03070109 CITY OF CUPERTINO "° '"f
1 BUILDING DIVISION pj3gibjj'j CONTRACTOR I,NFrORMATION ,
BUILDING ADDRESS: MARCO ROOFING PERMIT NO.03070109
E AME: CT PERMITIESUEDATE
43230 OSGOOD ROAD
ONE: SANITARY 0. CONTROL NO.
(510) 656-6400
1.11
CHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 Q t� 0
u0LICENSED CONTRACTOR'S DECLARATION lob Description
I hereby affirm that 1 em licensed under provisions Of Chapter 9(commencing
7, h Section7001po(Division Sof NC Basin and Norman Co andmylimmets,
force and p C63 EROOF
jgense
ZF Date se T/O. SHAKES RESHEET/ADD 30YR COMP- SHINGLES
yQ 7W7W ARCHM-CT'S DECLARATION r •l
Y < Iunderaundmyplismshillheuud as
publicrecofds
OWU
it
u Licensed PmfcssionalI p ']
sO3 OWNER-BUILDER DECLARATION 2003
P I hereby affirm that I am exempt from Ne Conmetors ummu law for be .�
AUG +
n D following resume.(Section 7031.5,Business and Professions Code:Any city or county
$ which requlms a permit to construct,a1ur.improve,demolish,or repair any anucuta
FZ< Prior o its issuance,also requires the applicant for such Permit o flea signed statement
£SS that he ire licensed rrosuanOO the raviaionnfthe Contractor.Gicen.Law(Chapter 9 Sq.Ft. Floor Area 1LUII Valuat430
CF$ (commencing with Section 70(s))of Division 3 M the B usiness Intl Professions Coded or
Nal he Is exempt therefrom and the basis for the Bllcged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil Penalty of 3g1�Ill glgl�er00 Occupancy Type
.or...roma Nan five hundred delta.35W).
wil
L u owner,the p ermun rn my cmntended moffingee u (Sm.
eom.Ilmdoon,
.it Pr lesion.and Ne awnnalsnotNmneedo Law doforst notpply 7o u.Easiness Required Inspections
Forrand my n obs Code:The Cs thoroom nd who
law don not apply lf,t owner of q P
me enywhob,provided that
Neaogand who doe eauchw.k himulfm through his 305 - FRAME
however,the euildin providedoriNat impruch ovement
truld improvements ear of c orortcrcd for Owner. 307 — INSULATION
however,the building or improvement is old within one year of completion,the owner. .
builder will have the burden of proving Nn he did not Wild or improve for purpose of 601 - ROOF TEAR OFF
sale.).
[:]1,as owner of the property.am exclusively contracting wish licensed contractor,to 602 - ROOF PLYWOOD NAIL
construct the project(Sec.7Ud4,Business and Profession Code:)no Contractor's Li. 603 — ROOF BATTENS
=rise Law does not apply to an Owner o(pmpeny who Wilds or improves thereon,and - 6O4 — ROOF IN-PROGRESS
who contracts for such projecu with a comoodoold licensed pursuant to the Contractor's
License Lo-
0 lam cxcmpt no.Sec. B 9 P C for this..on
owner Dau
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
1 have and will trainize a Cenlficam of Consent to selFinsure for Worker's Compe n
1031.1W
inn,as provided for by Secsion 37M of the Labor Code,for the pcHom rmec of the
rk for which this permit is nosed. "
1 have and will maintain Worker's Compensation hounna.as required by Section
of the labor Crel for Ne performance of Ne won for which this Permit is issued.Worker's Compent cion Insurance cannot end Policy number art:
rtier: Polity No.: _
CERTIFICATE OF EX EM MON FROM WORKERS'
COMPENSATION INSURANCE
(This action need not he completed If Ibe permit is for one hundred dollar($100)
ear less.)
