R 3050 TB— :fin
PERMIT
APPLICATION FOR CITY OF CUPERTINO NUMBER R; 3050
REROOF PERMIT INSPECTION DIVISION PERMIT EXPIRATION
(408) 252-4505 EXT. 228 PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN IBD DAYS OF PERMIT ISSUANCE OR
160 DAYS FROM LAST CALLED INSPECTION.
BUILDING ADDRESS - BUILDING USE
ASISPM' 9� RESIDENTIAL COMMERCIAL OTHER
OWNER'S � �`�2�
NAME HAZARDOUS ROOF
FIRE COVERING
AREA CLASS
ADDRESS ger ILS ,B�T/ C� EXISTING ROOF COVERING
PHONE 9-. 577- 30 63 NUMBER OF EXISTING COVERINGS 1
CONTRACTOR'S ' �^ �7 ` , ,..� TO BE REMOVED TO BE RETAINED
NAME 01 NVA4 \G �a�.+� TYPE OF ROOF COVERING
ADDRESS
CITY&ZIP ZOS-6 IV,Smr�1yL�.� �p4
J� EXISTING
4siyb
PHONE 1��� �/23— 7Ulo� BUILT-UP ROOF
LICENSE t. 7 ASPHALT SHINGLES
NUMBER
WOOD SHAKES
LICENSED CONTRACTORS DECLARATION
with Section affirm that .1 ivisiotl 3 Of t provisions of Cnepser 9(commam
mg with ens7000) of Division 3.f the Basi rpy ons case. WOOD SHINGLES
and my Ilcanu Is In full tome and efiecL pY
Do,* a CIaRI Lic.Number
D01 �"--- cDECL R OTHER (SPECIFY)
OWNER m..BUILDER DE DECLARATION
-
hereby affirm mat 1 . exempt from the Contractor's Llc onto Law for
ma iollOwinq raa.on. (Sec. 703 1.5, Business and Professions Coda: Any city PROPOSED
or cp..ty Which requires a permit to construct °lar, 'mercy., aamo isn,Or
repam ir env.buctun.Pflo1 to Its Issuance, also squires the pplic."forsucn BUILT-UP ROOF
Perrin It 10 fila a signed statement that he if licensed pursuant to the pravislon.
of the contractor. License Lew (Chapter 9 (commenting with Section 7000)
of Div lsi on 3 of the Business and Plofessioh,Cade)or that he If..Amp,there.
from end the basis for the alleged ...Tenon, q ASPHALT SHINGLES
7031.5 b rev ant to violation Section
y any applicant for a permit subjacb the applicant to a civil penalty
01 not more twat five thehundred dollars 1$500).): WOOD SHAKES
❑ I, n owner of the property, or my employees with wages of their tole
COmpansatlon.Will do the Work, end the structure if not iPl.nd.d or Orland
for sale(Sec. 7044, au,ina,.end Professions Code: The Contractor'.License WOOD SHINGLES
Lew do.not apply to an owner of PI.Perty who build.or improve,th anon,
and who does Such work himself or through his own employees,Provided Net `�
such ng or improv Are not intendedlwilor one
year
for ala. I1, however, ma OTHER (SPECIFY) I—''v
Peiping
or
improvement
bent i, of within Ona yeas pl of builcompletion. the owner
builder will have ins burden Di proving that he aid not build or improve for
Purpose aisle.,. PROVIDE LC.B.O. REPORT
❑ I, s owner st [M1e property, I ( tic. 7exclusively4, contracting with Ilcanaetl
contnctms to construct Ne project (Sec. J044, Business and Professions
y Code: The Contractor's 11 ..unense no Who contraplycts foauch PI .11. i Property PROVIDE MFGR. INSTALLATION SPECS,
who "antl, l improve, suant t, aha who actor's Li for such prolan,with a
contrector(s)licensed pursuant to the Contractor's License Lew.
❑ I em eaempt under Sec. ,B.6P.C,I.,this
reason
Owner Co'. APPLICATION DATE VALUATION PERMIT FEE
WORKERS'COMPENSATION DECLARATION rO
1 hereby affirm the, I have a certificate of consent to eel Linfwa,o p n
tificete at Workers' Compensation Insurance, a c ['lied copy Nersof(Sac. A g
3800,Lee.Cd. .�/- C I SEISMIC
Palicv No. CO,Pp..Y_41 µKS(arolled copy is hereby furnished. I OCTIVI 9 4
Carlil led copy Is filed with the city inspection division. 9 199
A li<ant C1
CERTIFICATE E EXEMPTION FROM WORKERS' ERMITyVAUDATION DATE
COMPENSATION S millet INSURANCE
I($10ThIs feCSIDn need not be completed if the palmi[ is for no hundred tlol Ly
ran 1$100)01 4n.)
1 certify tnat in tna pada Person of the work for which this permit is _ ✓•— Fl ��
to the I shall not employ ion Person in any manner so as to become subject
to the Workers'Compensation Lawf of California,
Date Applicant
NOTICE TO APPLICANT: Ii, after making Nis Canificats of Exemption.
YouNouto become subject to the Workers'Compensation provisions at the
Labor Coad, you must forthwith comply with such provisions or this permit
.hall be side,etl musttl. I All types of root shall be inspected prior to any roof being installed.To .
I unify that 1 have read this application and ort.met the,bov.inform.. receive a final I am aware there will be three approved inspections:
P.n it Correct. I .qr.. to comply with all city and county ordinances and Pre, inprogress,and final. If roof is applied without first obtaining an
.lata laws rooting to building construction, and hereby author'.. Ieprosem inspection, agree will remove all new material for inspection.
tatives Of this city to anter upon the above-mentioned property for inspection
purposes. '
(WSJ agree to save, indemnify and keep harmless the City of Cupertino
against liabilities,judgments,costs and expanses which may in any way accrue e
NOeg°imt said City In consequence of the granting of this permit.
SIGNATURE OF APPLICANT DATE
(REQUIRED PRE-INSPECTION IN-PROCESS INSPECTION FINAL INSPECTION
INSPECTIONS INSPECTOR DATEINSPECTOR DATE_:�l ::CTOR— DATE
NOTE: OSHA APPROVED ACCESS TO ROOF SHALL BE PROVIDED FOR INSPECTION
OFFICE COPY -
#�rz-3o s'o
MELVIN R. HILL, INC.
R.C.E. 19704
142 KENNEDY AVENUE
CAMPBELL, CA 95008
408-866-1546
FAX 866-1375
92068
5 November 1992
Building Department
City of Cupertino
10300 Torre Avenue
Cupertino, CA 95014
Dear Sir:
O'Hara Construction is re-placing the roof at 21825 Benetti
Court in Cupertino, California. Unfortunately there was no
pre-site inspection by the City of Cupertino. I have in-
spected the roof and found no dry rot or other deterioration
in the existing under roofing structure. I also inspected the
sheathing and found that it was constructed in accordance with
the 1992 Uniform Building Code.
I have approved the construction to continue, subject of
course, to your approval . If you have any questions, please
feel free to call me at my office.
QROFESS/p y
Yourstruly
CM m
No.19,704
Exp.Sep.30,1993
Melvin R.
R.C.E. 197
�T9T CIVIL
FOF CAQ1