03070107 (2) s CITY OF CUPEW111,10 a^''
BUILDING DIVISION PERMIT CONTRACTT R INFORMATION
I BUILDINGADDRESS: MARCO ROOFING PERMIT NO 03070107
•OWNER'S NAME: 43230 OSGOOD ROAD PeaMrr tare DATa
ONE: SANITARY NO. CONTROL NO.
(510) 656-6400
III
CHITEC rENGINEER: BUI LDI No PERM IT INFO
BLDG EIF.CT PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATIONI hereby affirmthat 1 am licensed under pr ons arch ter 9 meneinlob Description
h Section 7M))ofDoision Sof NC Business rufessig�arad ylicenae a
ull force ands c.yn Cl �%`✓' ase.«'1���� 00 F
- Data Crmna°r T/O, SHAKES, RESHEET/ADD 30YR �tVIP SHIN LES
flu ARCHITECTS DECLARATION jt�j II /�
flu 1 unJcraunJ my plans shall be used as public records
°.m.Y1
aU
c License)Pmfessionel ry
S OWNER-BUILDER DECLARATION AUG O 1 ZOO
<f 1 hcrchy affirm that I am exempt firm Ne Cnmracmh License Law far the
pO following mason.(Section 71131.3,Business roti Professinm Cody.Any city m rounty
�i which requires a permit to concoct.altar,improve,dcarobah,or mpair'any aructum
FI< prior or its issuance,also myvires the applicant for such permit to Tic a signal summent
used he is licensed pursuant to the provisions of the COfliMIori License Low(Chapter 9 Sq. Ft. Floor AreakValuat'r,�'i9720
91--0 (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
Wthat he is exempt twmfmm and the basis fm the alleged nemptian.Any violation of p,,
Section 7031.5 by arty applicant fon it permsubjects the appliuu
no a civil penalty of 3WkD90x��y,y�510-U00 Occupancy Type
not mom than nn hundred dollen(5500).
I,as owner of the pmpmy,army employer with wagesas their sole compenadan.
will Protrusions
ands: swnum is rot intended of o w do for We(Sec.no an Baser of
and Pmfnsiobu Code:The Contractor's Liana Law dor not apply to an Owner of Required Inspections
proPcny who builds orimpmsv thereon and who dauuch..it himselforthmugh his 305 - FRAME
Own employees,provided that such improvements arc not intended or offered for sale.If. 307 — INSULATION
however,the building or improvement is mld within one year of completion,the Owner.
builder will have the burden of proving that he did not wad or imptom for purpose of 601 — ROOF TEAR OFF
ash.).
01,as Owner of the property,am exclusively contracting with licensed contractors to 602 - ROOF PLYWOOD NAIL
Consists the project(Sea.70dA,Businev and Profusions Code:)The Contractors Li. 603 — ROOF, BATTENS,
cense law does not apply to an owner of property who wilds or improves Bierman,and 6O4 — ROOF IN-PROGRESS
who contracts for such projects with a contnrses m
gor(s)licensed possums the Contractor's
License UW.
❑I am exempt under Sec. ,B@PC for this rcasan
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury,one of the following declarations:
I have and will maintain a Conifeste of Combat tool f-jasum for WorkcM1 Compen.
IC331.0()
ion,as provided for by Section 3700 of the UdWr Code,far the Terrarium.of the
Is
for which this permit is issued.
I have and will maintain Worths Compmaram.Insurance,as acquired by Section
of the Ubor Code,for Be performance of the work for which this Permit is issued.
Worker's Compensation Insursnce Cartier and Policy number artrrier: Polity NO.: _
CERTIFICATE OF EXEM MON FROM WORKERS'
COMPENSATION INSURANCE
MrsYatton reed not be completed if tbe permit is far arc hundred dollars(SIBS
or let.)
I cer iry that in the performance of the work for which this Permit is issued,I shall not
employ any person in any manner an as in become subjeet to the Workers Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:IL after making this Ccmifcare Of Exemption,you should
become subject to the Workers Compensation provisions of the UMr Code,you must
., O forthwith comply with such provisions or this permit shall be deemed revoked.
