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R-4072 PERMIT R_ APPLICATION FOR CITY OF CUPERTINO NUMBER INSPECTION DIVISION PERMIT EXPIRATION REROOF PERMIT (408) 252-4505 EXT. 228 WITH(N 180 DAYS OF WORK ISSUANCE OR IBI(DAYS FROM LAST CALLED INSPECTION. BUILDING ADDRESS3z3 BUILDING USE d2 L,C)J O ` . CON RESIDENTIAL COMMERCIAL OTHER OWNER'S +r._rL�`} /�y, ROOF NAME �d` ` " \ '11 '� \' ` O\ • " �` '1 FIREAREHAZARDOUS N� COLASS VERING ��-.4 ADDRESS Ivo/(TVA/Po hT �,.J V EXISTING ROOF COVERING' I\ PHONE I Z ^t0 3 ( NUMBER OF EXISTING COVERINGS CONTRAC OR's ;Y--D NAME Q O'�` J O C-2 TO BE REMOVED ` TO BE RETAINED TYPE OF ROOF COVERING CITY&ish Q��S �^� 7S 7th +� EXISTING PHONE I 71 — / S00 BUILT-UP ROOF LICENSEZ,UI� ASPHALT SHINGLES n/ NUMBER WOOD SHAKES ry LICENSED CONTRACTORS DECLARATION I hereby affirm that I em licensed under ptoyismns of chapter 9 my with Section 7000) of Division 3 of the Business and Professions Coda,(common. WOOD SHINGLES and my license h 1 rca and eliect. ,,11 .ws�`� np,� Dote License Cl • �f Contractorer Y &Cf - OTHER (SPECIFY) OWNERBUILDE R DECLARATION J I hereby affirm that I am exempt from the Contractor's License Lew for PROPOSED the following reason. (Sec. 7031.6, Business and Professions Code: Any city or county which requires a permit to construct,alter, improve, demolish,or tape lr env structure,Prior m its issuance, also requires the applicant for such BUILT-UP ROOF permit to Ill.•signed to mat he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code)or that he is exempt more ASPHALT SHINGLES from and the bests for the alleged ...mplion. Any violation of S. Ii.P 7031.5 by any applicant for a permit++5001.1: WOOD SHAKES ubjects the applicant to a civil penalty o1 not more that five no noted donors(s ❑ I, es owner o1 the property, or my employees with w....+their sole compensation,will do the work, and the structure is not intended o oliered o for le(Sec. 7044, Business and Professions Code: The Contractor's License WOOD SHINGLES Law does not apply to an owner of property who build,.1 improver thereon, and who don such work himself or through his own employees,provided that I beach improvements are not intended or offered for sale. If, however, the OTHER (SPECIFY) uilding or improvement sold within one rear of completion, the owner builder will nava the burden of proving that he did not build or improve for purpose ere PROVIDE I.C.B.O. REPORT NO. ❑ I, + owner ji 11 property, t ( asst lu044. Gutman an with licensed .do: her. to construct he project does t app Gutman anowner and f propeons rty code: The 0, impcure$ License and who cot tracts fotuch projects with PROVIDE MFGR. INSTALLATION SPECS. who build+ )licensed t thereon,t and who contracts for such projects with a contract am l emptd under Spursuant[o ma Connector's License Law. _ ❑ 1 em exempt under Sec. ,B.&P.C.for this ..wenn APPLICATIO19 DATEI VALUATION PERMIT FEE Owns. Dad - WORKERS'COMPENSATIONDECLARATION IIA( (li ���� Building I hereby affirm son have i n I n uran , courant to del PY th r or a ter. v(� IY 3111, of Wo.ke.i Compan+anon lm r nca,ora<aanetl copy m roof(Sec .1V13 O Seismic �� /y Polio.Lob.Cy>Ib7/4 company S''�'a�¢ 1�—uhC.{ Cil UP L Q L�—r�L}/e Policy Certified BCarti iea espy is hereby turn iched. Ur'tryll(yU Total canined�cogr burcity s cion diyb�on. Applicant C CERTIFICATE OF EXEMPTION FROM WORKERS' N.C.O PERMIT AUTHORIZATION DATE COMPENSATI O NINSURANCE (This section need not be completed if the permit is for one hundred dot ISIS 151001 or lees.) I certify that in the performance of the work for which this permit is issued, I that not employ any person in any manner 10 as to become subject to the Worker.'Compensation Laws of California. Dad Applicant NOTICE TO APPLICANT: ll, after making this Certificate of Exemption, you should become subject to the Workers' Compensation provisions of the Labor Coda, you must forthwith comply with such provisions or this permit All roofsshall be Inspected prlortoany roofing material being .hotI be domed rwoked. I certify that I It...toad this SpplicafiCn and state Ines the above inform. Installed If a roof IS Installed Without first obtaining an non is W. ela I torn m comply with an city am by nay orto n end i n,I rem 0 neW m ref IS for IR8 eCtIOR tine laws nit.I m building ply with all and hereby authorize to "an. ..Sivas of this city to enter upon the above Mentioned property for inspection purpose+. rt IWtI agru to uv indemnify and keep hermdes the City of Cupertino 7 against liabilities, conse see,cobs and eapensn which er in any way accrue against said city in consequence of the granting of mit permit. S NATUflE OF APPLICANT DAT 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 i SUBIECI': REROOFING POLICY FOR 771E CITY OF CUPERTINO BUILDING DEPARTrb1ENT PRIOR TO ISSUANCE OF PERMIT AND INSPECTION PHASE. 1. Prior to permit issuance, you roust agree to comply wilh U.B.C. standards and manufacturers spec's o" reroofing. 2. New roof coverings sliall not be applied willnout first obtaining all inspection and wrilten approval from the building inspector. A finial 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 roorbei"g installed. d. In order to receive a final,you "lust complete steps 1, 2, and 3. 1,) Preinspectio"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. G. If any roof is applied without first obtaining on 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 TILE POLICY HOMEOWNERS NAME: Nam- r n I ADDRESS: 1Z��s� Nom r wy REROOFING CONIPANYNAIv1E: APPLICANTS SIGNATURE: • C17`Y OF CUPERTINO BUILDING DEPARTNIENT Rercof/wimvord