03070112 CITY OF CUPERTINOx - %�>✓� ��"`' ,1
euaowc nnHSlory PERMIT CONTRACTOR INFORMATION
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UILDINGADDRESS: MARCO ROOFING PERMITNO03070112
WNER' Nor-
AME: PERMIT TRUE DATE
43230 OSGOOD ROAD
NE: SANITARY NO. CONTROL NO.
(510) 656-6400
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LOO LICENSED CONTRACTOR'S DECLARATION Job Description
U I hereby affirm that l am licensed under prnvisiuns of Chapter 9(commencing P
with Smtion7BIM))tir Diviiion3of thc Busin and ProfcssimsC endmy lie seia
in full force and a cat.
q_ tree, 211i�L� ' � EROOF
^^
Ga.
e ! T/O. SHAKES, RESHEET/ADD 30YR COMP. SHINGLES
££ AR hall
TS DECLARATION FINALE®
T undemanJ my plana shall he used as public rtrnr@
3uLicensed Professional
�0 OWNER-BUILDER DECLARATION
<0 AUG 1 8 2003
X I hereby affirm Nat 1 am exempt from the Contractor's License law for nW
O O following rtmon.(Section 7031.5,Business and Profcatinm Code:Any city Or county
which requires a permit to construct,eller,improv,demolish,car repair any stracture -
HZi pdortoitsissuance.alsorequimaaheapplicantforsuchPermittollleasignedsutemem Sq.Ft. Floor Area
BUfM43O
that he is licensed pursuant to the provisions of the Connector's License Lew(Chapter9
O (commencing with Section 70M)of Division 3 o(Ihe Business and Professions Crdc)or
$ that he is exem(d therefrom and the basis for in,alleged es mipfion.Any viobtlon of
Section 7031.5 by any applicant for a permit subjects the applicant-to a civil penalty of - 3,h,BAi daT.,.�1.erOO Occupancy Type
not mom than Bw hundred dollars($5(10). 6`0+1`S V' O
I,as owner of the Pmpeny,or my employers with wages u their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections
and Professions Code:The Contractor.License Law does net apply to an owner of q P
property,who builds orimproves themon,and who doeuuch work himselror through his 305 - FRAME
..employ..provided thanSoch improvements...at intended.,.Resed for sale.If. 3O7 — INSULATION
however,the building or improvement is Sold within one you of completion,the owner.
builder will haw the burden of proving But he did not Wild or improve for purpose of 601 - ROOF TEAR OFF
ole.).
❑I,as owner of the property,am exclusively contracting with licensed eontsaaors to 602 - ROOF PLYWOOD NAIL
connect the project(Sec.704A,Business and Professions Code:)The Contractors Li. 603 — ROOF BATTENS,
come Law docs not apply to an owner or property who Wilds or improve,thereon,and, 604 ROOF IN-PROGRESS
who contracts ror such projects with a coma torp —licensed pursuant to the Contractors .
License law.
❑l am exempt under,See. ,B gr.P C for this mason
tC33737v,00
n Data
WORKER'S COMPENSATIONDECLARATION
I hereby af0rm under penalty of perjury one of Ne following declarations:
1Fuveand will maintain a Cmificate of Consentto selblmum for WorkeM1 Comfen-
ion,as provided for by Section 3700 of the LaWr Code,fm Ne performance of the
rk for which Nis p,min is issued,
1 have and will maintain Worker's Compensation Insurance,as required by Section
of the Labor Code,for Ne Performance of Ne work for which Nis pamil is Issued Worker's Cnmp rmation Msu taco carrier and Policy mm Wr art:
rtier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not Wcompleted if the permit is farm=hundred dollars(SIM)
m less.)
I certify that in the pen normic,of the work for which this permit is issued.1 shall not
employ any person in any manner an as m become subject n be Workers Compensation
Laws of Cal ifomia.Data
Applicant
NOTICE TO APPLICANT:If, it,,making this Certi festa of Exemption,you should
become subject to the Worker's Compensation provisions of the labor Code,you must
.,,'Z fonhwi th comply with such provisions or this permit anal l Wtleemed revoked.
