03070110 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT .CONN R°ACTORRANFORMATI;NW .
BU ILDING ADDRESS: MARCO ROOFING PERMITNO03070110
AME: CT PERMIT ISSUE DATE
43230 OSGOOD ROAD
ONE: SANITARY 0. ONTROL NO.
(510) 656-6400 C
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDGPLUMB MECH
EIF.Cr
0 t PL
!r
LICENSED CONTRACTOR'S DECLARATION Job Description
m❑ I hereby affirm that 1 am licensed under pmviaions of Chapter 9(commencing
ZW with Section]00),rDivision Sof NC Busine uProfcssit eC , rad my he cis
in full force and a fit. 9 EROOF
pre? Liccnsc Class
qD"` L DELL T/O. SHAKES, RESHEET/ADD 30YR COMP. SHINGLES
q'N ARCH1I k suss DECLARATION �'����®
22 33 1 untleuunJ my plans shall he used u public records
D�u
Licensed Pmfcuimod
3 OWNER-BUILDER DECLARATION
g2 .I hereby effort that 1 am exempt from the Conlnesos's License Law for the AUG 1 9 2003
p 0 following moon,(Section?1131.5,Stations and Profession Code:Any city or county
X m which requires a permit in consumes,alter,improve,demolish,or repair any structure
soprior it its issuance,also requires lhemplinmformer pamito fleaaigood statement
F < Ihatheislicensed pursuant tothe Provisions nIB,Contnnur',Licen.¢Law(Chepter9 Sq. Ft. Floor Area �1aIa���a1� � II�� ((��.�[jaluat,
y�$ (commencing with Section 7000)of Division 3 of the Business and Profession( hodc)ur BUILDIN
.. that he is exempt therefrom and the hula for the alleged exemption.Any=of
Section 7031.5 by any applicant for a permit subjects she applicant to a dvil penalty of 381�1ilglglaeipp OCCUpancy'Type
not roam them five hundred dollars($500).
❑h as Owner MNe property,or my employee with wage u Nein ole compensation,
will do the work and the structure is not inumiladm.nemd fonale(Sec.70st,Business Required Inspections
and Professions Cade:The Cons.cams Licensee e law donot apply to an owner of 1 q -
property who builds.,brim.shereonandwhod.,uchwmk himself.,through his 305 - FRAME
own employees.provided Nal such improvements are not intended or offe,aa for sale.If. 3O7 — INSULATION
however,she building or improvement Is mid within one year of completion,the owner-
builder .will have the burden of proving that he did not build or improve toy purport of 601 — ROOF TEAR OFF
tile.).
01.as owner of the property,em exclusively contracting wish licensed convectors In 602 - ROOF PLYWOOD NAIL
construct the pmjcct(See.?Ddd,Business and Professions Cotle9 The Coarsens Li. 603 - ROOF BATTENS.
cense Law doe not apply to an owner of property who builds or ins question,and 604 - ROOF IN-PROGRESS
who contracts for such projects with a contractor(s)licensed pursuant o de Commeob
Liwnse Law.
0I ame.emptunder Ses. ,Bk PChothismason
Owner Data
WORKER'S COMPBNSATION DECLARATION
1 hereby a mm under pe..try of perjury oro of the following decimal...:
I have and will meinuin a Cenifcem of Consent to self-imam for Worker's affitum,u provided for by Section 3700 of its,labor Code.roe the pe,fmmance of tho
work for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,as required by Section
37W of she labor Code,for the performance of the work for which this permit is issued.
My Worker,Compensation I...on.canter and Policy nmmbenrc:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(rhis se,ice need not he completed if the permil is for one hundred dollars($10(8
or lets.)
1 certify That in the performance of the work for which this permit is issued,I.hall not
employ any permn in any manner sat as to become subject to the Workers'Compomasion
Law,of California.Date
Applicant
NOTICE TO APPLICANT:IL after making this Cenificm,of Exemption,you should
become.Object to use Worker's ComPemation provisions of she Lou,Code, no muss
.Jz forthwi In comply with such provisinm or this peons mall be deemed rtwk.d.
