Loading...
R-4536 PERMIT R_ 4536 APPLICATION FOR CITY OF CUPERTINO NUMBER INSPECTION DIVISION PERMIT EXPIRATION REROOF PERMIT (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 p\���� "4'i RESIDENTIAL COMMERCIAL OTHER OWNER'S .O S HAZARDOUS FIRE AREA _2,??-, VES ❑ If yes—I understand that a Class A NAMI! �&,n I�>��(ry.�__ roof assembly is required. NO ❑ Initial I.C.B.O.N ADDRESS �.Ph 0 f f�-C9— cf LtG, - - EXISTING ROOF COVERING PHONE I4 B NUMBER OF EXISTING COVERINGS CONTRACTOR'S A TO BE REMOVED—5 1��TO BE RETAINED NAME p � / ADDRE S r S. TYPE OF ROOF COVERING CITY&ZIP EXISTING PHONE r11 r0 t — cop BUILT-UP ROOF ❑ LICENSE NUMBER �% ASPHALT SHINGLES ❑ LICENSED CONTRACTORS DECLARATION I hereby affirm that I em licensed under provisions of Chapter 9(commencing with Section WOOD SHAKES 71 of Division 3 of the Business and Professions Code,and my license Is In full torte and effect. WOOD SHINGLES ❑ License Class LIC.Number Date Contractor OTHER(SPECIFY) ❑ OWNER-BUILDER DECLARATION PROPOSED I hereby affirm that I am exempt from the Contractor's License Law for the following reason. (Sec.7031.5,Business and Professions Code: Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to Its Issuance,also requires the BUILT-UP ROOF P A I C❑ applicant for such permit to file a signed statement that he is licensed pursuant to the provisions , . of Is Contractors License Lew(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Cada)or that he Is exempt therefrom and the basis for the alleged ASPHALT SHINGLUG 22 1§5 exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to (J e civil penalty of not more than five hundred dollars($500).): WOOD SHAKES ❑1,as owner of the property,or my employees with wages as their sole compensation,will do ❑ the work,and the structure Is not Intended or offered for sale(Sec.7044,Business and Profes. r1Ty VI- GUI LK I INU sions Coda:The Contractor's License Law does not apply to an owner of property who builds or WOOD SHINGLES ❑ Improves thereon,and who does such work himself or through his own employees,provided that such Improvements are not Intended or offered for sale.If,however,the building or improvement Is sold within one year of completion,the owner-builder will have the burden of proving that he did OTHER(SPECIFY) ❑ not build or Improve for purpose of sale.). ❑I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:The Contractor's License Law does not PROVIDE I.C.B.O.REPORT NO. apply to an owner of property who builds or Improves thereon,and who contracts for such projects with a contractors)licensed pursuant to the Contractor's License Law. PROVIDE MFGR.INSTALLATION SPECS. ]1 am exempt under Sec. ,B$P.C.for this reason Owner Date APPLICATION DATE VALUATION PERMITFEE WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declaration: ❑I have and will maintain a Certificate of Consent to self-Insure for Works r's Compensation, Q /Z 2 1 Building as provided for by Section 3700 of the tabor Code,for the performance of the work brwhich ihie vl/ 1 permit is Issued. have end will maintain Worker's Compentonfor Insurance,as required by Section 3700 01 Seismic th ebur Cotle,for the performance of the work for which this permit Is issued.My Worker's Total ompsnsat n ur/en9e car no Policy umber are: /� �" Carrier ' ` U Policy No. /" (9 52 97 PERMIT AUTHORIZATION DATE CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE IN Q (This section need not be completed If the permit Is for one hundred dollars(5100)or less.) I certify that In the performance of the work for which this permit Is Issued,I shall not employ any person In any manner so as to become subject to the Workers'Compensation Lowe of Cali. All roofs Shall rig inspected prior toy roofin a n Ing fornia. installed. If a roof is installed wi out first obtaining an Date Applicant inspection,I agree to remove all new materials for inspection. NOTCsubject I.E eOWor Workers' mpensatio n proANT: If,aftr Nalonis oftheiiLaborr Code,rticate of yolu must forthwith should comply Applicant understands and will comply with all non point with such provisions or this permit shall be deemed revoked. Source regulations. 1 certify that I have read this application and state that the above Information Is correctl agree to comply with all city and county ordinances and state laws relating to building construction,and All roof Coverings to be class"C" etter. hereby authorize representatives of this city to enter upon the above-mentioned property for In- spectlonpurposes. /J r3 (We)agree to save,Indemnity and keep harmless the City of Cupertino against liabilitiee, 9 C 7 judgments,costa and expenses which may In any way accrue against said Clry In conseque ATURE OF APPLICAN ' DATE of the granting of this Permit. 