03070113 • CITY OF CUPERTINO 'sav°+.' ��M' +* ''^� "�^I�- "
BUILDING DIVISION PERMIT �CONTRACTORANi RMATION
BU ILDING ADDRESS: MARCO ROOFING PERMIT NO 03070113
OWWY
NER'S NAME: 43230 OSGOOD ROAD PERMIT ISSUE DATE
ONE: (5 1 p\ .A,(7 E® SANITARY N0. CONTROL NO.
ARCHITECiIENGINEER: \ / AUG 2 12003 BO BUILDING PERMIT OO LUM MECHO
LOO
LICENSED CONTRACTOR'S DECLARATION �' ]obDescri Ilan
I hereby affirm that 1 am licemrd under provisions mf Chapmr 9(commencing �'�� P
Us with Section70fllrynf Dwislon3af the Besinesa and Professions Code.mdm licence is
_.D� in full msec and eft C� R ROOF
tqz License ��3 /_Lic.N a
Data Com SHAKES, RESHEET/ADD 30YR COMP. SHINGLES
req ARCHITE'Ps T
y a 1 understand my plans shall W used as public records
Df
isC Licensed Professional
��, OWNER-BUILDER DECLARATION
�<i 1 hereby affirm that I am exempt from Ne Contractors License Law for the
0 0 fallowing meson.(Sects..71313,Business and Professions Cale:Any city or county
K$ which requires a permit in cmnstrua,alcor,impala,demolish or repair any structure
prior in its issuance,9110 requires the applicant for such psomitln rile a signednaement
ss< that he is licensed passions to the prnvisionsorshe Contraaor'sLicense Law(Chapter 9 Sq.Ft. Floor Area Valual�g720-
F$ (commencing with Section 7IXk7)of Division 3 of the Business and Prufessinns Cnde)or
—
that he is exempt therefrom and due basic par the alleged exemption.Any vinlasinn of ,A H �i.Ln sea,
Section 7031.5 by any applicant for a Permit subjects the applicant to a civil Penalty of 3P0]}]➢WfSN+IOO Occupancy Type
nos more than five hundred della.(S500).
❑I,a Wrier of the properly,or my employees with wages u their sole comPensaUon,
will do the.,it,and she wcture is net inmsMcd oro@serf fotnlc(See IDN.Business Required Inspections
and Professions Code:The Contractors Liam Law does reet apply W an owner of q P
property who build,or improv fhereon.and who dauuch work himselfor through his 305 - FRAME
own employees,provided that such improvements are not intended in allemd for sale.If. 307 — INSULATION
however,the building Or Improvement is sold within one year of cnmPlesion,she Owner,
builder will have the burden of Proving dust he did not Wild or improve for purpose of 601 - ROOF TEAR OFF
samI
E]1.as Owner of she prepeny,am exclusively concocting wish licensed contractors to 602 - ROOF PLYWOOD NAIL
constmn the project(Sec.7044,Business and Profusions Coati The Convenor's Li603 — ROOF BATTENS.
come law dots not apply to an owner of property who Wilds or improv thereon,and 604 - ROOF IN-PROGRESS
who contracts[of such projects with a contractor(s)licensed pursuant or the Contractors
License law.
❑I am exempt under Sec. .B k P C for this meson
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby eafrm under penshy of perjury one of the following declarations:
1 Mee and will maintain a Certificate of Consent to self-bau,for Worker's Compere
ation,as provided for by Section 3700 of the labor Code,for the Performance of the
work for which this permit is iaocd.
❑I have and will maintain Workers Compensation Insurance,a required by Section
37M of the Labor Code,for the Performance of Ne work for which this Permit is issued.
My Workers Compensation Insurance carrier and Policy numhenrt:
Cartier: Policy NO: _
CERTIFICATE OF EXEM MON FROM WORKERS'
COMPENSATION INSURANCE
(Thu section coed not W completed if she Permit is for one hundred di($100)
or less.) -
1 cervi fy Nut in the performance of the work far which this permit is issued.I shall not
employ any prompt in any manner an as to boc rqr subject to the Workers Compensation r
Laws of Celimrnie.Data
Applicant r
NOTICE TO APPLICANT:If.after making this Ceniricam of Exemption,you should
become subject to the Worker's Compensation provisions of de labor Code,you must
.JO forthwith comply with such provisions or this permit shall M deemed mvoked.