1 cenify that In the Performance of the work for which this permit is issued.l shall not
employ any Person in any manner in as In become subject to the Worker:Compensation
Laws of California,Dau "
Applicant
NOTICE TO APPLICANT:IL after making this Oci ifcau of Exemption,you should
become subject to the Worker's Compensation prevision of the labor Code,you must
.JO mMwio comply with such imod,ions.,his remit shall W dimmed minted.
z' CONSTRUCTION LENDING AGENCY
'F+ �N+ I hereby affirm Net Nem is a conswnintionding agency for the performance of
fY" > Ne work for which this Permit is issued(Sec.3097,Civ.C.)
ALender's Name
z Lender's Address
V Q I cenify Net I have read thirty and coon and sou that tnd shove information is -
C)U building coagree m co.any with all auffirkin county nNines Or and Cute less;relatingupoto
the
pU ithevingeonawniroert herebyemhon formaesenmisesof his City tocnmrupmn the
W eMvo(We)siedpropcny forinspectionmoreha.
(We)eget,use,indemnify and kap hay in an the City accrue
CuPenst a against
Z Iicmotitles,judgmc R��
n and of
.1mayinany way eccroegainstmidCity
f)z APLICAorthe '
'-` APPLICACOA Y WIjH ALL NON-POINT Issued by: CDate
SOURCE �
IIS/o 3 Re-roofs
Signature of ApplicanVConuactorate
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof .
Will the applicant or future building uccupem store or handle hamnaous material
as defined by the Cupertino Municipal Code.Chapter 9.11,and the Health and safety
Colo.Section 25532(a)? All roofs shall be inspected prior to an roofs material beim installed.
Inisl ❑Yea ❑Nm P P Y S g
Will Ne applicant or future buildingoceapem one equipment at devices which If a roof is installed without first obtaining an inspection,I agree to remove
i,do&SOf
it ha'mmous air=ruminants as defined by the Bay Arta Air Quality Management all new materials for inspection.
hia7
0Yci ❑NoI have mad the Nnrdous materials requirements under Charter 6.95 of the Califon m cSccdnn 25511 SJOcx d25 Ihlmldcrsmntl Nwif the Willingcone ovc e� t i y po liry m nn"'NcacurentofNcniam ' rc ey Signature of Applicant Date
All roof coverings to be Class"B" or better
Owner.euthmiucd agent Z paid
Building Division
10300 Torre Avenue
;1 rlF4
Cu
TM,x Per[ino,CA 95014-3255
CITY 0 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 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/4"per foot slope and demonstrate that
there is no ponding.
2. An I.C.BP. 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: �'' G� Q�
ax
Address: _��G 75 WtiQ �� II-
Reroofing Company Name:
Applicants Signature:
nn , -_Date: "7 / ,f
Joe Antonucci
(Chief Building Official)
6/25/01
07x15/200^ 2E1: 5105299292 LEGALITIES INK PAGE 03
' k/LLo
titCITY OF CUPERTINO �o j,6
t
REROOF0-70/ 6) 9
IUPCER,TITY
INO P19RMIT APPLICATION FORM
APN # Date: !1 S`03
Building Address:
Owner's Name: Phone#:
z6Z-3 2_Z3
Contractor: """" Phone#: License#:
)44a)l_c� S/off (os6-6 foo
Contact: G Phone #6 Cupertino Business License#:
w
-2-1317
T Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles X Asphalt Shingles
-21 Wood Shakes O Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide LC.B.O.Report k
To be Removed ❑ Provide Mfgr-Installation Specs.
ave Read. Understand and W':11 Co5ply ComplyWith Cu rtino's Tear Off Policy:
Job Description: -fo �� , _ _ �rf�Q 30y,, `'t'W`Y-
Residential Commercial 0 �^
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are any restrictions: LI
Cost of Project:s Type of Construction: Occupancy group:
Qty. if
Applicable Fee TD Fee Description Fee Group
/ BPERMFEE Bldg Permit Fees BUILDING
BENERGYEner _ BUILDING
1 BSEISMICRE 4 i Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
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