03070106 (2) CITY OF CUPER'1'INO ,
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION .
BUILDINGADDRESS: MARCO ROOFING PERMITND03070106
OWNER'S NAME: 43230 OSGOOD ROAD PERMrrL%UEDATE
ONE: SANITARY NO. OMROL NO.
(510) 656-6400 C
ARCHITECryENGTNEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
400 LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 1 em Ii it under prnpios of Chapmr 9 . mmeniing Job Description
with Scaion 7akq of Diviaion3of the eusincxaa �fcnapion RJ tl yliccnse'
—may
' full force d e
Lpz License aanLie. OOF
Dam m
ARCHITECTSTS DEDECLARATION T/0. SHAKES, RESHEET/ADD 30YR COMP. SHINGLES
Di @u IundcrsunJ my plena shall he mcdupublic records F0(sa�It�VALED
u. Licensed Pmfcineril
OWNER-BUILDER DECLARATION 1
a I 1 hereby affirm that I am exempt from the Contractor's License law for the AUG 8 2003
S aa0 following moon.(Secdon 7031.5,Business and Professions Code:Any city m county
X ro which mquims a permit m consumer,alcor,improve,dcmnlish,or repair any structure
prior to its issuance,also requires the applicant for such permit to fila signed statement
�z< That he is licensed pursuant to the provisions of the Comracmr's License Law(Chapter 9 Sq.FL Floor Area )QI I'L®Ip5/� Valua'"720
$ rearm mending with Section 711M)of Division 3 of the Busineasand Profeainns CoBUILDING
or NG '7-a
.. Nat he Is exempt therefrom and the eases for the alleged camption.Any vinlalon of
Section 7031.5 by any epplicamfor a pcmrf subjects the applicant to a civil penalty of 3M1Nftgtber00 Occupancy'Iype
not marc Nen five hundred dollen(SSW).
❑1,as owner of the property,at my employees with wages As their sole compensation.
will do the work.and theswcturt is not intended or offered for ale(Sec.70th,Business
and Potion..Codi:The Communes License Law does not apply to an owner of Required Inspections
propeny who builds or improves thereon,and who does such work himalfar through his 305 — FRAME
awn employees,provided Nat such improvements art not intended or offered rot late.If, 307 — INSULATION
however the building or improvema ,is sold within one or of completion.the owner
builder wilt hats the burden of proving Nat he did but build or improve(m purpose of 601 - ROOF TEAR OFF
ale.).
❑1.as owner of the property.am exclusively convecting with licensed contractors to 602 - ROOF PLYWOOD NAIL
convect the project(Sec.70aa,Business and Professions Code:)The Contractors Li. 603 — ROOF BATTENS.
cane law docs nor pply tote.ownercar property who Wilds or improve Merton,and, 604 — ROOF IN-PROGRESS
who contracts for such projects with a contractor(&)licensed pursuanno the Contractor's
License Law.
D I am exempt under Sec. .B&P C for this moon
Owner Data
WORKER'S COMPENSATION DFCV RATION
1 hereby affirm under penalty of perjury one of the following declaration:
I have and will maintain a Certificate of Consent to selFiron,for WinkeM1 Copper.
1031.L.,100
ion,u provided for by Section 3700 of the ober Code,for the perfmmance.(,he
rk for which Nis permit is issued.
1 have end will maintain Wmkcri Compensation Insurance,u required by Section
of Ne labor Code,for Ne perfowmce of the work for which Nis permit is issued.
Worker's Compensation Insurance carrier and Policy number art:
rtier: Polity No.: _
CERTIFICATE OF EKEMP ION FROM WORKERS'
COMPENSATION INSURANCE
(TMs seedim lead not Wcomp)ctcd if the Permit is renne hundred dollars(SIM)
or less.)
1 eanify Net in the perfomanee of the work for which this Fermin is issued,1 shall nm
employ any person in any manner an As to became subject o the Wokeri Compensstion
Laws of California,Data
Applicant
NOTICE TO APPLICANT:If,after making this Cenifrcate of Exemption,you should
became subject to the Worker's Compensation provisions of the labor Code,you must -
,JO forthwith comply with such provisions or this Permit mall be deemed revoked.