.Zig CONSTRUCTION LENDING AGENCY
Ihereby affirm that there is a consuuninnlanding agency l Or the performance of
fl> Ne work for which this Permit is issued(Sec.3097,Civ.C.)
RWr Q Lenders Name
Z)Z Lenders Address
U O 1 Onfify that I ban read this application and sum that the above infnmuniun is
W P: correct.I agme to comply with all city and county ordinances and sum laws misting to
DU building coaswcsion,and hereby euthaim mpresemativ Of Nis city to coal,upon the
W amae-mcntimacil property for inspecfion purposes.
gy (We)agree sea ave,indcmni fy and keep harmless the City of Cupertino against
N liebllidea,judgments,costs and expenses which may in anyway accrue against said City
t)Z inconsequenceofthegrantingmfthisper 's.
"^ APPLICANT UN STAND LL CO Y Mill ALL NON-POINT Issued by: Date
SOURCE REG 10 ��115�5
Re-roofs
'OL
Signature of AppliaHAZAR O Onc
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Ne applicant or future building occupant Store or handle hartdous material
a defined by the Cupeninn Municipal Code,Chapter 9.12,and the Health and Safety
Cada.Section 255324)? All roofs shall be inspected prior to an roofing material beim Installed.
C]Yes ONO P P Y g 8
Will the applicant or future building Occupant use equipment at devices which If a roof is installed without first obtaining an inspection,I agree to remove
it hmardnus as r contaminants a de r,.d by Ne Bay Ama Air Quality Management all new materials for inspection.
strict?
0Yc1 0 N CNE/ �%�C�.
I have mad Ne hararduue materials requirements under Chapter 6.95 of the Califon <
ria Health k Safrsy Code,Sections 25505.25533 and 25534.1 undcomnd that if the building 7/7-5
,J/C73
dace no,currcndy ¢nam, at it' y,eeponxi 'lily to miff the rccupal of the /
reyuisementsw al 0anaof mirr.�oraapn.nayy Signature of Applicant Date
?/1,4�0_ All roof coverings to be Class"B"or better
Owner or authorized agent sal g
Building Division
10300 Torre Avenue
` Cupertino,CA 95014-3255
CITY O Telephone: (408)777-3228
CUPEkTINO F= (408)777-3333
Building De�par't 'ment
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&hall 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'/4"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: rn t=
Address: ao , a
wJLA
Ijeroofing Company Name: q/ _ M S
r
Applicants Signature: ',
Joe Antonucci
(Chief Building Official)
6/25/01
07/1512003 20: 72 5105363232 LEGALITIES INK PAGE 05
,� 701/3
CITY OF CUPERTINO
REROOF
8C*0 4* RMIT APPLICATION FORM
APN# Date:
i v�.�
Building Address: 7`l Sl o3
,�7O (oa5 LA)
Owner's Name: T Phone #:
f G' �a-a2a.r�a ¢� 2G 2 -3 u3
Contractor: Phone #:
License#:
�4wtux> S/o� �5G-� t{00 Z�ro-z 9/a/
Contact. G ; Phone #S � Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
C3 Asphalt Shingles Asphalt Shingles
3i 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 I Comply With Cu ertino's Tear Off Policy:
Job Description: 7�0 ;_ _ add 3p y t
Residential Commercial ❑ F
Fire Zone- Yes ❑ No ❑ Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project: r^ Type of Construction: Occupancy group:
_ 0_72-0
Qty. if
Applicable Fee UE) Fee Description Fee Group
! I BPERMFEE_ _ Bldg Permit Fees BUILDING
BENERGY _Energy BUILDING
BSEISMICRE+ Seismic Fee Res BUELDING
BSEISMICOD Seismic Commercial BUILDING
BPLANCHK Plan Check FeeBUILDING
BUSLIC Business License _ BUILDING
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