03070102 CITY OF CUPERTINO "^" ' '^�'r.� t•* '" °�^"r''�'
BUILDING DIVISION PERMIT GONTRAGTOR,;INFORMATION.`::
BUILDING ADDRESS: MARCO ROOFING PERMIT NO 03070102
0 NER'S NAME: 43230 OSGOOD ROAD PERMIT LSUE DATE
ONE: (510) 656-6400 SANRABY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0
1110 ij LICENSED CONTRACTOR'S DECLARATION
Z1 hereby upon Old 1 am licensed under provisions or chapter 9(commencing Job Description
< wish Seenion7Mlll of Divialmn3of the Ousinus and fessinns Co e.an license is
in full ft me and e
D q? Liamc Ep f�a 3 4 see. ..ahER10F
-� Datecnntr ARCHITECTS DECLARATION T/0. SHAKES, RESHEET/ADD 30YR COMP. SHINGLES
Iend...land my plenashell he used..publiememds
?�U
3 0 Licensed Professional
ryy OWNER-BUILDER DECLARATION
3<y I hereby affirm that I am exempt rrum the Contractors License Lew for the AUG 0 7 2003
C O following reason.(Section 73I.5.Business and Pmfasions Code:Any city or county
$ which rtquims a .it to const.,,,e)m,.improve,demolish,nr rtput,any smucmm
pdor m its istuanct,clan require Oc applicant for such Permit to File a signed smtemdnt
WH�< that he is licensed eursmm 1.do,provisions of the Cmuldcmr's License Li.(chapter 9 Sq. Ft. Floor Area Valuat' 4670
(commencing with Section 70"ofDivision 3oftheBusiness and ProfessintmCode)or BUILDING
n3..
that he is attempt therefrom and Ne basis for Ne alleged exemption.Any violsfimn of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil Penalty of - 3.A,BN.(Wg1.Or 00 OCCapanCy TypE
nm more Nen Rva hundred dollars(S5M). 0'0 SV` Y
❑Lo due
wo ofthe pmperry,art myemplended withwaguuHei(tett compensation,
will do rre work end the structure eCounis nos intended Law do(Oxide(Sec.70th,Business
and Pmfwild bas ldsor The C,doodod,License Law docs not apply tom owner of Required Inspections
formally wild bulldanrimprossthereon,and whodasmch work himself orthrough his 305 — FRAME '
own employees.provided that such improvements am not intended or offered for sale.If, 307 — INSULATION
however,Na building or improvement is sold within ora year of completion,theowner-
builder will bin ftburden of proving that he did not Wild or improve for purpose of 601 — ROOF TEAR OFF
sale.).
0 1,as owner of the property,am exclusively contracting with licensed contractors to 602 - ROOF PLYWOOD NAIL'
construct the project(Sec.7010.Business and Pmfeuions Cars)The Conudl Li. 603 — ROOF BATTENS.
cense law does not apply Loan owner ofpropeny who builds or impmKs themon,ma, 604 — ROOF IN—PROGRESS
who contracts for such records with a contractors)licensed pursuant to the Contrscto s
License Law. -
0 1 am exempt under Sec. ,B&P C for this ration
Owner Data
WORK ER'S COMPENSATION DECLARATION
I hereby afNm under penalty of perjury one M the following declarations: -
I run and will maintain a Cardinale of Consent rel Gloom for Worker's Compete
1371M
ion,as provided for by Section 3700 of she Labor Code,for the Performance of she
rk for which this permit is issued.
1 have and will maintain Worker's Compensation Inaunnca,u mquined by Section
of the Labor Code,for the Performance of the work for which this permit is issued,
Worker's Compensation Insurance artier and Policy number art:
rtier: Polity No.: _
CERTIFICATE OF EXEM MON FROM WORK ERS'
COMPENSATION INSURANCE
(This section decd our be,tordeted lithe permit Is former hundred dollars(SIM)
or test.)
1 certify Net in the performance of the work for which this Permit is issued,I shall not
employ any person in any manner an as to become subject no the Worlecri CompeasNon
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,afmr making this Certificate of Exemption,you should
become subject to the Worker's Compensation previsions trim,labor Code,you must
Qz forthwith enmply witb.aeh Provision.ms his permivall M domed¢voted.
zO CONSTRUCTION LENDING AGENCY
-�-+"l' I hereby alRrm that there is a cmtstdction lending agency for the performance of
Cid the workfur which this permit is issued(Sec.3097.Civ.C.) -
W Q Lendcr's Name
Lender's Address
az
U. Q 1 certify that 1 has it this application and.tam that the ends l information Is
U. f-' building 1 egret to comply with all city and county ntati n of and cute laws relating e .
QU building construction.and hereby amhonm'cous. sivesaf this city meaner upon the
ahnve mentioned to saw,for inspection an duteous.
H y
(We)agree In us,inticmnify and keep harmless the city of Cupcnina sgaidu
h liabilitles,Jutlgmcnts,cauand cxeenusw 'ch may in any way eccroc
looCity
V(� in cnnuqucnct of Ltng of is '
" APPLICANT ERST D LL Y NON DINT Issued by: Date
SOURCE �j f
Re-roofs
Sign+Lure of
HAZARDOUS
AZA ApoliaRDDOO ate
HAZAUS MATERIALS DISCLOSURE Type of Roof
WIII the applicant cert fMuni building arupmt store ter and the
h Health
and
as defined io the Cupertino Municipal Coda.Chaeta 9.12,and the Health antl Safcny
code.sermon 25532(o' All roofs shall be inspected prior to an roofing material beim Installed.
❑vda pNu P P � Y g g
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
it hvardnus air concealments as diluted by Ne Bay Arta Air Quality Management all new materials for Inspection.
ismin7
❑Yes Otho
I have read the havardeus materials requirements under Chapter&95 of the Calder. s
niaHwlth&SafbryCodc.sccdau3utit I my and 25539.1 uo offy dooccucbeof he
InernJens not cuncn0y hose ext,then it i my sibility to npfy tM occupant of the
o,cut.wnicnm mete' n ranamr mrrxeuP.ncr. Signature oCApplicant Dale I'g
/ ISD All roof coverings to be Class "B" or better
Owner m amhmood agar Dale,
Building Division '
10300 Torre Avenue
Cupertino.CA 95014-3255
CITY 0 Telephone: (408)777-3228
CUPEkTIN® F= (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 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:
Address
G�
Reroofing Company Name: ' S
Applicants Signature: .. „�a,
-_Date: Z /�ar
,'� .--9 d
Joe Antonucci
(Chief Building Official)
6/25/01
07f15r20nll 201: 26 51F152P32E2 LEG:LITIES INK P"GE 07
yY1 kAc a
zo
CITY OF CUPERTINO' REROOF
*UPER,TINO P9RMIT APPLICATION FORM
APN # I — Date:
Building Address: //G SL)U
Owner's Name: a� R Phone #:
Contractor: — Phone #: License#:
arca _ �S/off ros6 -6 q00
Contact: Phone #6 Cupertino Business License#:
� 213/
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles )( 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 Comply With Cu ertino's Tear Off Policy:
Job Description: _r/0 ,,,,�' -- , �a� s.16- �P 30 Y, anV74. ; (h
Residential — — Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are any restrictions: U
Cost of Project: Type of Construction: Occupancy group:
'�6 70 - can
Qty. if
Applicable FCC JID _ Fee Description Fee Group
I BPERMFEE Bldg Permit Fees BUILDING
BENERGY Ener- BUILDING
BSEISMICR ` Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK j Plan Check Fee BUILDING
BUSLIC I Business License BUILDING
IMF
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