'ZIn CONSTRUCTION LENDING AGENCY
"r+ I hereby affirm Net there its contructino lending agency Or the performance of
C > the work for which this permit is issued(Sec.3097,Ci,C.)
W Q Lender's Name
z Lenders Address
U
<)Q 1 ccnee Nat I have with
Mistyapplication
and ciunond sure Na Ne above was misting is
g4 U bonding 1 agree m comply with ell city end county ordinances aiva,of end Calc laws r upon t e
(]U abovenMandel prolixity
fenny amhonp rcpresemerivesof this City menmr upon the
W ahovomemionW property forinspenion purposes
(We)agree to ave,indcmni fy and keep hasmiess the City of Cup,nine against
Hy liabilities judgment,costs and expenses which may in any way accrue against said City
V7 IAncL-Aancc he grant (tA WILL PLY ITHALL/p'ONPOINT Issued by: Dale /
Re-roofs
Signature of ApplicoData
HAZARDOUS MATERIALS DISCLOSURE Type of Roof _
Will the applicant orforum building occupant Bore or handle material
a dcOncd by the Cupertino Municipal Code.Chapter
and 9.11,and the Health and Safety
Codd,s❑lYion 25532(.)+ ❑Na All roofs shall be inspected prior to any roofing material being installed.ea
Will the applicant or future building occupant use equipment or device which If a roof is installed without first obtaining an inspection,I agree to remove
it havodens air comm a mnis o defined by the Bay Arca Air Quality Management all new materials for inspection.
trin7
❑Yes 0 N
I have read the haxardous materials requirements under Chapter 6.95 of the Caliber. 6�
7daenrl,ima
Health&''Safcl Cndc.secduns 35N1,35533 anJ155J9.l undcmmnd Natif Jen building
ha,c a ren 4 r s my res sibiliry o b.61'y the i ccupat of Nc
uirtmcn rbn m rA briaam raCcamof«gya/ryZ Signature of Applicant DateJJ All roof coverings to be Class "B" or better
wner tar anthOri'rcJ agent D c '
Building Division '
• r, ' 10300 Torre Avenue
Cupertino,CA 95014-3255
CITY O k p� Telephone: (408)777-3228
CUPEkTINO Fax: (408)777-3333
building Departinent
Subject: Reroofing policy for the City of Cupertino.
L 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 i/V 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: CC
.o
Address: Z/ L 6 S Ir
i
Reroofing Company Name: ' S
Applicants Signature:
Date: Q
Joe Antonucci
(Chief Building Official)
6/25/01
FJ7115!2eFI2 29:22 51053e3202 LEGALITIES INK PAGE 01
0 101D
-� CITY OF CUPERTINO
` REROOF q ��
�UPER,TiNO PIRRMIT APPLICATION FORM
APN# Date:
Building Address:
Owner's Name: CC f C ; Phone#: 2 3 2-
2 3
Contractor:�" Phone #: License #: tJ�4G�
M+ hum S/O �s4 -6 qO0
Contact: G y Phone#6 Cupertino Business License#:
_ 2
Type of Roof Covering:
Existing: Proposed:
O Built-Up Roof O Built-Up roof
❑ Asphalt Shingles Asphalt Shingles
A Wood Shakes ❑ Wood Shakes
O Wood Shingles ❑ Wood Shingles
O 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 11 Comply With Cu ertino's Tear Off Ptilic
Job Description: T1030yt
Residential V Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are any restrictions: UU
Cost of Project: od Type of Construction: Occupancy group:
Qty. if
Applicable Fee r _ Fee Description Fee Group
/ BPERMFEE Bldg Permit Fees BUILDING
BENERGY Energy _ BUILDING
E;
BSEISMICRSeismic Fee Res BUILDING
BSEISMICO ___ Seismic Commercial BUILDING
BPLANCHK '' _ Plan Check Fee BUILDING
BUSLIC Business License BUILDING