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R 48560 .^ OFFICE COPV PERMIT R_ 4 8 5 6 APPLICATION FOR CITY OF CUPERTINO NUMBER REROOF PERMIT INSPECTION DIVISION PERMIT EXPIRATION (408) 777-3228 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN IBO DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. BUILDING ADDRESS 21go5RESIDENTIAL COMMERCIAL OTHER OWNER'S HAZARDOUS FIRE AREA �v�� ,y-�� If yesunderstand VES ❑ If yeas I understand that. Class A that NAME1 v! e_i� `\`�ll�/V 1A11���.. 111 mbly IN Initial I.C.B.O. # ROOF COVERING NUMBER OF EXISTING COVERINpS / I ADDRESS 2' PHONE 99- CONTR OR'S NAME ^ TO BE REMOVED TO BE RETAINED ADDRESS, l r r�O TYPE OF ROOF COVERING CITU&ZIP l EXISTING PHONES e BUILT-UP ROOF ❑ ,v,P`/�`'?. � LICENSE NUMBER ASPHALT SHINGLES ❑ LICENSED CONTRACTORS DECLARATION hereby affirm that I am licensed under provisions of Chapter B (commencing with Section 700 0) of Division 3 of the Business and Professions Code, and my license Is In full force and WOOD SHAKES �J effect. License C see Lid. Numb Q� WOOD SHINGLES 9 ;� � oat Contrac OTHER (SPECIFY) JUA� ❑ r NER-BUILDS ECLARATION y - ° O I hereb affirm Ih I am exempt from the Contractors License Law for the following r aeon. ]031.5, Business Professions PROPOSED ``/' 9 (�/- 9s4 (See. and Code: Any city or county which requires ° permit construct, alter, Improve, demolish, or repair any structure, rlor to Its Issuance, also requires the BUILT-UP ROOF ('LY Ifo a signed statement that s licensed pursuant to the provisions applicant for such pecan © v of the a a with 7000) of ionthe 3 of the and tPro License Lew S o the ss Business and or that h Is ex pt t and Cotla or that he Ia exempt therefrom end the basis for the therefrom for ASPHALT SHINGLES ❑ exemption. Any violation of Section violation at by any applicant for a permit subjects the applicant to scant to e civil penalty of not more than five huntlred dollars ($500).): hundred ❑ I, as owner of theproperty, or my employees with wages as their sole compensation, will do WOOD SHAKES the work, and the structure Is not Intended or offered for sale (See. 7044, Business and Proles. slons Code: The Contractors License Law does not apply to an owner of property who builds or Improves thereon, and who does such work himself or through his own employees. provided that such Improvements are not Intended or offered for sale. ll, however, the building or improvement WOOD SHINGLES ❑ Is sold within one year of completion, the owner -builder will have the burden of proving that he did OTHER (SPECIFY) E]not build or Improve for purpose of sale,), ❑ I, as owner of the property, em exclusively contracting with licensed contractors to construct the project (See. 7044, Business and Professions Code: The Contractors 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 or such projects with a contractor(s) licensed pursuant to the Contractor's License Law, El am exempt under Sec. ,B S P. C. for this reason PROVIDE MFGR. INSTALLATION SPECS. Owner Date WORKER'S COMPENSATION DECLARATION O APPLICATION DATE VALUATION PERMIT FEE I hereby affirm under penalty of perjury one of the following declaration: ❑ 1 have and will maintain a Certificate of Consent to self -Insure for Workers Compensation, pe provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is Issued,Wl /'�� fl Building g $elSrnlC ❑ have °ntl will Workers Compensation Insurance, as required by Section 700 ofto ) the pelf the Labor Code, or the performance a work for this permit Is Issued. My Worker's Worker's C tion ur c rrl1 J Total ::;;j,umberangZ= alis o.') J PERMIT AUT ORIZATION DATE CERTIFICATE O XEMPTION FROM WORKERS' COMPENSATION INSURANCE N.C.D (This section need not be completed If the permit I$ for one hundred dollars ($100) or less.) 1 certify that In the performance of the work or which this permit Is Issued, I shall not am JOY In any person any manner so as to become subject to the Workers' Compensation Laws of Cell. All roofs shall be inspected prior to any roofinj m erial being fornix. installed. If a roof is installed without first obtaining an Data Applicant inspection, I agree to remove all new materials for inspection. NOTICE subject o the Workers' Compef, after nsation prolvisions ofthlellcate LaborCode, Exemption, mustforthwithlbecame comply Applicant understands and will comply with all non point with such provisions or this permit shall be doomed revoked, source regulations. I certify that I have read this application and state that the above information Is correct.I agree to amply with all city and aunty ordinances and state laws relating to building construction, and hereby authorize representative° of this city to enter upon the above-mentioned or In- Allr�nLcoverings toMs property spection purposes. 6oretter. "DAT (We)agree to save, Indemnity and keep harmless the City of Cupertino ap°Inst liabilities, judgments, costs and expenses which may In any way accrue against said City n consequence of the granting of this permit. 51UNIATURE OF APPLICANT 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 COPV SUBJECT: REROOFING POLICY FOR THE CITY OF CUPERTINO BUILDING DEPARTMENT 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 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. a.) Operable smoke detector verification 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 UNDERSTAND THE ABOVE POLICY ON REROOFING AND WILL COMPLY WITH THE POLICY HOMEOWNERS NAME: ADDRESS: - REROOFING COMPANY NAME: APPLICANTS SIGNATURE: CITY OF CUPERTINO BUILDING DEPARTMENT i Reroof/winword