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R-22460 APPLICATION FOR CITY OF CUPERTINO NUMBIER Rse 2246 REROOF PERMIT INSPECTION DIVISION PERMIT EXPIRATION PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR IBD DAYS FROM LAST CALLED INSPECTION. BUILDING ADDRESS BUILDING USE 10936tL1nua Vista Dr. 'RESIDENTIAL 'x COMMERCIAL OTHER OWNER'S _ NAME doberL Chen HAZARDOUS ROOF FIRE - COVERING AREA CLASS - EXISTING ROOF COVERING ADDRESS 10936 .Linea Vi5'La Dr. NUMBER OF EXISTING COVERINGS 1 PHONE _ - ' CONTRACTOR'S SecuriI:y Roofing, !nc. TO BE REMOVED TO BE RETAINED TYPE OF ROOF COVERING NAME ADDRESS CITY&ZIP P. 0. Box 2450, Menio Park 94026 EXISTING 947-6811 - BUILT-UP ROOF PHONE LICENSE ASPHALT SHINGLES NUMBER 305844 - WOODSHAKES heavy ' LICENSED CONTRACTORS DECLARATION affirm gnat am under provision of Chapter 1 hereWith S ud.iod s on.(common pine With s.ptmn Toon of Dmi.ion 3 of me auan.a and code. WOOD SHINGLES (v�rmeeaan. and my licenseiy,'nfl0Iryo ce and effect qqee 306844 oaten, Cless_�}__ e3_L Conneno Jre-cvI-r�-v—Rmrf i ny 44 3 V �OWNER-BUILDER OTHER (SPECIFY) - DECLARATION I ' qIj I hereby affirm that 1 am exempt from the Contractor's License Law 'lu ••. PROPOSED . the following reason. (Sec. 7031.5, Business and Professioni Code; Any city o1 county which requires,a permit to construct, alter, improve, demollsh,or. repay env structure, Prior to its issuance, eGo requires the applicant far such _ BUILT-UP ROOF permit to file a signed statement that he Is licensed pursuant to the provisions of the Contractor', License Law (Chapter 9 (Commencing with Section 7000)' of Division 3 0f the Business and Professions Code) or that he Is exempt mere. ASPHALT SHINGLES from end the basis for the alleged exemption. Any violation of Section 7031.5 by any. applicant for a permit ubjects the applicant to a Civil penalty of not mora that five hundred dollars ($600).):- WOOD SHAKES - heavy ❑ I, es owner of me properly, or my employees withwages as their sola con causation, will do the work, and the structure is not intended ° offered for sale (Sec. 7044, Business and Profession Code: The Contractors License WOOD SHINGLES ' Lew dam not apply to an owner of property who builds or improves thereon, and who dam such work himself or through his own employees, provided that such Improvements are not intended or offered for sale. If. however, the OTHER (SPECIFY) building ° r improvement is sold within one year of completion, the owner builder will neve the burden of proving that he did not build or Improve for . Purpose 1, a.own ❑ I, s owner the property, a exclusively contracting with Iieensetl PROVIDE I.C.B.O. REPORT NO. st confrectars to construct Ina project (Sec. 7044, Business and Professions ' Code: The Contractor's License Law does not apply to in owner of property PROVIDE MFGR. INSTALLATION SPECS. Who builds or improves thereon, and who cantrapts for such projects with e cuntranor(s) licensed pursuant to the Contractor's License Lew. ❑ 1 em exempt under Sec. ,0.&P.C. for this reason FASTENER Ow Do,. WORKERS' COMPENSATION DECLARATION 1 hereby affirm that I have a certificate atconsent to calf -insure, or a car. ,;fiesta of Worker; Compensation Insurance, or certified copy thereof (Sec. a TYPE n a i 1 s 3800, Lab. C, . Policy No. '285-9lompany $La$e Comp. ins. Fwid pp cariir.e pop s Hereby mmunee. - is LENGTH 6D yJ Ceaiile ° fiya nlcW/ ion division. FEE SUMMARY xs Applicant r nON CER (FIC ATE EXEMPTION FROM WORKERS' FROM ' COMPENSATION INSURANCE- - (This section need not be completes it the permit is for one hundred doh millet lets (5100) or less.) VALUATION $6,195-00 1 certify that in the perfo.mance.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 California. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption,5U PERMIT FEE 90. you should become subject to the Worker; Compensation provisions of the Labor Code, you must forthwith Comply with such provisions or this permit .ha11 be deemed ray.k.d. DATE OF AP N I certify that I have reed this application and state that the above Inform.. rich is correct. I agree to comply With all city and county ordinances and �/s/ep rUl eN! �i1QJ1Y1 APR hate laws relating to building construction, and hereby authorize reprasom unives of this city to enter upon the above mentioned property for inspection PERMIT Purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs end expenses which may in any way accrue City in nuenc of�try� gra againstaids qnting of this Permit. r­ - g,�U.lurdfiof Applican VCantrenor Data REQUIRED PRE -INSPECTION IN -PROLE SPECTIONFINAL INSPECTION INSPECTIONS INSPECTOR . DATE INSPECTOR DATE INSPECTOR DATE NOTE: OSHA APPROVED ACCESS TO ROOF SHALL BE PROVIDED FOR INSPECTION OFFICE COPY • Cit14 of Cuperti>"o 10300 Torre Avenue Cupertino, California 95014 y Telephone: (408) 252-4505 DEPARTMENT OF PLANNING AND DEVELOPMENT °IZ SUBJECT: SMOKE DETECTOR CERTIFICATE OF OOMP=CE P.O. Box 500 Cupertino, California 95015 I understand and agree to comply with Section 1210 of the Uniform Building Code. Section 1210 requires when repairs to a single family dwelling exceeds $1,000 a smoke detector will be installed mounted on the ceiling or wall at a point centrally located in the corridor or area giving access to rooms used for sleeping purposes. If existing smoke detector complies no new detector shall be required. I understand the above requirement and certify that we now have smoke detectors installed that do comply. ADEMS: 10936 Linda ViSta Dr. PEMT NUMBER: 46 HOMEOWNERS SIGNATURE: uJi/',(. �• �T HATE: 411 o /9 1 smokedetc(B-1)