03070103 (2) CITY OF CUPERTINO �a �+r �r�� n ,g kT1'�i*
BUILDING DIVISION PERMIT �IDNTRACT(lR�1\i•{,04`MCl.Td01\ �•
' BUILDINGADDRESS: MARCO ROOFING PERMIT N0.03070103
OWNER'S NAME: 43230 OSGOOD ROAD PERMIT ISSUE DATE
ONE: -
(510) 656-6400 SANITARY NO. CONTROL N0.
ARCHTTEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MEC"
0 0 0 0
LOO LICENSED CONTRACTOR'S DECLARATION Job Description
Ya 1 hereby efrom Thal 1 em licensed;4ahlelolrx
fChapter 9(commencing PwithSenion7(N)lOofDivision Sof the Busc. licenseiin full farce and f OOF7c License CI Lie. ��.�Da cdo T/O. SHAKES, RESHEET/ADD 3 YREC'OIgIP. SHINGLES
QQ ARCHITECTS DECLARATION
1 understand my plans shell he used as public inrnNs
AUG
1 ry
f'IUU 0 7 2003
3C Licensed Pmfcasionel
S OWNER-BUILDER DECLARATION
. M 1 hereby affirm that T am exempt from the Contractor',License Law for the BU ILDIN
00 following mtsnn.(Section 7031.5,Business and Mormons,Code:Any city lir county
K m which mquiras a permit in construct,alter,improve,demolish,lir repair any structure �7
rZT prior to its issuance,also requires he applicant for such permit to li Is a signed statement
x< that he is licensed purmanl to the provisions of the Contractor's License law(Napler 9 Sq. Ft. Floor Area Valuat"430
%WE (commencing with Section 70001 of Division 3 of the Business and Profession,Code)or
i that he is exempt therefrom and the basis for the alleged exemption.Any violation of ,A,�A��1.L. {,
Section 70313 byany applicant for a permit subjects the applicant to,civil pe..try of 3FPO PSVY�9eJ00 Occupancy Type
not more than five hundred dollars($S00).
❑I,ssowncr arth.property,or my employees with wagaas their vele..mpenult...
will do the work.and the structure is not intended or offered for sale(Sec.7044,Business
and Professions Code:The Contnamn's License Law docs not apply to in owner or Required Inspections
property who builds or improves Nerome,ind who does,uch work hims0forthrougb his 305 - FRAME
own employees,provided that such improvements are not intended created forsale.It, 307 — INSULATION
however.the building or improvement is sold within one year of completion,On owner.
builder will have Ne burden or proving that he did not build or improve for purpose of 601 - ROOF TEAR OFF
sale.).
E]1.as owner of the property,am exclusively contracting with licensed contractors to 602 'i— ROOF PLYWOOD NAIL
construct the pmject(See.7W,Business and Professions Code:)The Contractors Li. 603 ROOF BATTENS.
cause Law it.,not apply to an an,of property who builds or improves thereon,and 604 - ROOF IN-PROGRESS
who convects for such projects with a contracmr(a)licensed pursuant to the Contractor's
License l.aw.
Lm exempt under Sec. .B h P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
1
City
affirm under penally of perjury one or the following deelantions:
T have end will maintain a Cenificmc of Cnn,cnl to self-insure for Warkeri Compcn-
cation,as provided for by Section 37W of the Tabor Code,for the performance of the
work for which Nis permit is issued.
❑I have and will maintain Worker's Compensation Insurance,as inquired by Section
3700 of the Labor Code,for the perfam mance of one work for which his permit is issued.
My Worker's Compensation Insurance anicr and Policy number am:
Cartier: Policy Ne:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This action need not he completed Bite permit is for one hundred dnllas($100) -
others.)
I certify that in the perrormanec of the work for which this permit is handed,T shall not
employ any person in any murnersn as;to become subject to the Workers'Compensation
Laws of California.Dale
Applicant
NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you shouW
become Subject m the Workers Compensation provisions of the labor Code,you must _
z forthwith comply with such provisions or this permit shall he deemed hawked.