Z O CONSTRUCTION LENDING AGENCY
N Ihereh affirm Na them is a connection lending sen (or Fw Y t t ry Performance of
!>: i the work for which this permit is issued(Sec.3097,Civ.C.) )
W Q Lender's Name
z l<ndcr's Address
U I cenify Nal I have read this application and sane Out the above information is
W f—' correct.I agree to comply with all city and county ordinances and sum laws telling to
0 building construction,and hereby authorim repmsenanives of this city to enter upon the
W�L. ahovomentioned pmpony for impection purposes.r (We,)agree to save,indemnify and keep harmless the City of Cupertino against
173
(.�y liebilidrs,)udgmcnts,costs and expenses which may in anyway accrue,against said City
U in,cmuOmmcaofthegamingofffi permit.
APPLICA NDERST N OD WIL OMPfY WITH ALL
ON-POINT Issued by: Date
SOURCE GUL!� r
Re-roofs
Signature of AliniaMConuaclor U Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Ne applicenn or future building Occupant store or handle haamd.us material
as dented by the Cupertino Municipal,Code,Chapter 9.11,and the Health and Safety
Code,161ioYrs ❑Nu n 15531(.)? All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building Occupant use equipment or dcvicm which If a roof is installed without first obtaining an inspection,I agree to remove
It harardnus air contaminants as derined by the Bay Arca Air Quality Management all new materials for inspection.
strict?
❑Yes [D NO
I have real the hamodtas materials mquiemenu under Chapter 6.95 of the Califon-
Iia HwIN K Safety Code,Sections 5511
25.15513 and]SS.N.1 underhand to. Ne,
at if building
does nm turmoil,hew a tenant Nal it is my resp.mihibly In nobly too occupant of the
myuimom main he usuan�ig(pC'm9e.w.roseIFfin/eyy Signature of Applicant Date
fit"" "" �J' 7 /03 . All roof coverings to be Class "B"or better
Owner aunh.rimd agent pec
Building Division
10300 Torre Avenue
- Cupertino.CA 95014-3255
CITY 0 Telephone: (408)777-3228
CUPEkTINO Fax: (408)777-3333
Building Depakment
Subject: Reroofing policy for the City of Cupertino.
1. 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
Reroofing Company Name:
Applicants Signature: ' y, �
Date: -7 / LO
Joe Antonucci
(Chief Building Official)
6/25/01
97/15/2993 29: 32 5195393232 LEG4LITIES INK P-AGE 92
r
CITY OF CUPERTINO
REROOF
IUPEkTINO PIORMIT APPLICATION FORM 0 ' D
APN# _ Date:
Building Address:
Owner's Name: G /� f Phone#: e? 73 p
Contractor:)"" Phone #: License#:
V�wer0 I� �sio) �5G -6 foo `�o�4Gl
Contact: G � Phone 116 Cupertino Business License#:
Lit c c / /
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles p{ Asphalt Shingles
Y Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) L ❑ Other(Specify)
Number of existing coverings--., 1'! ❑ Provide I.C.B.O.Report#
�( To be Removed ❑ Provide Mfgr. Installation Specs.
1WHave Read, Understand and W`I Comply With Cu ertino's Tear Off Policy:
Job Description: T10 ��,"_ .�_ def 30y" f1,,,,_?, JIA4-1 • 1,
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Det. if
there are an restrictions: LLJJ
Cost of Project: e, Type of Construction: Occupancy group:
S4i,3o
Qty- if
Applicable Fee TD _ Fee Description Fee Group
BPERMFF,E Bldg Permit Fees BUILDING
_ BENERGY Energy BUILDING
13SEISMICRE; Seismic Fee Res BUILDING
BSEISMICOMI Seismic Commercial _BUILDING
_ BPLANCHK _ Plan Check Fee BUILDING
BUSLIC Business License BUILDING