03070101CITY OF CUPERTINO
BUILDING DlvlsloN PERMIT
CONTRACTOR INFORMATION
BUILDING ADDRESS:
MARCO ROOFING
PERMIT NO 03070101
OWNER'S NAME:
432.30 OSGOOD ROAD
1'ERMrr LSBUE DATE
ONE:
(510)656-6400
SANITARY NO. CONTROL NO.
ARCHT ECTIENGINEEB:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
j LICENSED CONTRACTOR'S DECLARATION
Job Description
P
1 hereby affirm Oh IL I am Eansed under powmiona of Chapter 9 (commencing
with Section 7M�d{a�r�Division J of NC Buain sand ProfasinaC c. end my license is
i in full farce rand �J C •
REROOF
: Lice s
Dau
T/O.SHAKES, RESHEET/ADD 30YR COMP. SHINGLES
ARCHI CTS DECLARATIOI
t 1 understand my plans shall he used as public records
1�' p a
■ice /A16 �®
Licensed Pndcssinnel
OWNER—BUILDER DECLARATIONContractorslaw far Inc
exempt from Nc Conlns
I hreaso .(firm'ha 11. Any
AUG 2UU3
Coc : c
> following mason. (Section 703 1.5, , alter. and Professions Code: Any tiny or Corny
which requires a pmmil re construct, allay, improve, ore
t, improve. de sig any swmum
h Permit a
� prior ll1its 165YYn[C, a1AU requires the applicant for such permit to RIC 861gnCtl e101C111Cn1
t
r that he is licensedpubmanuntheprovisionsoftheContractor'sLicencelaw(Chapter9
Sq. Ft. Floor Area
BUIL®I oat"430
�
3 (commencing with Section 7")or Division 3 of the Business and Professions Code)ser
that be is exempt themfrom and de buil for the alleged camption. Any vinl.d. of
.A,�7a�aa7.,,
31Dvp tyvypvglFJetOO
MN 9 V"O'Y
Occupancy Type
Section 7031.5 by any applianl fon Permit Ohe applicant to a civil penalty of
not more Nan give hundred dnllarc ($500).
1, a owner of the property, Or my employees with wga as Nei, .In eompenution,
Required Inspections
enor's q P
will do the work, and the suuaum is not inumded or Read I ... 1.(Sm. 7Oa, Business
Code: The ComraLiam
and Prof salons Law does rut apply to an owner or
property who builds or improves thcaon,and who doe such work himulfor through his
305 — FRAME
own employees, provided that such improvements an, not intended or offered for ale. If.
307 — INSULATION
however, Nre e building or improvement Is sold within oyear of completion, the owner
huilder will haw the burden of proving that he did not Wild or improve furpurpouor
601 - ROOF TEAR OFF
ale.).
602 - ROOF PLYWOOD NAIL
C:] 1. as owner of me property, am exclusively contracting with licensed mnlractora to
Construct the project Bee, 7W, Business and Professions Cade:) The Contractor's U.
603 — ROOF BATTENS.
come law does not apply to an owner of property who Wilds or improwa Nemon,and,
604 — ROOF IN -PROGRESS
who contracts for such projects with a contractor(s) licensed pursuant m One Contractors
Lieenx Law.
❑ I am exempt under Sm B & P C to, 'his reaann
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penally of perjury one of the following declarations:
I haw and will maintain a Certificate of Consent o rel bimum for Worloos Cwnpem
Own, a provided for by Section 3700 of the Isbor Code, for Ne perfmmmce of the
work for which this permit is issued.
❑ 1 have and will maintain Worker's Compensation Insurance, a orpimd by Section
3700 of the Labor Code. for the performance of the work for which this permit is issued.
My Worker's Compensation Insurance artier and Policy number ale:
Cartier. Policy No.: _
CERTIFICATE OF FX EM MON FROM WORKERS'
COMPENSATION INSURANCE
(Ihk union need nm W eompleud If the permit Is fm one nundad dollars (Slip)
nr less.)
1 ccniry that in the performance of the work for which this permit is issued, I shall not
employ any person in any manner so a to WComc Subject to Workcts Compensation
Laws of California. Dau
Appliam
NOTICE TO APPLICANT: If, after making this Ceniflevu of Exemption, you should
become subject to the Worker'sCompensation provisions of Ne "hot Code, you must
foMwith comply with such Provisions Or this permit shall the deemed nvnked.
