R 3544 l
APPLICATION FOR CITY of CUPERTINO NUMB R R" 3544
. INSPECTION DIVISION PERMIT EXPIRATION
REROOF PERMIT
(408) 252-4505 EXT. 228 PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN IS0 DAYS OF FROM LAST ERMIT CALLED INSPECTION.OR
IBD DAYS FROM LAST CALLED INSPECTION.
BUILDING ADDRESS BUILDING USE
21703 Castleton Street RESIDENTIALX COMMERCIAL OTHER
OWNER'S
NAME Ronald Thorne HAZARDOUS ROOF
FIRE COVERING
AREA www CLASS
ADDRESS 21703 Castleton Street, Cupertino EXISTING ROOF COVERING
PHONE 408-253-3141 NUMBER OF EXISTING COVERINGS 1
CONTRACTOR'S
Security Roofing, Inc. TOBEREMOVED E
1 TOBERETAIND 1
NAME TYPE OF ROOF COVERING
CIT&ZIP Ps Q. Box 2450, Menlo Park, Ca. 94026
EXISTING
PHONE 408-947-8811 BUILT-UP ROOF
NLICENSE UMBER 21680 ASPHALT SHINGLES
WOOD SHAKES X
LICENSED CONTRACTORS OECLARATION
I hereby affirm that 1 am licensed under provisions of Chapter B(common. r
Ting with Section 7000) of Divbion 3 of the Business and Professions Code, WOOD SHIN?L $ t�
and my llcm s I II force and effect 'I
Lire��rFa GGjryryae LF.Numy.r �.-aTTH fl PS
Datl{� M/ZI Contrectod6yyy9, IncIn 1 ' CiF(n'7� 1� Fn
_
OWNER-BUILDER DECLARATION Y V Y
I ho,by affirm that I am exempt from the Connector. License Law for pROPO D VV
the following reason. (Sec. 7031.6, Business and Profession.Code: Any city
or co.nW which squires • permit to construct, alto, Improve,demolish,or
reaalr any.,ructus. Prior to ib inuenca,also equine the aPPlican,for such B�I LT•lF
Is= to Ills a signed statement that he if licensed pursuant to the ps.i.iom
of the sion 3 ofoi s Business
Law (C leater 9oin. . (commencing with section]000)
of Division 3 of me Bfor the
and Profession.tiod,l or Mn of If enamor Mere ASPHALT SHINGLES
from and an bases for Ms alleged exemption.the
Any violation Of Section
7031.6 b,any tSPPII five hundred
fora permit subjects Ms applicant to•civil penalty WOOD SHAKES
of not more that five the pro dollenr my e.1:
❑ 1, owner 01 the property,it my employes with wends as Meir tree
compensation,(Sewill do the work, sntl the NuCode if not intended oLicefotl
for do s no apply
Buena and Professions Com: The orimproves
Contractor's License WOOD SHINGLES
Lew eras not apply o a owner of h nigh his
n em to improves[hereon,
and who dies such work himself int Or ed o r Offered his own r sea. eIf, Providedvetl Mn h
suis imp, mares ere not .to wed or n. Ya far sal.. ti however,owner OTHER (SPECIFY) 1 2 Ply 10fi fel
building fir improvement if sold proving
One year of completion.ion, der owner a�jl
builder will nava the burden o1 p/Ovine that he tlltl not build or improve for !1
purpose offal..). PROVIDE I.C.B.O. REPORT NO.
❑ 1, f r of the prop...., em exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business and Profession,
Code The Contractor's Lic.n.. Law do.$not apply toan owner ofproperty pflQVIDEQAFGR. INSTALLATIONSPECS.
Who builm or improves Memo and Who contracts for such projects with a r' /A p
contractor,)licensed purfueaM
t to e Contractor's License Law.
❑ 1 am exempt under Sec. S.&P.C.for this
O.s r Date - PPLICA AT nVALUATION PERMIT FEE
WORKERS'COMPENSATION DECLARATION 199q Building 900
I hereby eIfi,m that 1 have a certificate of consent to sell inure,or a car 'I .70
filit. of Workers'Compensation Insurance,or a certified copy thereof(Sac. /CI X il/
Polio. No.a)5-94 company State Workman Como Ins Fu d 2 J y l � '�ur n71��00 e 00 seismic
ppCertified Top,I.hereby Irrni.p.d. Total qn-7.0—
7rX Certified copy it filed wi ter. itY in!P¢tio ivi.ion.. ,
Applicant
CERTIFICATE OF ENIEMPTION FROM WORKERS' N.C. 0 PERMIT AUTHORIZATION DATE
COMPENSATION INSURANCE �/�j.��/) ng..//�
I This section need not be completed I
ad if the permit if for one hundred deI
Ian($100) tIn n 7
I artily that in Me performance of In. work lar which his Permit is
iesu.d, I hell no,employ any person In any manner so as to become subject
to the Workers'Compensation Laws of California.
Dal. APplic.n,
NOTICE TO APPLICANT: If, after making this CotNicafe of E.emptirn,
You should become subject to the Work.,% Compensation provision.of the
Labor Code, You must forthwith comply with such provisions or this permit
.hall be deemed revoked. All roofs shall be Inspected prior to any roofing material being
I certify Mat I haw read this application and aceta that the above inform. Installed. If a roof is installed without first obtaining an
tion if correct. I agree to comply with all city and county ordinances and Inspection,I agree to remove all now materials for Inspection.
.use laws foisting to building construction, and hereby authorir, repletion. //``�� /^f
purposes.Of t11,CItY to enb/upon the ebrvfmention,tl property for Inspection Wa'1r 1
pur(We) L�J` �- 3-9�
I st l agree s, save, indemnify and expenses
harmless which the in
of Cupertino
against liabilities, consequence
judgments,con.and gxpmes.which mem in my way accrue
I � agsimt sele City in conuruanLv of the nesting o/this permit SIGNAT E 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 _
• citta of cupel-lino
P.O.Box 500
10300 Torre Avcnue
Cuper Ono, California 95014 Cupertino,California 95015
Telephone: (400) 252,4505
DEPARTMENT Of PLANNING AND DEVELOPMENT
SUBJECT: REROOFING POLICY FIR CITY OF CUTE UM BUILDING DEPAFIEVib I' 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 an
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 hispected prior to any roof being
installed.
4. Iii order to receive a final, you must complete steps 1, 2, and 3.
• 1. Preinspection approval
2. Inprogress inspection approval
3. Final inspection approval
a. Operable smoke detector verification
b. Spark arrestor installation
5. If any roof is applied without first obtaining an inspection, you will
remove all new material down to the sheathing and a building inspector
will inspect all sheathing at that time.
WE UNDERSTAND I11E ABOVE POLICY ON REROOFING. AND WILL OOMPLY WI71I TILE
POLICY ^
IICMEOWNERS NAME:
ADDRESS: .2170
REROOFING OOMPANY NAME:
APPLICANT'S SIGNAMIC
• CITY OF CUPERTINO
BUILDING DEPARIMEN'T