R-3713PERMIT
APPLICATION FOR
CITY OF CUPERTINO NUMBER R— 3 713
REROOF PERMIT INSPECTION DIVISION PERMIT EXPIRATION
(408)252-4505 EXT. 228 WIPERMIT EXPIRES OF THIN IN DAYS OF PERMRK T NOT
OR
IN DAYS FROM LAST CALLED INSPECTION.
OWNER'S / /`-
NAME �AQI/�"e ��//.LGl a ile
ADDRESS J1 If/s-e
BUILDING USE
HAZARDOUS
FIRE
EXISTING ROOF COVERING
NUMBER OF EXISTING COVERINGS
yV � ry p // I
NAME 1—o
/bC�`'zeG (1 TO BE REMOc .r
ADDRESS
CITY & ZIP �//�%2 J EXISTING
PHONE -2,
LICENSE
NUMBER !_ S
LICENSED CONTRACTORS DECLARATION
I hereby affirm Chet I am 11,....d under provision. of Chapter 9 Icommem
cin. with Saction 70001 of Division 3 of the Business and Professions Code,
and my license a in hu for.• and affect.
License Cleo Lic. Number
Dote Contractor
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for
the l.f.win...amn. (Sac. 7031.5, Buslna.aa and Profession[ Code: Any city
or county which requires a permit to construct, alter, improv, demolish,or
repair any structure, prior to its issuance, also requires the applicant for such
Permit to ill. a signed statement that he is licensed pursuant to the provisions
of the Contractor', License Lew (Chapter 9 (commencing with Section 7000)
of Division 3 of the Business and Profession, Code) or that he is exempt Mere
from and the basis for the alleged exemption. Any violation of Section
7031.5 by any applicant for a permit subjects the applicant to a civil penalty
of not more that five hundred dollars ($500).1:
El 1, at
owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered
,fpr sale (Sac. 7044, Business and Professions Code: The Contractor'a License
Law does not apply to an owner of property who builds or improves thereon,
and who does such work himself or through his own employees. provided that
such improvements a not intended or offered for sale. If, however, the
building or improvement is sold within one year of completion, the owner
builder will have the burden of proving that he did not build or improve for
purpose of tele.).
❑ 1, as owner of the property, a exclusively convecting with licensed
contractors to construct the project (Sc7044, Business and Professions
Code: The Contractor's License Law does not apply 10 an owner of property
who builds o improves meroun, and who contracts for such projects with a
contractor($) licensed pursuant to the Contractor's Licence Law.
❑ 1 am exempt under Sac. ,B.&P.C, for this
Owner
ow Data
WORKERS 'COMPENSATION DECLARATION
I hereby affirm )het I M1ava lificate f consent to sell ins or a car
tificata of Work etio Insprenca, oron emit tl copy breof (Sac.
3800, Lab. C.1. SW 'm f%/�
P01iico�y_No. �'Campany
Car
A/pllc est tii 149p,�c oscl copy 10 heedbwitur hi est p/\C tion tllvisian.
CERT( FI1e
CAOF EXEMPTION WORKERS' C//
COMPENSATION INSURANCE N.C. ❑
(This section need not be completed it the permit i$ for one hundred dol
fart ($100) or less.)
1certify $bat in the performance of the work for which this permit is
i[[u ad, I [hell not employ any parson In any manner so as to become subject
to he Workeri Compensation Laws of California.
Dote Applicant
NOTICE TO APPLICANT: Ii, otter making this Cenif icrte of Exemption,
you should become subject to the Workers' Compensation provisions of he
labor Coda, you must forthwith comply with such provisions or this permit
shall be deemed revoked.
I certify that I have read this spplocstipn and .tete IM1st the above inform.
tionact. I agree to comply with all city and county ordinances and
.late .We .We to building construction, and hereby aumori:• r•pres•m
Utivas of this city to anter upon the above mentioned property for inspection
purpose.
(We) agree to uvs. indemnify and keep harmless the City of Cupertino
against liabilities, judgments, costs and expanses which may In any way accrue
against said City in consequence of the granting of this permit.
BUILT-UP ROOF
ASPHALT SHINGLES
WOOD SHAKES I\ r ,/
1 \ _ — G
WOOD SHINGLES , ' , /� "� I �_
Lo \11 6
OTHERSPECIFY)
PROPOSE
BUILT-UP ROOF
ASPHALT SHINGLES
WOOD SHAKES r�
WOOD SHINGLES
OTHER (SPECIFY)
PROVIDE I.C.B.O. REPORT NO.
PROVIDE MFGR. INSTALLATION SPECS.
IAPPLICATION DATEI VALUATION I PERMIT FEE I
.411)
7 Z9of C-766
IVr, PERMIT AUTHORIZATION I DATE 1
All roofs shall be inspected prior to any roofing material being
Installed If a roof is installed without first obtaining an
inspection, I agree to remove all new materials for Inspection.
SIGII OF APPLIWT
DATE
NRS INSPECTION: DATE I PLYWOOD: INSP. -DATE IINSP,OGRESS: DATE I
TEAR OFF INSPECTION: BATTENS: FINAL:
INSP. DATE INSP. DATE INSP. DATE
NOTE: OSHA APPROVED ACCESS TO ROOF SHALL BE PROVIDED FOR INSPECTION
OFFICE COPY
SllI11DC'I': ItI:ItOOPING POLICY FOIt '11117 CITY OP CUl)Glf1'INO BUILDING llLPAR'I'MLN1'
I'ItI01t'f0 ISSUANCII OF PElt" ' AND INSI'LC"PION 111IASG.
I. Prior to pcnuil issuoncc, you muss ag(CC to comply )villi U.D.C. strmdards and nreuufaClulCls spcc's
on reroofing. .
lsi)cction and
2. New 111af cOve' ug ilsit:"' not
e f'111:11 l(llsvidloltjOjI nlul opprovalgslc)it Ibe obtained fronlllthc buildi Ig
inspector Ivhcu lite Icroofulg is eonlplcled.
I All lyl)cs of roof shall be ilispccic(I pl for to ;Illy roof I)ciug iuslallcd.
4, III Order to ICCCIVC 8 1111;11, you uulst coulplClc sIcps I, 2., and J.
I,) I'Iciuspcclion or Icar oD"opproval.
2.) In plogress inspection approval.
7.) Final iuspcclion approval.
;I) Opclablc snlol(c (ICICC1O1 velificaliou
b) Sp;lll( Nlcstor IIIstalhltlOn
5. If Illy)voo(I is inslallcd, a I)I)'O'oo(I IIIIII IIIspCClloll Is IC(IIII ICE I.
G. If any roof is applied without first obUdilinl, an inspccliou, you (viii be rcquircd to "C"love all ncly
mnlerial dolvn to the shcalhiug and ;I building inspcclor will inspect all shcalhiug al Ilial lime.
\VD UNDERSTAND'11117 ABOVE POLICY ON ILI:IIOOI--ING AND WILL COMPLY WI'fll hili
POLICY
IIOMIOWNBItS IJAMI:
ADDRESS:
Itl:ftOOPING COMPANY NAMI7:
t
AI'PLICAN'I'S SIGNA'I ME:
CI'T'Y 017 CUI'171t'I'INO
BUILDING DBI'AM MEN
• Itcroofhvimvold
LI
•
10.100 lour Avenur.
Cupci liuo, CA 9501.1-.1255
Tcicplumet (100) 25)4505
TAX: (40111252-0751
COMMUNITY UCVTL01'MLNI
Cityq 0f Cupvrtil10
r.o. Oox 500
Cupul lino, CA 95015.0500
SMOICI; DETL'C'f01C ' - flfB=ICA'IE Oil COMPLIANCE
I understand and comply with Seclion 1210-a of the Uniform Building Code.
Section 1210-a rcquires when repairs to a single family dwelling exceed $1,000, a smoke
detector will be installed, MOL Mled on the ceiling or wall ill each sleeping room and at a
point centrally located in the corridor or arca giving access to room used for sleeping
purposes. If existing smolecd deleclors con)ply, no new deleclor shall be required.
I uuderslaud the above requirement and certify lila) we now have snlolce delectors
inslallul Ilial do comply.
ADDRESS:
PERMrr NUMBER:
110MLOWNERS SIGNATURE:
DATE:
winwold/sn)kdet
T / 7 zya