CONSTRUCTION
ON LENDING AGENCY
is a C
' 1 horny affirm Ne' dure is Construction 3 lending agency fm Ik Performance of
i s
me work for which this permit is issued (Sec. 7097, ON. C.7
Lender's Name
Lender's Address
,
I 1 cenify that I have read this application and sure that Ne aWve information is
CURen. 1 Agra m Comply with all city and courtly ordinances and state laws rclaling to
building construction, and hereby auNorim representatives of Nis city to enter upon the
1 above mentioned properly for inspection purposes.
(We) egrce to save, indemnify and keep harmless the City of Cupertino against
1 Rab111llea,jVdgmCnts. Costs and expenses which may In any way ACCNC against said City
In Consequence of granting of lhi s Pe I.
' APPLICANT RST N A LL CO Y WITH ALL NON -POINT
'.
Issued by: Date
SOURCE 1�•�
1Sh5Re-roofs
Type of Roof
Signature of Appliam iComranor Dau
HAZARDOUS MATERIALS DISCLOSUR E
Will the applicant or future Wilding Occupant store Or handle haallous material
as defined by the Cupertino Municipal Code, Chapter 9.11, and the Health and Safely
code, Sc6mYen 155314)7
All roofs shall be inspected to any roofing material being installed.
❑s ONO
prior
If a roof is'installed without first obtaining an inspection, I agree to remove
Will the applicant or future building oaupantuse equipment ordevices which
it ha'mdous it rnmemimums a defined by the Bay Arca Air Quality Management
all new materials for inspection.
strict?
Dyes L) No
I have mad me bavarNms materials mquiumenu under Chapter 6.95 of Ne Cali bur
ria Halth&SafCtyC Senium 15505, 533 and 25534.1 understand drat if the Wilding
docs no' Current ve • ten.n s y rcapon IiIY m yrtily see re upanl n( N[
mgmam not romasl 'art a e ar pap` .
/
�aA I ✓
V16 1•E " ��
Signature of pp (cant - 7 Date
4
All roof coverings to be Class "B" or better
Owner or,mntrinl geut Onte
Building Division
' 10300 Torre Avenue
l 4
Cupertino, CA 95014-3255
CITY 0 Telephone: (408) 777-3228
CUPEkTINO Fax: (408)777-3333
Building Deipartgnent
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 withoutspectorpon
first obtaining all insecti
'and written approval from the building in
. 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
prop' City inspection can be performed.
IMPORTANT: I '
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 tbis policy.
Homeowners Name: Or x C' O.., , _ - _.a-_
Address:
Reroofing company Name:
Applicants Signature: 7�— �o� "
_Date: z/�0
Joe Antonucci
(Chief Building Official)
6/25/01
a7' 15r''2002 20:25
CCC.
SCITY OF
UPERJINO
51E152822S2 LEGALITIES INK PAGE fi6
om -10IoI
CITY OF CUPERTINO
REROOF
P#,,RMIT APPLICATION FORM
APN #
Date: /l l
7` S 03
I
Building Address:
Owner's Name:
BUILDING
Phone #:
Z6 ? -32-2-3
Contractor:
Phone #:
S* L54-4 x00
License #:
`Fo�46/
Irl � 1
BUILDING
Contact: G
�t c. c✓3/7
Phone #gam
Cupertino Business License #:
Type of Roof Covering:
Existing:
Proposed:
❑ Built -Up Roof
❑ Built -Up roof
❑ Asphalt Shingles
)5( Asphalt Shingles
is Wood Shakes
❑ Wood Shakes
❑ Wood Shingles
❑ Wood Shingles
❑ Other (Specify) -4
O Other (Specify)
Number of existing coverings _J _
❑ Provide I.C.B.O. Report #
To be Removed
O Provide Mfgr. Installation Specs.
Have Read, Understand and ill Compl With Cu ertino's Tear Off Policy:
Job Description: `i/p
30)m `'"^`f'.
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑
Confirmed with Planning Dept. if
there are an restrictions: LJ
Cost of Project Sy3000 Type of Construction: Occupancy group:
Qty. if
Anolicable
Feeii ID
Fee Descriotion
Fee Grout)
/ BPERMF'EE 1
Bldg Permit Fees
BUILDING
BENERGY
Energy
BUILDING
BSEISMIC _
BSEISMICOM
BPLANCHK ;'
Seismic Fee Res_
Seismic Commercial
Plan Check Fee
BUILDING
BUILDING
BUILDING
BUSLIC
Business License
BUILDING
ML
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