?O CONSTRUCTION LENDING AGENCY
.F^ I hereby affirm that share in comuoesinn lending agency for the
performance,of
(.Y the work for which this permit is iuuctl(Sec,31197.Civ.C.)
tL A Lenders Name
z Lender's Address
U 0 1 cenify that 1 have read this application and state that the above information is
ry F correct I agree to comply with all city and county ordinances and state laws relating to
pU building convection,and hereby adomore representatives.(this city to enter upon the
fLl .hove-mentioned propcny for inspection proposes.
4 (We)agree to save,indemnify and keep hamlet the City of Cupertino against
N liabllitiea,judgments,cost and open swhich may,.any way seems,against mid Cisy
f.1 z in cnnsequcnc the gnmi of s anis.
^ APPLICA NDE N W L M Y ITH ALL NON-POINT Issued by: Date
SOU
7 IJ`�9 Re-roofs
Sigmwrc of ApplicanVComncmr 0 m
HAZARDOUS MATERIALS DISCLOSURE Type of ROOF .
Will the applicant or future building occupanUofe or handle hawdous material
as,defined by the Cupertion Municipal Cods,Chapter 9.13,and the health and Safety
Cod.,Section 355331.)? All roofs shall be inspected prior to any roofing material being installed.
❑Ye ❑Nu
win thesprscanorfuturebuildingoccupantuseeguipmentordevice,which 'Ifaroof isinstalled without firstobtaining aninspection,Iagree toremove
rix hovardous air contaminants as defined by the Day Arta Air Quality Management all new materials for inspection. -
miss?
71 Yes ON.
I have mast she hmardnus materials requirements under Chapter 6.95 or she Califnn
niulicahh&Sett Cotic,Secdnm 35 35533 wJ 534.1 unJcrsunJ thmifthc Wilding ,,0
Jess not curt M1ovx m t I s my reap hility m nattily the Oxc0Post of the
myuirc . et d foam ccyy./ Signature of Applicant Date
5 y o All roof coverings to be Class"B"or better
Owner to esiths.67.J epcm Da¢
" �l`•,t� Building Division
f A�' 10300 Tore Avenue
5 Cupertino,CA 95014-3255
CITY 0 Telephone: (408)777-3228
CUPEkTIN® 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.
I .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.
I 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'/V per foot slope and demonstrate that
there is no ponding.
2• An LC.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: C�
Address: Fe;
Reroofing Company Name:
Applicants Signature:
Date:__2Z/ ar
Joe Antonucci
(Chief Building Official)
6/25/01
0?f15r200G 20: 32 5105289262 LEGALITIES INK PAGE 04
t
CITY OF CUPERTINO 664
REROOF
SUPEkTINO PFjRMIT APPLICATION FORM
APN # � ;n Date:
D& 7 /1 S`03
I f
Building Address:
Owner's Name: %yy� , p Phone #: 3 G 6 ^fO y Q
Contractor:� Phone #: Y License#:
�rlcvici, S/o X56-6ri00
Contact: G r Phone#S � Cuperti-2- 1 / 7 lussiin�s License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles )( Asphalt Shingles
X Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
O Other(Specify)_ ��� C3Other(Specify)
Number of existing coverings�, ❑ Provide I.C.B.O.Report#
;A To be Removed ❑ Provide Mfgr. Installation Specs.
ave Read, Understand and W 1 Comply With Cu ertino's Tear Off Policy:
Job Description: -r10 „„,:i_ _ C�d�P 3o y-t ; (d
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Det. if
_ there are any restrictions:
Cost of Project: 72o no Type of Construction: Occupancy group:
Qty. if
Applicable Fee 1•D Fee Description Fee Group
I BPERMFEE Bldg Permit Fees BUILDING
BENERGY i Energy BUILDING
BSEISM_ ICtL^_ Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK ? Plan Check Fee BUILDING
BUSLIC Business License BUILDING
6 °