03040055 CITY OFCUPERTINO g;} `�.a �i'rasisiyJ 1�t �s�* h r�z
BUILDING DIVISION PERMIT Wq-0 sl.�'IO
BUILDING ADDRESS: PERMIT NO.
11856 WOODHILL CT MARCO ROOFING 03040055
OWNER'S NAME: PERMIT ISSUE DATE
CHEN PAUL C AND VIRGINIA H 43230 OSGOOD ROAD 04/09/2003
E: SANITARY NO. CONTROL NO.
(510)656-6400
ARCHITELT/ENOINEER: BUILDING PERMIT INFO
. BC] O PLUMB
MECHO
u00 LICENSED CONTRACTOR'S DECLARATION
4 I hereby affirm that I am licensed under provisions of chapter 9(commencing Job Description -
elthSmOm7")of Division 3 of the Business it fourtslims Codc.and my][.am is
Lm .n in full force and cff 3 d110 2 gI
jY�IZ uoensy�I s���Can REROOF . yI1{ /� p
ty. Lm-a Contactor r—0 p Hyl/J�iA$rtE
q�q ARCHITECTS DECLARAT ON
�Wty Iunderstand my plans shall be used As public records IIIN 5 2003
h 0 Licensed Profexsteel J U
OWNER-BUILDER DECLARATION
MI hereby affirm that I am exempt form the Contractor's License Low for the pry
eo following mamn.(SecHan7031.5,Business and PrefessionsCode:Any city orcounty BUILDING
$2 which requires a permit to..codes.-e@r.improve,demnitsm h, rcPat,Any alm
num
prior to its issuance.Alco requires the applicant for such permit to file a signed matemem ,
< list he 1,11consedpunmettotheprovislomafineCoommuor'WanselawlCheNer9 Sq. Ft. Floor Area $ Valuation
E (commencing wilhSation]OW)ofDivuion Ja(Iheeusinesa and ProfemoionaCnde)a 12930
3$ lost he"Ins exempt therefrom and the basis for the Alleged exemption.My violation of
Section 7031.5 by my applicant for a permit subjects me Applicant o a civil penalty of
not more man five hundred dollars($500). 3M�LLI T. 00 Occupancy Type
O1,m employees of the property,army employwith wages As their mile compensation, U'f l
willdo the ward end me moucmrt 1,not Intended offered forest.(Site.7W.Business
and Professions Code:The Coomme's License law data not apply to an owner of 305 - FRAME Required Inspections
property who builds orimprorca moment,and who does such work Aimselforthrough his 307 - INSULATION
own employers.provided that such improvements ere not intended oroffered for Wt.if.
however.the building or improvement is sold withinone yearafempledon.me owner. 601 — ROOF TEAR OFF
Wilder will haw the burden of proving that he did mml build or Improve(or purpose of 602 — ROOF PLYWOOD NAIL
O]..a reactor the property.am exclusively ronvAeting with liaved convmtoss to 603 — ROOF BATTENS
construct the project(Sec.7044,Business and Profession$Cede:)71M ConracmYs U. 604 — ROOF IN-PROGRESS
=me law deal not apply to an owner of property who Guilds or improves thereon,and,
who conmms for such projects wit acamnetor0)licensed pun ent to the Contnemfs
License law.
O I Am exempt under See. .B 9 P C for this reason
Owner Data
WORKERS COMPENSATION DECLARATION
1 hereby alfirm under penalty of perjury arc Of the fallowing declwiom:
hoe and.111 malnuin•CeNficate of Concent toxelfdmum for Wim't Camper '
mon,As provided for by Section 3700 of the labor Code.fm On patient=of me
wait for which anis permit is issued.
O 1 have and will maintain Workers Compenmilm Insurance,u required by Section
3700 of me labor red,,for the performance of the work for which anis Permit is Imbed.
My Workers Compewtion Insurance carrier and Policy number am:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATIONINSURANCE
-
(bts moduanced not ccompleted if the permit is fosooe hunmeddrllan(SIM)
tar eat)
I eenify met In the performance of the work for which this Permit Is issued,I alba l trot
employ any person in any manner An As to become subject to the Workerf Campenmotian
Laws o(Califom]A.Data
Applicant
NOTICE TO APPLICANT:If,after making this CCnIR.ale of Exemption,you mould
become subject to the Workers Compensation provisions of the Iabm Code,you muss
.J O forthwith comply with such provisions or this permit shall he deemed reeked.
Z tiCONSTRUCTION LENDING AGENCY
1 hereby a from that mea is a construction lending agency for the performance of
Ye
the work for which this permit is issued(Sec.3097,Civ.C.)
YQ lender's Name-
=z Lender's Address
J 0 1 comity that I haw read this application and slam that the show Informathm is -
correct.I agree to comply with all city and county ordinances and sum law relating in
V building construction.ad hereby aumorire reprse
enWives of Oil City to enter upon the
�U show-mcmimed Property for Inspection PmPOJmL -
(We)agree to move.indemnify and kap harmless the City of Cupertino against
to liabilities,judgments,costs and expenses which may In any soy acerae against mid City
J 7 In consequence of the greeting of this per ot.
�7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS, /
yl9�p S Re-roofs
Signatum of ApplicmVContracmr r 0
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building Occupant store rehandle hanrdous nominal
An de0ned by the Cupertino Municipal Cam,Chapter 9.13,and the Health and Safety
Code,Section 25533(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes
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
t havardnos air womminants As defined by the Bay Area Air Quality Management all new materials for inspection.
Oyes Q�
I hawmad the Immdous materials requirements under Chapter 6.95 of the Cali for. �7
alaH..Ith&SafctyCode,Secdom25505.25533and25534.]unictrmnd lhatifthc building
data not caromly hew a tenmi.met it is my responsibility W notify the occupant of the
require menu nbcmclp' micsuonaof.Certificate ofOrFu cr ' Signature ofApplic "Y Date
Owner anuthrriyc agent bate g
L� / All roof coverings to be Class "B"or better
- � '
Building Division '
10300 Torre Avenue
Cupertino,CA 95014-3255
CITY40 Telephone: (408)777-3228
CUPEkTiN® Fax (408)777-3333
Building Deparb'nent
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 withoutfirst obtaining all inspection
'and written approval from the building inspector.A final inspection and
completed.
approval shall be obtained from the building inspector when the reroofing is
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.
G� 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 VV 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: yo C f
Reroofing Company Name:
Applicants Signature: �- Date: y4 a,3
Joe Antonucci
(Chief Building Official)
6/25/01
CITY OF CUPERTINO D 3
REROOF
CUPEkTINO PERMIT APPLICATION FORM
APN# Date:
3z6-;::-
Building Address:
Owner's Name: / C Phone#:
Contractor: V Phone#: License#:
a/Lco 6V0 456 - 6VOL) V0246
Contact: �^ # Phone#: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
71 Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) Other(Specify) p
Number of existing coverings Provide I.C.B.O.. Report6 S6 (S•L ")
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
• I Have Read, Understand and Will omply With Cu ertino's Tear Off Policy:
Job Descrition: T a
ga�w
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed wit anning Dept: if
there are an restr' tions: LJ`\
Cost of Project: Type of Construct Occupanc grou
�? 930
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Energy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
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