01100145 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10630 CULBERTSON DR. MARCO ROOFING 01100145
OWNER'S NAME: APPLICATION SUB DATE
TAKAMOBU TOBORI 43230 OSGOOD ROAD 10/26/2001
PHONE: (510) 656-6400 SANITARY NO. CONTROL NO.
O O ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BDG ELECT PLUMB MECH
y<d D CJ J
S'yi LICENSED CONTRACTOR'S DECLARATION
j z_o I hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Deseripti n
wl–rr with Section 70010)ofDism..3oftheBusiness And Prid ionsC"de.Andmylicense REROOF.
cy Z. is in full fon and t
a-mm¢ L.cen.3 x"34 Lie.a 1101711 T/0 COMP . SHINGLES, &
f 0 a U Dae Y 0—'j Commmnr '
a3ati - ARCHIfELT'SDECLARATION ADD 25YR. COMP. SHINGLES .
O, I undaisnud in,plans shall be used As Public ree°rds
r
3 i o O Licensed Professional
OWNER-BUILDER DECLARATION
in 1 hereby affirm that I I. exempt from,M1e Contractor's License law for the
t?a following mason.(Semon]031.5.Business and Professions Code:Any city on-county
which requires A Permit re construct,applicant
improve.demolish, repair any wment
3m phot I '. < Is req ,he pplcan,liar such Contractors
rile a kenseL en statement
that be litp rs e nI tbepo . nsofclic the
eBusne a e . !A (CM1apter9 S FloprA
(commencingwlhSn ]o0p)ofD' rsonJoftheBusineupdProfessions coae) 1'�' ' > eYt y9 •r t &�',tI 'f1' it 25)b'ation
m Nat he lis cxcmpc therefrom and the basis for the alleged exemption.Any violation ! `S`. V / i a.+ 5l. '�;I 1.
of Section]031:5 by any applicant for A permit subja,s the applicant to A civil Petry
of amt mom lhao five hundred dollars(SSW). 3 7 E 1TW '" 0'0 p: Occupancy Type '
❑I;as owner of the property,or my employees with wages as their sole compensation.
will do the work,and the structure is not intended or offend for sale(Sec.78
'Business and Prufessio ns Code:The Contractor's License Law docs not apply to an 305 - FRAME Required Inspections' r'
owner"f pmpeny Who builds or improves,hereon,and who does such work himself
or Through his own employees.provided,hal such improvements arc not intended or 307 - INSULATION i
.cBercd ion.flo IL howcvemrhe llovn I.sola within one - - - — _ . ._ _ ._.. ._ .. ......
g°rim°'°"`""" year"r' 601 - ROOF TEAR OFF ".-F."-
improve
ompinion,,he owner-builder will have clic Widen of proving that he did not build oro" '
for P."..f sole.). 602 - ROOF PLYWOOD NAIL
_Elim owner of the property exclusively cc t i g with lcnsedcnlaaom to 603 ROOF BATTENS ' .. - .-.
AFconsAn the projat IS c ]0M Business ine d Pr f ons Cod )ThContractor's
Licence L"' sass nw pplyl owner lip pent n bold o improves thereon 604 - ROOF IN-PROGRESS' f
who an... fn such.projects with a contractors)licensed punuant to the _.. _- -. ..._.._.. _. . .. I
Con Liccnsc L -'
O I Am exempt under Sec. ,B&P C for this reason
I hereby affirm under pcnalry of perj 1
C"6m,
WORKER'S COMPENSATION DECLARATION
y ory rine of the following dcdantions: O O
( O 1 have"and,will mannan'a Cenificate'"f Consent to self-insum far Worker's /
Compensation, As provided for by Section 3700 of the Lidoor Code; for the
performance of the work for which this permit is issued.
�,L have Arid will maintain Worker's Compensation Insurance,as required by Section
3]00 of the Tabor Code,far Ile pciformance'of Ne work far which this permit is
issued My Work s C pe sato 1 sura c camr� and Policy nomberapre
Cam PoTVIJ J M 1 f "( (, b'
CE 11-1 ACOMPENFATION INSURANM WORKERg i', - rt•it s ( Q 1,toot f'. nn s,Ar:. a i�..cess ix •, s_
COMPENSATION INSURANCE"
is se2tion need net be completed if IM1e permit is for one hundred dollars ---
' (5100)or or less.)
1 camfy.Ihat in the pBEAonAAce of the work for which this Permit is issued;I
shall rot employ,any person in any manner so as to becomc'sunject
Compensation Laws of California.Dam
Applicant
. ._ .. .. _
NOTICE TO APPLICANT If, fie,makingN' Cri fecal of Exemption,you should
bey bj ec ion the Wo k f C rope sit, p- 's of the Labor CsMe you moil "
Q forth lh Comply with such provisions or this Permit hall be deemed revoked.
"'' r ` •CONSTRUCTION LENDING AGENCY
s a 7 ' 1 hereby ali in Nat Neje is is construction lending agency for the perfoimm ice
0 of the work for which this permit is issued'(Sm.309],Civ.C.) '
s Nam
Und
e J.i..:.. ... , ....::,.:. .:.
I.
;1I.,nee tna 1 have ly read Nis it,..it Application and smtc ilia,the above informationsrein,
E. Correa.L agree tr comply with.11 ebb sit,antl countysenoolvesi and scam laws reining
the above
-mentioned
of thiscity to cmcr upon
the abo(We)a nce'no propcbadam ily And
purymnle
[.. L. (We)agree m save,indemnify and kttp harmless chi Ciiy'of Cuperiirio against
V] liabilities,judgments,costs and expenses which may in any way,accrue against Aid
V•.Zi City inconsequence of the granting of this permit.'
APPLICANT UN TT'NSAND ILLCOMFLYWI'rHALLNO -POLT ISSDed by: Date
SOURCE RECO EONS.
iam olA
'Al FP icanJC I I r D Re-roofs
H RDOUS MATER DISCLOSURE
p. W111he pylic t future bald,gocc psion vote or handle hsanii ma A -Type Of Roof
as defined by Ne C pen Mu pa CT pts 912 and th Health d S(ry .?P„• !! r.f x F• r:w —. •_ ._ ___.
Code Sal on 25532(a) 4 f.: . 1Ye .. L, r 5\,i 15 l•'.t s'S'I +)tits .:'x•. 'I _
oY r _All roofs shall,be inspected prior,to any roofing material.being installed.
wapplicant- t w 4 Idm t pA I e If a roof is installed'wi[han inspection;I'agi'eeao'remove
eR Nmit h a contaminants as d fi by,h Bay Area A Q l ry Mmout firs[obtaining anSgemc
°i”` ' all new materials for inspection. A hcant understands and will comply with
..• all non-pour
int soce regulations:
1 nae d the Safari
Code, materials 505.re c Is d 2 Chapin 695 of die '" •- -
Calif Health&Safety Cod at ate 25505ta is
and 25534:I yto notify
dthe
d e.b"Id g docs not tune Arty is ten I that I mYssuanc ,b (I n city the /G /
a m f N<re Ai which mos be et Puritan,issuance f Iirficate of - b
Occupy cy -.. .• . '.. � � � ,
/oat Signature of Applit6ant Date
Ammod�ea gen, - . Pete. All roof coverings to be Class "B"or better '
1 - . .:.. . . ... OFFICE
Building Division
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
�UPEkTINO
Building Department
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 1/4"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:
Address: `04 3 U
Reroofing Company Name: 21;1-)
CY
Applicants Signature: Date: /U 2 6-A/
Joe Antonucci
(Chief Building Official)
6/25/01