'Z CONSTRUCTION LENDING AGENCY
.Fh I hereby affirm that there its construction lending agency for Performance of
C the work for which this permit is issued(Sec.XN7,Civ.C.)
W Q Undcr's No
z Lendeis Address
U Q 1 comity that i ban read this application and sum that the above information is
f-^ correct.l agree to comply with ail city and county ordinances and sum laws relating to
pU building concoction,and hereby authorize representatives of this city to enter upon the
'A'4 above-mentioned pronely for inspection purples.
(We)agree to on,adcmnt fy and keep harmless the City of Cupemina egainV
F' in Iiebilitiu,judgmcnLLeasts and expenses which may to any way acerae against acid City l
UZ in consequence of the gaming if this permit
ASOURCERE ATIO PPLICANT U ERSTAN ILL CO PLY VID ALL NO -POINT Issued by: Date )))
? s�� Re-roofs
Signame ofAppli sm/Creonomr DamT
HAZARDOUS MATERIALS DISCLOSURE Type Of Roof
Will the applicant or future building occupant store lir handle ha ardours material
es defined by the Cuper ian Municipal Code,Chapur 9.12.and tbe Health and Safety
cmle,scenes 23532(a>7
❑Yes ON. All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building Occupant uY equipment or dcvicn which If a roof is installed without first obtaining an inspection,I agree to remove
III hmsrdnvs our conmminenu as dcfneal by the Bay Area Air Quality Management all new materials for Inspection,
Wiwi?
❑Yes ON. -
Ihave mad the hacamousmaterials requirements under Chapter 6.95 of the Califs- se
nice HenWKSafely Coda,tenant 25505,25533yrespo25514.1 understand Oat ifthc Wilding rj'NiLA' 7//S�Q
J(Na no,eurtcntly n n tenant Nati ry respon try m Cantly the xcuP of the
rcquircmcntsw muslM p' v aauenan temfencOfOceuPadey. Signature of Applicant Date
7��0
Owner or mdoomd sacro r (Date,- All roof coverings to be Class "B" or better
Building Division
10300 Torre Avenue
Rb ✓'
...rx � Cupertino,CA 950143255
CITY 0 Telephone: (408)777-3228
CUPEkTINO Fes: (408)777-3333
Building Deplarhnent
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.
• S. 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'K"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 abovepolicyon reroofing and will comply with this policy.
Homeowners Name: Lj?�&�yw
Address: l/(,.30 ✓l/•, LYP APJL-
U
Reroofing Company Name: , s
Applicants Signature: ' �
Date: 7Z/ �
Joe Antonucci
(Chief Building Official)
60101
07/15/2003 20: 26 51053632E2 LEGALITIES INK PAGE 02
'"C.0
- ' CITY OF CUPERTINO 5416
SCTY Or REROOF 3 7 7
UPERTINO P�RMIT APPLICATION FORM
APN # --- — Date:
Building Address: /!G 30 n .�
Owner's Name: --G� l%trLv2�I Phone#:
Contractor: " Phone #: License#:
s/o) 1,sc-6Cfoo �{0�4G1
Contact: Phone #g Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof 0 Built-Up roof
❑ Asphalt Shingles '>( Asphalt Shingles
X Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings I ❑ Provide I.C.B.O. Report#
To be Removed ❑ Provide Mfgr.Installation Specs.
Have Read, Understand and Will Comply With Cupertino's Tear Off Policy:
Job Description: -rp � _ _ zdv w y t "`r"` . Z,4.,,,.
• (�
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are anrestrictions: C
Cost of Project: �00 Type of Construction: Occupancy group-
S'720
Qty. if
Applicable Fee.)D Fee Description Fee Group
/ BPERMFEE Bldg Permit Fees BUILDING
BENERGY 1 Energy BUILDING
BSEISMICRE _ Seismic Fee Res BUILDING
BSEISMICO- _ — Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING