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R 4860• 0 • PERMIT q_ 486 APPLICATION FOR CITY OF CUPERTINO NUMBER 0 INSPECTION DIVISION PERMIT EXPIRATION REROOF PERMIT (408) 777-3228 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 1 W DAYS OF PERMIT ISSUANCE OR - 130 DAYS FROM LAST CALLED INSPECTION. BUILDING ADDRESS I ((('/�) ( /��,y" /y� /) /'` If ,—I 0 \ f bI � / J ! i, . RESIDENTIAL ` COMMERCIAL OTHER OWNER'S HAZARDOUS FIRE AREA �� YES ❑ Ii yes - I understand that a Class A NAME reel assembly is required. NO ❑ Initial I.C.B4O. # EXISTING ROOF COVERING ADDRESS 2— PHONE + NUMBER OF EXISTING COVERINGS I CONTRACTOR'S TO BE REMOVED TO BE RETAINED I NAMf ADDRESS TYPE OF ROOF COVERING CITY &ZIP EXISTING PHONE BUILT-UP ROOF ❑ LICENSE NUMBER a ASPHALT SHINGLES 'ENS D CONTRACTORS DECLARATION I hereby affirm shot I am licensed under provlsans of Chapter B (commencing with Section WOOD SHAKES ❑ 7000) of Div jai on 3 of the Business and Profeeelona Co and my license is In full force and affect. WOOD SHINGLES ❑ '•d Lie a CI Lie. Number OTHER (SPECIFY) Oet Centracto NER- BUILDER T _ PROPOSED 01199 I hereby affirm that I am exempt from the Contractor's License taw for the following r son. (Sec. 7031.5, Business and Professions Code: Any city or county which requires ` U U ^' a permit construct, alter, Improve, demolish, or repair any structure, to Its Issuance, also requires the t p`el) prior for to file that he Is licensed BUILT-UP ROQF ❑ 4Jr �ti applicant such permit a signed statement pursuant to the provisions of the Contractor's License Law (Chapter a (commencing with Section 7000) of Division 3 of the J(• Ctt� Business and Professions Code) or that he Is exempt therefrom and the basis for the alleged ASPHALT SHI S exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): [2 1, as owner of the property, or my employees with wages as their sole compensation, will do WOOD SHAKES the work, and the structure Is not Intended or offered for sale (Sec. 7044, Business and Profes- sionsCoder The Contractor's License Law does not apply to an owner of property who builds or Improves thereon, and who does such work himself or through his own employees, provldod that WOOD SHINGLES ❑ such Improvements are not Intended or offered for sale, II, however, the building or Improvement Is sold within one year of completion, the ownar-builder will have the burden of proving that he did OTHER (SPECIFY) ❑ not build or Improve for purpose of sale.). ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct ' the project (Sec. 7044, Business and Professions Code: The Contractor's License Law does not PROVIDE I.C.B.O. REPORT NO. apply to an owner of property who builds or Improves thereon, and who contracts for such projects with a contractor(a) licensed pursuant to the Contractor's License Law. ❑ I am exempt under Sec. ,B a P. C. for this reason PROVIDE MFGR. INSTALLATION SPECS. Owner WORKER'S COMPENSATION DECLARATION APPLICATION DATE VALUATION PERMIT FEE I hereby affirm under penalty of perjury one of the following declaration: ❑ 1 have and will maintain a Certificate of Consent to self - Insure for Worker's Compensation, Building 9 as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit Is fssued ❑have and will and Worker's' on as (squired by Sectionorke0l (,r ' / -) h ^ ///��� /' /! ` ---• (DS Seismic the performance the Labor Code, for the performance of the wo for which this permit Is Issued. My Worker's the which this Compensetl n In once carne Policy num are: Total N��.i+ l oar a Pollcyn - PERMIT AUTHORIZATION DATE CERTI CATE OF EXEMPTION FROM WORKERS' � f/ COMPENSATION INSURANCE NA.p (This section need not be completed It the permit Is for one hundred tlollers ($100) or lase.) I certify that In the performance of the work for which this permit Is Issued, I shall not em toy any person In any manner so as to become subject to the Workers' Compensation Laws of 911- All roofs shall be inspected prior to any roofing material being far t installed. If a roof is installed without first obtaining an Date Applicant inspection, I agree to remove all new materials for inspection. NOTICE to the workers' Compensation ten protvisions of the Labor Code, yolu must bdhwtlth co ply subject Applicant Understands and will comply with all non point with such provisions or this permit shall be deemed revoked. source regulations. I certify that I have read this application and state that the above Information Is correct I agree to comply with all city and county ordinances and state laws rotating to building construction, and All roof coverings to be pf ss "C" or better. hereby authorize representatives of this city to enter upon the above - mentioned property for In- I spection purposes. ' (We) agree to save, Indemnity and keep harmless the City of Cupertino epalnst liabilities, C judgments, costa and expenses which may In any way accrue against said City In consequence of the granting of this permit. SIGNATURE OF APPLICANT ATE PRE - INSPECTION: PLYWOOD: IN- PROGRESS: INSP. DATE INSP. DATE INSP. DATE TEAR OFF INSPECTION: BATTENS: FINAL: INSP. DATE INSP. DATE INSP. DATE NOTE: OSHA APPROVED ACCESS TO ROOF SHALL BE PROVIDED FOR INSPECTION OFFICE COPY 0 SUBJECT: REROOFING POLICY FOR THE CITY OF CUPERTINO BUILDING DEPARTMENT PRIOR TO ISSUANCE OF PERMIT AND INSPECTION PHASE. 1. Prior to permit issuance, you must agree to comply with U.B.C. standards and manufacturers spec's 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 types of roof shall be inspected prior to any roof being installed. 4. In order to receive a final, you must complete steps 1, 2, and 3. 1,) Preinspection or tear off approval. 2.) In progress inspection approval. 3.) Final inspection approval. a.) Operable smoke detector verification • b.) Spark arrestor installation 5. If plywood is installed, a plywood nail inspection is required. 6. If any roof is applied without first obtaining an inspection, you will be required to remove all new material down to the sheathing and a building inspector will inspect all sheathing at that time. WE UNDERSTAND THE ABOVE POLICY ON REROOFING AND WILL COMPLY WITH THE POLICY HOMEOWNERS NAME: ADDRESS: REROOFING COMPANY NAME: APPLICANT'S SIGNATURE: CITY OF CUPERTINO BUILDING DEPARTMENT • Reroof/winword FIRM, Mi M_. �_