R-4891 r/
PERMIT
APPLICATION FOR CITY OF CUPERTINO NUMBERR_ 489
INSPECTION DIVISION PERMIT EXPIRATION
REROOF PERMIT (408)777-3228 PERMIT PIKES IF WORK IS NOT STARTED
WITHIN 10080DAYS OF PERMIT ISSUANCE OR
100 DAYS FROM LAST CALLED INSPECTION.
BUILDING ADDRESS 7� 1 }�
IOI E /u I r O CI RESIDENTIAL COMMERCIAL OTHER
OWNER'S HAZARDOUS FIRE AREA
YES ❑ If yes—I understand that a Class A
NAME m- ( a N S, 46,4roof assemby is required.
/ NO K IniGa1 I.C.B.O.M
ADDRESS I s ¢ , �, . ec #ZZo S3 G� 95 166 EXISTING ROOF COVERING
NUMBER OF EXISTING COVERINGS z
PHONE
CONTRACTOR'S /�
_ � ,. � " TO BE REMOVED Z TO BE RETAINED
NAME SS I(( 0 t K
a.�. C .,[ c p TYPE OF ROOF COVERING
CITY&ZIP— I� -�y� `�. �1� . 7�h�osG l 11Z iy
EXISTING C
PHONE �� Tit I-7Soa BUILT-UP ROOF—
LICENSE AS ALT SHIt -ES P J JJjl
NUMBER ZQ a ®e
LICENSED CONTRACTORS DECLARATION
• hereby affirm that em Business
under provisions of Chapter 9(commencing with Section SHAKES
]000)of Division 3 0l the Business entl Professions Code,and my license Is in lull force and
street. _ Q QQD L ❑
License Class ` Lie.Numbs !/
Data co act OiIR($PE ❑
OWNER-13DERD CLAR IN PROPOSE/DL
I hereby affirm that I am exempt from the Contra ansa Law for the following reason.
(Sac.7031.5,Business and Professions Code: y ell r county which requires a permit to
construct,alter,improve,demolish,or repair any at a,prior to Its Issuance,also requires the BUILT-UP RO F 0/�
applicant for such permit to file a signed statement that he is licensed pursuant to the provisions
of the Contractors License Law(Chapter 0(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that no is exempt therefrom and the basis for the alleged ASPHALT SHINGLES 1,1 ❑
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).1: Lr v
❑l,as owner of the property,or my employees with wages as their sole compensation,will do WOOD SHAKES ❑� 961
the work,and the structure is not intended or offered for sale(Sec.7044,Business and Profes-
sionsCode:The Controcmrs License Law does not apply to an owner of property who builds or WOOD SHINGLES EJ
improves thereon,and who does such work himself or through his own employees,provided that
such improvements are not intended or offered for sale.If,however,the building or Improvement
is sold within one year of completion,the owner-but Ider wl 11 have the burden of proving that he did OTHER(SPECIFY) x�ll �Qls-L�.JOp Q'
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 Cotla: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 contractors)licensed pursuant to the Contractors License Law. PROVIDE fill INSTALLATION SPECS.
1 am exempt under Sec. ,B&P.C.for this reason
Owner Date APPLICATION DATE VALUATION PERMIT FEE
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declaration: ,'J
have and will maintain a of 11.icab of Coe,for to performs for Worker's Compensation, OC Building/27
7
as C]I have
tl lardy Section 37000)the Labor Code,lot the performance of Worker's
work for Compensation,
this y�
permit Issued. 2-b �� I p`^`�`�. Seismi
ll Ta
I have and will maintain Worker's Compensation Insurance,as required by Section 3700 of
th L bar Code,for the performance of the work for which this permit is issued.My Workers
1 'Compensation Insurcarrle ntl Poll number are: Total
Carrier `�ance .,icy,o. �ZI N_ PERMIT AUTHORIZATION DATE
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE N.C.❑ ^
(This section need not be completed if the permit Is for one hundred dollars($100)or less.) S�rQ l '
I certify that In the performance of the work for which this eMIR I 'si ued,I shall not employ dill
any perao In any m nor so as to become a ora mp : on wa of call. All roofs shall be inspected prior to any roofing material being
forniar. installed. If a roof is installed without first obtaining an
Dare J ZO Ap inspection,I agree to remove all new materials for inspection.
subecome
ject iroEn W rk�eCc T. If,
ater proi11 vigonsoftrlili YoroCode,
youmustforthwith dcomply Applicant understands and will comply with all non point
with such provisions or this permit shalCbe named r oked. sOUr ations.
Icertity that lhave read this eppliratione hat the above information is corracLl agree ll��
to comply with all city and county ordinances and state laws relating to builtling construction,an0 All rO COV g e/CIBSlx�Dr t)etteL
hereby authorize representatives of this city to enter upon the above-mentioned property for Ir
sp Wpurposes.
( e)
(Wel agree to save,indemnify and keep harmless the City ai Cupertino y Inagainst liabilities J
judgments,casts and expenses which may In any way accrue against said City In consequence
of the granting of this permit OF AlLICANT RYE
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
® 10300 Torre Avenue
Cupertino,CA 95014
Ctipert.1110 Building Division
(408)777-3228
(408)777-3333 (fax)
March 18, 1997
De Anza Oaks HOA
1635 The Alameda#220
San Jose, CA 95166
SUBJECT 10181-10171 Firwood
R4890, R4898 Reroof permits
Dear Homeowner Association:
• We have been going through our files in the Building Department, and contacting those
people with permits which have remained "open".
According to our inspection records, the subject permit has never been finaled. Many
times an inspector will sign the permit in the field, but neglect to report all of the
information to the clerical staff for input into the computer. If your records show the
subject permit as finaled, would you please contact us so we may complete our records?
If the permit is not signed off your permit can be reactivated and an inspection could be
scheduled for final closure of the permit
If we do not hear from you within ten(10) working days, we will dispose of the file and
remove the records from our computer.
Thank you for your assistance.
Sincerely,
CITY OF CUPERTINO
Christy Akatiff, Administrative Clerk
:eu u,,so,::=-V =:-gyp,