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 ACCESSTO ROOF SHALL BE PROVIDED FOR INSPECTION OFFICE COPY PERMIT R_ 4536 APPLICATION FOR CITY OF CUPERTINO NUMBER INSPECTION DIVISION PERMIT EXPIRATION REROOF PERMIT (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 p\���� "4'i RESIDENTIAL COMMERCIAL OTHER OWNER'S .O S HAZARDOUS FIRE AREA _2,??-, VES ❑ If yes—I understand that a Class A NAMI! �&,n I�>��(ry.�__ roof assembly is required. NO ❑ Initial I.C.B.O.N ADDRESS �.Ph 0 f f�-C9— cf LtG, - - EXISTING ROOF COVERING PHONE I4 B NUMBER OF EXISTING COVERINGS CONTRACTOR'S A TO BE REMOVED—5 1��TO BE RETAINED NAME p � / ADDRE S r S. TYPE OF ROOF COVERING CITY&ZIP EXISTING PHONE r11 r0 t — cop BUILT-UP ROOF ❑ LICENSE NUMBER �% ASPHALT SHINGLES ❑ LICENSED CONTRACTORS DECLARATION I hereby affirm that I em licensed under provisions of Chapter 9(commencing with Section WOOD SHAKES 71 of Division 3 of the Business and Professions Code,and my license Is In full torte and effect. WOOD SHINGLES ❑ License Class LIC.Number Date Contractor OTHER(SPECIFY) ❑ OWNER-BUILDER DECLARATION PROPOSED I hereby affirm that I am exempt from the Contractor's License Law for the following reason. (Sec.7031.5,Business and Professions Code: Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to Its Issuance,also requires the BUILT-UP ROOF P A I C❑ applicant for such permit to file a signed statement that he is licensed pursuant to the provisions , . of Is Contractors License Lew(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Cada)or that he Is exempt therefrom and the basis for the alleged ASPHALT SHINGLUG 22 1§5 exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to (J e civil penalty of not more than five hundred dollars($500).): WOOD SHAKES ❑1,as owner of the property,or my employees with wages as their sole compensation,will do ❑ the work,and the structure Is not Intended or offered for sale(Sec.7044,Business and Profes. r1Ty VI- GUI LK I INU sions Coda:The Contractor's License Law does not apply to an owner of property who builds or WOOD SHINGLES ❑ Improves thereon,and who does such work himself or through his own employees,provided that such Improvements are not Intended or offered for sale.If,however,the building or improvement Is sold within one year of completion,the owner-builder will have the burden of proving that he did OTHER(SPECIFY) ❑ not build or Improve for purpose of sale.). ❑I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:The Contractor's License Law does not PROVIDE I.C.B.O.REPORT NO. apply to an owner of property who builds or Improves thereon,and who contracts for such projects with a contractors)licensed pursuant to the Contractor's License Law. PROVIDE MFGR.INSTALLATION SPECS. ]1 am exempt under Sec. ,B$P.C.for this reason Owner Date APPLICATION DATE VALUATION PERMITFEE WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declaration: ❑I have and will maintain a Certificate of Consent to self-Insure for Works r's Compensation, Q /Z 2 1 Building as provided for by Section 3700 of the tabor Code,for the performance of the work brwhich ihie vl/ 1 permit is Issued. have end will maintain Worker's Compentonfor Insurance,as required by Section 3700 01 Seismic th ebur Cotle,for the performance of the work for which this permit Is issued.My Worker's Total ompsnsat n ur/en9e car no Policy umber are: /� �" Carrier ' ` U Policy No. /" (9 52 97 PERMIT AUTHORIZATION DATE CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE IN Q (This section need not be completed If the permit Is for one hundred dollars(5100)or less.) I certify that In the performance of the work for which this permit Is Issued,I shall not employ any person In any manner so as to become subject to the Workers'Compensation Lowe of Cali. All roofs Shall rig inspected prior toy roofin a n Ing fornia. installed. If a roof is installed wi out first obtaining an Date Applicant inspection,I agree to remove all new materials for inspection. NOTCsubject I.E eOWor Workers' mpensatio n proANT: If,aftr Nalonis oftheiiLaborr Code,rticate of yolu must forthwith should comply Applicant understands and will comply with all non point with such provisions or this permit shall be deemed revoked. Source regulations. 1 certify that I have read this application and state that the above Information Is correctl agree to comply with all city and county ordinances and state laws relating to building construction,and All roof Coverings to be class"C" etter. hereby authorize representatives of this city to enter upon the above-mentioned property for In- spectlonpurposes. /J r3 (We)agree to save,Indemnity and keep harmless the City of Cupertino against liabilitiee, 9 C 7 judgments,costa and expenses which may In any way accrue against said Clry In conseque ATURE OF APPLICAN ' DATE of the granting of this Permit. 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 ACCESSTO ROOF SHALL BE PROVIDED FOR INSPECTION OFFICE COPY