Loading...
R 5827 PERMIT APPLICATION FOR CITY of CUPERTINO NUMBER R- 5827 INSPECTION DIVISION PERMIT EXPIRATION REROOF PERMIT (408)777-3228 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 160 DAYS OF PERMIT ISSUANCE OR 160 DAYS FROM LAST CALLED INSPECTION, BUILDING ADDRESS 6V1e -%7/VO Chi RESIDENTIAL COMMERCIAL OTHER OWNER'S - HAZARDOUS FIRE AREA /r/r2 ! /.. /•���N YES El It yes—I understand that a Class A NAME �H- roof assembly is required. - NO Initial I.C.B.O.M ADDRESS L0620 EXISTING ROOF COVERING PHONE NUMBER OF EXISTING COVERINGS / CONTRACTOR'S n_ NAME w�4�eX /�di�l/✓� 6DW77 TO BE REMOVED TO BE RETAINED ADDRESS TYPE OF ROOF COVERING CITY&ZIP /Z-Z' Y-Z 5%t ,r1Su.Vy 4-) - yA.LRTd6A� 9S'D'SCD EXISTING PHONE_7:2:?---9r 33j'3� BUILT-UP ROOF El LICENSE NUMBER �- ( ` • Z� ASPHALTSHINGLES ❑ LICENSED CONTRACTORS DECLARATION / I hereby affirm that I am licensed under provisions of Chapter B(commencing with Sect WOOD SHAKES 7000)of Division 3 of the Business and Professions Code,and my license Is In full force and effect. �f OD SHINGLES P A I D ❑ License Claes 6 3fLie.Number '� � 2—`• Date /`Z/— Contractor'"A4) O��JiJy, O (SPECIf^��w21 © OWNER-BUILDER DECLARATION PROPOSED COI hereby affirm that I em exempt from the Contractor's License Law far the following reason. l r l UF(Sec.7031.5,Business and Professions Code: Any city or county which requires a permit to (x UrCry I IIV,l,1, construct,sitar.Improve,demolish,or repair any structure,prior to Its Issuance.also requires the BUILT-UP ROOF LI of the for etch permit to Ills a signed statement that he Is licensed pursuant to the provisionsofthe of the Conor ouch LimnLicense Lew(Chapter t (commencing h with Sensed 7000)01 o Chelan 3 of the Business and Professions Code)or mat he Is exempt therefrom and the basis for the alleged ASPHALT SHINGLES exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than live hundred dollars($500).): E)1,as owner at the property,or my employees with wages as their sots compensation,will do WOOD SHAKES ❑ the work,and the structure Is not Intended or offered for sale(Sec.7044,Business and Profes. sions Code:The Contractor's License Law does not apply to an owner of property who builds or WOOD SHINGLES Improves thereon,and who does such work himself or through his own employees,prmided that ❑ such Improvements are not Intentletl or offered for sale.If.however,the building Or Improvement Is sold within one year of completion,the owner-builder will have the burden of proving that he did OTHER(SPECIFY) �OSa SN�.�Hr,vb 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 Lew 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 contractors)licensed pursuant to the Contractor's License Law. PROVIDE MFGR.INSTALLATION SPECS. ❑I am exempt under Sec. ,e&P.C.for this reason Owner Date APPLICATION DATE VALUATION PE T FEE WORKER'S COMPENSATION DECLARATION 1 In y affirm under penalty a1 perjury one of the following declaration: have and will maintain a Certificate of Consent to self-insure for Worker's Compensation, Building as provided for by Section 3700 of the Labor Code,for the performance of the work for which this / permu ive and 6D Seismic �— have end will maintain Workers Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued.My Worker's Compensation Insurance carrier and5Policy number are: 99yy Total , Carrier5e, � �7J�✓fJ Policy No. PERMIT AUTHORIZATION DATE CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE N.CZ] \ /)� (This section need not be completed If the permit Is for one hundred dollars(5100)or lees.) ��•l/ 1 certify that In the performance of the work for which this permit Is Issued.I shell not employ any person In any manner so as to become subject to the Workers'Compensation Laws of Call. All roots shall be inspected prior to any roofing material being fornia. installed. If a roof is installed without first obtaining an Date Applicant inspection,I agree to remove all new materials for inspection. NOTICE TO APPLICANT: If,after making this Certificate of Exemption,you should become Applicant understands and will comply subject to the Workers'Compensation provisions of the Labor Code,you must forthwith comply pP ply with all non point with such provisions or this permit shalgbe deemed revoked. Source regulations. I certify that l have reed this application and state that the above Information Is Correct.I agree to comply with all city and county ordinances and state laws relating to building construction,and All roof coverings to be class"C"or better. hereby authorize representatives of this city to enter upon the above-mentioned property for In- spection purposes. /I , (We)agree to save,Indemnity end keep harmless the City of Cupertino against Ilabilitles, u _ judgments,coats and expenses which may In any way accrue against said City In consequence of the granting of this permit. NATURE APPLI A T DATE 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 • CITY OF CUPERTINO — BUILDING DEPARTMENT RE—ROOFING POLICY 1. Prior to permit issuance, you must agree to comply with U.B.C. standards and manufacturers specs on re-roofing. 2. New roof coverings shall not be applied without first obtaining all inspections 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 types of roofs shall be inspected prior to any roof being installed. 4. In order to receive a final, you must complete steps 1,2, and 3. I. Pre-inspection or tear-off approval 2. In-progress inspection approval 3. Final inspection approval a. Operable smoke detector verification 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 sheating and a building inspector will inspect all sheating at that time. IMPORTANT: 1. Flat roofs must have a ''/4" per foot slope, or demonstrate that there is no ponding. 2. I.C.B.O. reports are required to be on the job site at the time of inspection. If you do not have one, contact the building department. WE UNDERSTAND THE ABOVE POLICY ON RE-ROOFING AND WILL COMPLY WITH THE POLICY. HOMEOWNER'S NAME: ADDRESS: & 4i0571XI Vox RE—ROOFING COMPNAY NAME: APPLICANT'S SIGNATURE: • CITY OF CUPERTINO BUILDING DEPARTMENT Re-roof/winword