R 6191 PERMIT R_ 6191
APPLICATION FOR CITY OF CUPERTINO NUMBER .
REROOF PERMIT INSPECTION DIVISION PERMIT EXPIRATION
(408)777-3228 PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
BUILDING ADDRESS —7
20 S&—Z,b'4OZ C,01 1) C9611,V G , RESIDENTIAL' COMMERCIAL OTHER
OWNER'S HAZARDOUS FIRE AREA
NAME I50V % J T Yt R✓I no0ff;.luers f,s"requirrednIlt. Class A
• NO ❑ Initial I.C.B.O.#
ADDRESS GAMS EXISTING ROOF COVERING W
PHONE` 0aoLrOa — 10 NUMBER OF EXISTING COVERINGS 7
CONTRACTOR'S �//����
NAME I Al�'�s?ir.Tfr6 K.00F "& CC I IJ TO BE REMOVED TO BE RETAINED
ADDRESSa TYPE OF ROOF COVERING
CITY a zIP2Z—IZ L10[,oL0 -Ay .S_'S,� 951'IFj
/ \ EXISTING
PHONE `4' / 4'�I'� �d6`L�i BUILT-UP ROOF ❑
LICENSE
NUMBER ASPHALT SHINGLES
LICENSED CONTRACTORS DECLARATION
hereby affirm that I em licensed and
Pr Professions
of Chapter 8(commencing with Section WOOD SHAKES
7000)of Division 3 0l the Business end Prolesslone Cotle,and my Ilceroe Is In lull force entl
effect.
WOOD SHINGLES
License Class, C-10% Lic.Number 5 X36 '
Date 9 Z� a Contractor ��A�'S'A^7 RA7�t1.1a(�j� OTHER(SPEC
OWNER-BUILDER DECLARATION PROPOSED
hereby affirm that I am exempt from the Contracloes License Law for the following reason. D 1(]98
(Sec.7031.5,Business and Professions Code: Any city or county which requires a permit to Q P
construct,alter,Improve,demollah,or repair any structure,prior to Its Issuance,also requires the BUILT-UP ROO J�f ❑
applicant for such permit to file a signed statement that he Is licensed pursuant to the provlelons,
of the Contractor's License Law(Chapter S(commencing with Section 7000)of Dlvleion 3 of the
Business and Professions Code)or that he Is exempt therefrom and the basis for the alleged ASPHALT SHIN $
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(5500).): WOOD SHAKES
❑I,as owner of the property,or my employees with wag as as their sole compensation,will do �� - ❑
the work,and the structure is not Intended or offered for sale(Sec.7044,Business and Proles-
. elons Code:The Contractor's Llconse,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,provided that ❑
such Improvements are not Intended or offered for iIf,however,the bulltling or Improvement
Is sold whhin one year of completion,the owner-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,em exclusively contracting with licensed contractors to construct /2 �-
the project(See.7044,Business and Professions Code:The Contractor's License taw does not PROVIDE I.C.B.O.REPORT NO."%_2
apply to an owner of property who builds or Improves thereon,and who contracts for such projects
with a contractor(s)licensed pursuant to the Contractors License Law. PROVIDE MFGR.INSTALLATION SPECS.
❑I am exempt under Sec. ,B&P.C.for this reason
Owner Data
WORKER'S COMPENSATION DECLARATION APPLICATION DATE VALUATION PERMIT FEE
'
I hereby affirm under penalty of perjury one of the following declaration: �
C]f have entl will maintain a Certificate of Consent to self-Insura for Workers Compensation, Building of / r 0�
as provided for by Section 3700 of the Labor Code,for the performance of the work for which this
permit Is Issued.and �,� �•�� 1' ��� Seismic Z: S2
A neva entl will maithe Pelrf Workers f the work
for Insurance,as required Is I by Section Workers s V
,Ihe Labor Code,for the performance of the work for which this permit le leaned.My WorkerTotal S 2
Compensation Insurance terrier and Policy number are: TOta
Carrier_7TA-M FOAM Policy No. Ai ¢703 PERMIT AUTHORIZATION DATE
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE N,C.O
(This section need not be completed If the permit Is for one hundred tlollars,$100)or lees.) �Oe
I certify that In the performance of the work for which this permit is Issued,1'hall not emoIoy
any person In any manner so as to become subject to the Workers'Compensation Laws of Call- All roots shall be inspected prIaMany ro fing rfiaterial being
fornix. installed. If a roof is installed without first obtaining an
Date Applicant inspection,I agree to remove all new materials for inspection.
NOT become
subject tithe Worrkers'Compensetlon provlTO APPLICANT: Iff,after elons of ththis e lLabcateor Code,you must forthwith comply Applicant understands and will comply with all non point
with such provisions or this permit shalCbe deemed revoked. SOU a regulations.
I certify that I have read this application and state that the above Information Is correct. agree
herebyto authorize
all city prese county ordinances and ter ulawsnthe bove- entl ng construction,entl All VQrlr}p t0 be class��C�.Of better.
hereby authorize representatives of this city to enter upon the sing to building
( property for no T`v ri -
spection purposes.
(We)agree to save,Indemnify and keep harmless the City of Cupertino against liabilities, .�
lud menta,costa and expenses which may In any way accrue against said City In consequence
of IRs granting of this permit. IGNATURE OF APPLICANT DATE
- PRE-INSPECTION: PLYWOOD: IN-PROGRESS: I .
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
SUBJECT: REROOFING POLICY FOR THE CITY OF CUPERTINO BUILDING DEPARTMENT
PRIOR TO ISSUANCE OF PERMIT AND INSPECTION PHASE.
1. Prior to permit issuance, you mus[ 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
• 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 ne•.v
material down to the sheathing and a building inspector will inspect all sheathing at that time.
YVE UNDERSTAND THE ABOVE POLICY ON REROOFING AND WILL COMPLY WITH THE
POLICY
HOi EOWNERS NAME: Zoi q(o — 2(7 ADZ GA•c.��t� C2� CT
ADDRESS:: : GAtL�yrJV16W t622PG6� 41oMEowNw ASsaetAlGvtoa
REROOFING COMPANYNANIE:
APPLICANTS SIGNATURE: — — -
SEP 2 9 1998
CITY OF CUPERTINO BLDG. INSPECTION DEPAR i WWI I'
BUILDING DEPARTNIENf CITY OF CUPERTINO
• I
Reroof/wintvord