03070114 (2) .. CITY OF CUPERTINO cwaa«'rk : z'^
BUILDING DIVISION PERMIT CONTRAC°TOR�INFOMATION _
`R :R
BUILDING ADDRESS: MARCO ROOFING PERMIT N'03070114
' OWNER'S NAME: 43230 OSGOOD ROAD PERMITISSUEDATE
'NE: (510) 656-6400 SANITARY NO. CONTROL NO.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
0 0 0 0
oOD❑ LICENSED CONTRACIDR'S DECLARATION IIOn
G I hereby affirm That 1 em licensed under provisions of Chapter 9(commencing ]Ob Description
nP2 with Section7MI)of Division 3 of NC Business and Promashou Code,and my license is
in full force and m
ito
License
39 Lie, REROOF
ARCH acrsDEGMATIOIT IfSHAKES, RESHEET/ADD MORRIER DURALITE
�i I understand my plena shall he used As public records VILLA TILE
4.o UU Licensed Professional
OWNER-BUILDER DECLARATION
iI 1 family affirm that 1 am escmpt from the Comncmr's License Law for the
00 following mason(Section 7031.5.Business and Professions Code:Any city at county
which acquires a Permit to construct,alter,improve,demolish,or reryir-any structure
HZ� prior In its iasuancc.also acquires be applicant for such Permit to rile a signed laumem
x< that he is licensed pursuant to the pmvisionsofthe Contractor's License Law(Chapter 9 Sq. Ft. Floor Area Valuation
yF$ (commencing with Section 7000)of Division 3 of Ne Business and Professions Crude)or
F g that he is exempt lhcrefrom and Ne foods for the alleged exemption.Any vioution of $18890
Section 7031.5 by any applicant for a recall subjects the applicant to a civil penally of APN Number Occupancy Type
not ream roam fiw hundred delta.Is5tw). 36616061 . 00
1]I,as Owner of the proper,o my employees with wages As their sole cempenas0on,
will do the work and Ncewmurt is not intindetl or offered foutle(Sm.7W,Business Required Inspections �R
and Professions Code:The Camncmflaors m e lOn$
s License w dnet Apply An owner of q p it V A +.�
properly who builds or improve Netaon,and who does such work himself or through his
own employees,provided that such improvements ort not intended orofrered for sale.If. 305 — FRAME q
however,%a building or improvement is sold within one year of completion,Ne owner- AUG `] 2��3
Wilder will haw the burden of prowImprove su
proving that he did not ed or r purpose of 307 — INSULATION A'
asl`')' 601 — ROOF TEAR OFF
❑Las owner of the properly,am Business
contracting with:)Too tl ronactors t. UI a DING
comwnthe projcn(SeeJ014,Bmineu and Profeuiom ewe:)Too Contncuh Li. 602 — ROOF PLYWOOD. NAIL
arae law dura nut apply m An as,of properly who Wilda m Improves thcman,and. 603 — ROOF BATTENS
who contracts for such projects with a contractor($)licensed pursuant to the Contractor's
License law, 604 — ROOF IN—PROGRESS
❑1 am exempt under Sec. .B J,P C far this reason
Owner Dela
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of Ne following declarations: -
1 haus and will maintain a Cedifien of Consent a self-insure for Worker's Compere
1'37E
ion,as provided for by Scctian 3700 of the Labor Cnde,for the performance of the
for which this permit is issued.
have end will maintain Workers Compensation Insulates,as requimd by Section
of the labor Code.for Ne performance of Ne work for which Nis Permit is issued.Worker's Compensation Insurance envier end Policy numwr art:
rrier: Policy Na.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This seelian need nos he completed If the Familiar...hundred dallara(311)(1)
fes)
1 cenify Chet in the performance of the work for which this Forah is issued,l shell not
employ any person in any manner an As In become subject o the Workers Compdnutlon -
Laws of California,Dow
Applicant
NOTICE TO APPLICANT:IL eller making this C(nificare of Excmrticn,you should
become subject to the Worker's Compensation previsions urine laws Cnde,you must
.Jz forthwith amply with such provisions or this Permit shall1s decreed revoked,
z CONSTRUCTION LENDING AGENCY
Ihereby affirm Nm there is a construction lending agency fin the performance of r
Ri✓ the work for which this permit is issued(Sec.3(197,Cl,C.) -
CLender's Name
;D z Lender's Address
U O 1 certify that 1 haw red this application and auto that the shove information is
Career.l Agree w comply with all city and county ordinances and sum laws misting to
�U building construction,and hereby sothorinrepreemTAws of this city to enter upon The
shove-mentioned property for inspection purposes.
