check Fee BUILDING
BUSLIC Business License BUILDING
60