Z OCONSTRUCTION LENDING AGENCY
'E~rte. I hereby affirm that there is a canslnctino lending agency for perfo aorta of
fYi the work for which this .it is issued(See 305D.Civ.C.)
!td A Lender's Name
z Lender's Address
t)C 1 certify Nal I have read this application and state that the above immmniun i1
;! P correct,1 agree to comply with all city and county ordinances and state laws relating to
pbuilding convection,and hereby authorize representmives of this city to enter upon the
Wabove-mcntinned property for inspmction purposes.
(We)agree in saw,indemnify and keep harmless the City of Cupertino against
.E". lin liabilities,judgments,costs and expenses which may In any way seem,against said City /
V z in cumse ucncc or gramingnr his t.
'-" APPLICANT U RST N ILL CO Y WITH ALL ON-P TNT Issued by: Date
SOURCE
��5'/r/� Re-roofs
Signature of ApplicanXi ntncmrell
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applieanuo future building oceupunl stere or handle hamrdous material
as refined by the Cupertion Municipal,Code,Chapter 9.13,and the Health and Safety
Code,Section 35532(a)7 All roofs shall be ins ected prior to an roofing material being Installed.
❑tion ❑Na P P Y g g
•
Will
the applicant lir future building occupant ox equipment or devices which "If a roof is installed without first obtaining an inspection,I agree to remove
I'
hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
istricrt
0W [D No
1have mad thede,Sllnusmaterials5R3Lord
omentsunder Chapter that iof ftheWilding
I a
nits no N¤Safettly Cod,all... 355113,355 3 an ortit, .I undc Lily
the licupant Of the
dpaa not curzcntly a Icnen4 it,' esponsihi' to nndly the occupant of Nc 1/
regaimmanli month, o ,i alit nfiate amdpm . Signature ofApplicant Date
Owner or authorized efcm Dam
All roof coverings to be Class "B" or better
Building Division
10300 Torte Avenue
CuPm-Lino,CA 95014-3255
C1TY 0 h I Telephone: (408)777-3228
CUPEkTI1 VC) Fax: (408)777-3333
Building Department
Subject: Reroofing policy for the City of Cupertino.
I. 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/��per foot slope and demonstrate that
there is no ponding,
2. An LC.B.0. 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: Y P g
Address: 114 SI0 f-4 -PJ ,o7 o
P
Reroofing Company Name:
«�S
Applicants Signature:
, Date: 2 /�
eAn�7 Antonucci
(Chief Building Official)
6/25/01
07,115/201013 201: 26 5101526'5262 LEGALITIES INK PAGE n5
CITY OF CUPERTINO
-
REROOF
�UPERTINO PERMIT APPLICATION FORM
APN# Date:
9 1
Building Address://4 140 /) a
Owner's Name: —� Phone#:
�'73 _c/ 'foS
Contractor:� _ Phone#: License #:
1 Ylwt cc, ��io) �sb -6 q00 o.Z 4G l
Contact: // Phone 11Cupertino Business License#:
G C di.c.c✓ S Q.ryi�
-2—/ 3/ 7
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles )( Asphalt Shingles
`d1 Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report#
;Q To be Removed ❑ Provide Mfgr.Installation Specs.
Have Read, Understand and WII Com I With Cu ertino's Tear Off Policy:
Job Description: -ro add 30y01 `'"''"`f-
Residential Commercial ❑
Fire Zone: Yes ❑ NN[ Confirmed with Planning Dept. if
there are an restrictions:
Cost of Project: i Type of Construction: Occupancy group:
S�3a
Qty. if
Applicable _Fee Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGYl Energy BUILDING
1 BSEISMICRE'` _ _ _ Seismic Fee Res BUILDING
BSEISMICO — _Seismic Commercial BUILDING
BPLANCHK m_ Plan Check Fee BUILDING
BUSLIC Business License BUILDING
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