(We)agree to sow,indemnify and keep harmless the City of Cupertino against
oFr N liabi titles,judgments,costs and expenses which may in any way accrue against said City
t)z in consequence of the gr ng of Ihiarani
^ APPLICANT UNDE AN OMPL IT NON-POINT Issued by: D
SOURCE REG 6
7�9�0 5 Re-roofs
Signalum of ApplicenUCamractor Dal
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will do applicant or Nlure building Occupant sure or handle h4cardous material
as defined by the Cupeninm Municipal Code.Chapter 9.11,and the Health and Safely
Cuda a15531a)?
0Yea ❑No All roofs shall be inspected prior to any roofing material being installed.
Will the applicant Or future building Occupant use equipment atdev;aswhich If a roof is installed without first obtaining an inspection, I agree to remove
A havardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection.
waiel?
❑Yes Ohio q
Ihawreety Code,
25305.25533 no M3 .Iu Chepwt495 of The Wilding
ria Health Xrcully Cade,Secants (IS.13533 noM34.l to molly Me nd that ifthe willing Y✓-1 //s0+.-1 7 /C o3
Jaenounts. ic he I is .oruihil] ronn4O.,trcu ant of the J
myuimmenks whir tM el r ss ata nfa lrCaw,d�Occu�an Signatuy of Applicant Date
Owner Or aothorired I
All roof coverings to be Class "B" or better
e
'Goal
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
L U PE J" 1 N Fax: (408)777-3333
Building Department
Subject: Re-roofing policy for the City of Cupertino
1. Prior to permit issuance,you must agree to comply with 1997 UBC Standards
and manufacturers specifications on re-roofing.
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 re-roofing
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) Pre-inspection 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 a 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 on inspection.
I understand and will complywiththe above stated policy on re-roofing.
Homeowner's Name:
Job Site'Address: 75 .2- 7 y� p0_?1-k 7 _
Roofing Company Name: ?
AplicanYsSignature: �' Date:
' / \�l/iShClpCX1
Greg eel
Building Official
Revised 1/30/03
Crinlad nn I]nnurlad Oannr
07/15/2003 20: 32 5105363202 LEGALITIES INK PAGE 06
a 3� -70Px'
t ' CITY OF CUPERTINO y0°"'4;0
REROOF
RUPEkTINO PERMIT APPLICATION FORM
APN# Date:
15/0-
Building Address:
-75 2"j o-nx �2c.wc�
Owner's Name: ' Phone#:
X1,5-02
Contractor: i ne#: License#:
Contact: .�God ' Phonc Cupertino Business License#:
i
ate— -1 /
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Buili-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
Wood Shakes ❑ Wood Shakes
'O Wood Shingles [] Wood Shingles buy
0 Other(Specify) .? )C Other(Specify)1�e�
Number of existing coverings� ❑ Provide I.C.B.O.Report# M_ S
[] To be Removed 0 Provide Mfgr.Installation Specs.
Have.Read, Understand and.Will Comply With Cu ertino's Tear Off Polic : ❑
J b Description: 71,o _ aM-It a
S7*1
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning D t. if
there are any restrictions:
Cost of Project* ao Type of Construction: Occupancy group:
18, �9a
Qty, if
Applicable Fee W .. Fee Description Fee Group
BPER-?A= Bldg Permit Fees BUILDING
BENERGY', Energy BUILDING
BSEISMICREr Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plari Check Fee BUILDING
BUSLIC Business License BUILDING
as `� 97 .