R 6188 PERMIT R_ 6188
APPLICATION FOR CITY of CUPERTINO NUMBER
REROOF PERMIT INSPECTION DIVISION PERMIT EXPIRATION
(408)777-3228 PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 100 DAYS OF PERMIT ISSUANCE OR
160 DAYS FROM LAST CALLED INSPECTION.
BUILDING ADDRESS//�� ^ n
1146Z,- 0-L AIL 6' cf" b(Z • RESIDENTIAL COMMERCIAL OTHER
OWNER'S . - HAZARDOUS FIRE AREA
r YES ❑ If yes-I understand Mata Class A
NAME�AIZ�6f�U1fsW �f,c,[p CFf DI�EOWIJ6,tC A$S,Df I ATIlr roof assembly is required.
NO ❑ Initial I.C.B.O.#
ADDRESS SAME EXISTING ROOF COVERING
PHONE �}�� Z( - )D NUMBER OF EXISTING COVERINGS1�
CONTRACTOR'S �a(
On'� /J TO BE REMOVED ,` TO BE RETAINED
NAME J&^)AtSir�iN 6� IC-d�FING LD. ING-
ADDRESS 2.Z9.Z uNGOL)J Ave-. 5:g,
TYPE OFROOF COVERING
CITY azlP ` EXISTING
PHONE (4_0S ) +4(6 74 BUILT-UP ROOF ❑ -
LICENSE
UMBER '
N _>`7 136 ASPHALT SHINGLES ❑
LICENSED CONTRACTORS DECLARATION
I hereby affirm that I am licensed under provisions of Chapter g(commencing with Section WOOD SHAKES
7000)of Division 3 of the Business and Professions Code,and my license Is In full force and
effect. WOOD SHINGLES
Cleanse Claes `��� Llc.Number �I i
Date Q'Z9-QQ contractor P�NA�/rMr�bFwG �o. IuC OTHER(SP FY) � ILL~
OWNER-BUILDER DECLARATION PROPOSED D u
I hereby affirm that I am exempt from the Contractors License Law for the following reason. xx q�f1�
(Sec.7031.5,Business and Professions Coda: Any city or county which requires a permit to SEP y 1 s_7
construct,alter,Improve,demolish,or repair any structure,prior to Its Issuance,also requires the BUILT-UPR ❑
applicant for such permit to file a signed statement that he Is licensed pursuant to the provlSlone
of the Contractors License Law(Chapter a(commencinp with Section 7000)of DI islan 3 of the
Business and Professions Code)or that no IS exempt therefrom and the basis for the alleged ASPHALT SH GLES
exemption,Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to I�V
a civil penalty of not more than live hundred dollars($500).): B --
❑l,as owner of the property,or my employees with wages as their sole compensation,will do WOOD SHAK ❑
the work,and the Structure Is not Intended or offered for sale(Sec.7044,Business and Profes-
sions Code:The Contractors 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,provided that
such Improvements are not Intended or offered for sale.II,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) ❑
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 Profoaslons Code:The Contractor's License Law does not PROVIDE I.C.B.O. REPORT NO/4STi 7-?W z 5.2
apply to an owner of property who builds or Improves thereon,and who contracts for such projects
with a contmctor(s)licensed pursuant to the Contractors License Law. PROVIDE MFGR.INSTALLATION SPECS.
I]I am exempt under Sec, ,B 8 R C.for this reason
Owner opts
WORKER'S COMPENSATION DECLARATION APPLICATION DATE VALUATION PERMIT FEE
'
I hereby affirm under penalty of perjury one of the following declaration: f
❑l have and will maintain a Certificate of Consent to self-insure for Workers Compensation, BUlldlflg.4��o�
as provided for by Section 3700 of the Labor Code,for the performance of the work for which This
permit la lve and I l m
MIhaveantl will themaintainrt Worker's Compensation the work
Insurance,asrequired by Sectionorke of _fi�- b SBIBmIC St
oy
the Labor Code,for the performance of the work for which This permit Is Issued.My Worker's 2 y,7 r (W
Compensation Insurance carrier and Policy number are: Total
Carrier `lIA1U Policy No.61AAki'11506 PERMIT AUTHORIZATION DATE
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE NA.p
(Tele section need the not r antecompletedthe
If the permit Is for one hundred sullen shall not
less.) CC-� 3 /
I 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 Cao- All roofs shall be inspected prix any rooting rhaterial being
fornoa. installed. If a roof is installed without first obtaining an
Date Applicant inspection,I agree to remove all new materials for inspection.
NOT CE Tbecome
subject t.theOWorrkeras'Compelnsation proviafter sionis Ofths theflLabor Code rticate of you Mustuforthwiou �h comply Applicant understands and will comply with all non point
with such provisions or this permit shell be deemed revoked, souf regulations.
I certify that I have read this application and state that the above Information Is correct,I agree
to comply with all city and county ominances and state laws rotating to bulltling construction,and All f OVerl t be class"C"or better.
hereby authorize representatives of this city to enter upon the abovesidection purposes. menlionetl properly for In•
(WB)agree to save,Indemnify and keep nywaharmless the City of st said Ci y Inagainst liabilities;
ence
of the gnts,ran coats and expanses which may In any way accrue against said Clry In consequence
. of the granting of this permit, SIGNATURE OF APPLICANT 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 -
SUBIECT: REROOFING POLICY FOR THE CITY OF CUPERTINO BUILDING DEPARTi ENT
PRIOR TO ISSUANCE OF PERIVI1T• 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 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 new
material down to the sheathing and a building inspector will inspect all sheathing at that time.
WE UNDER
STAi`ID THE ABOVE POLICY ON REROOFING AND WILL COivIPLY WITH THE
POLICY /I
HOivfEOWNERS NAME: �+���^� � � �t0eM6ow"t6�2S ASSoGtw�
ADDRESSS : J462 �/z A 'nl 'P6�2pL� Nz
REROOFING CObIPANYNAME: Ale'�`�66 'L00AN' CO INL
APPLICANTS SIGNATURE:
ED
jF a
CITY OF CUPERTINO SEP 2 91998
BUILDING DEPARTZMENT
. dLDG• CITY CUPERTINO ION rvidvl
OF
Reroof/wimvord