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R-4018 PERMIT APPLICATION FOR CITY OF CUPERTINO NUMBER Res -4018 INSPECTION DIVISION PERMIT EXPIRATION REROOF PERMIT (408) 252-4505 EXT. 228 WITHIN 1180 DAYS OF PERM T NOT OR 180 DAYS FROM LAST CALLED INSPECTION. BUILDING ADDRESS BUILDING USE c2 f�` ,` Q 1 20Zb5 - 2OZ3 NOC-4 J RESIDENTIAL COMMERCIAL OTHER OWNER' , ` ROOF NAME dim ?C�� A FIREHAZAROOUSCOVERING � - I AREA CLASS ADORES V`+ �I EXISTING ROOF COVERING PHONE \-04 1 5 A 5 2- toif NUMBER OF EXISTING COVERINGS CONTRACTORS � lk6C '1^ /! NAME ICJ,�I 'O'� ng `a TO BE REMOVED TO BE RETAINED c,.f TYPE OF ROOF COVERING ADDRESS &ZII 066'*3 7 :S�• J.:l , I'Mu t Z EXISTING PHONE-1-71 — 75Ca BUILT-UP ROOF LICENSE �J �O I� ASPHALT SHINGLES NUMBER J WOOD SHAKES �C LICENSED CONTRACTORS DECLARATION I hereby affirm that I am 11.....d near provisions.1 Chapter 9(commam ing with Section 7000) of Division a or the Business and Professions code. WOOD SHINGLES and my license h i ions'and offset. 46 201 as Licjtnsa Claes �'w7 Lic.Number Data Contractor TwCya OTHER (SPECIFY) OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractors License Lew for PROPOSED the following reason, (Sen. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct,alter, improve, demoliab,cr rwsir an,structure.prior to its issuance,also requires the applicant for such BUILT-UP ROOF permit to Ilia a signed ssetaman That he is licensee pursuant to the provision, of the Contractor',of the Lienee Lew ICMpur 9 kom)or hat with Section 70001 from Division 3 or ma efor the and Proalleged ex m ion.l or ma he is exempt S ma.. ASPHALT SHINGLES bons mtl the anis lot the allege' asempts th Any ant to of Penalty ]031.5 by any 'guilehu for a permit$500)."the applicant m e civil penalty or 0 more that nye the pro erne.s r my a 1'. WOOD SHAKES ❑ I,as owner of ins work, a or he employees why wands as r their mid tom ale (Sic. will ass the work, and ens structureCode h not intendedto 's License WOOD SH INGLES for sales(Sec. 7044, Business em Professions Code: The or imp ove$ License Lew eons not apply to an owner of property who bat lids Or imps oras[Moon, and wM10 do t rv=n work himself int ltr ed or offered nig own employees,provided that such ng or i Prov ere his i ld with r. neyfor sale. I1, however,owner OTHER (SPECIFY) �A� S Q�e building or as is sold proving one year of completion, the builder will neve[na Dearden of proving mat ns did not build or improve lltr Purpose of sole.). PROVIDE I.C.B.O. REPORT NO. ❑ 1, as owner of the property, a .elusively contracting with li ensee contrac fora to construct the project (Sec, 7044, Business and Professions Code: Tho Contractor's License Law does not apply to on owner of property PROVIDE MFGR. INSTALLATION SPECS. -no builds or improve. mare.", and who contracts for such projects with a onnactor(sl licensed pursuant[o The who License Law, raes❑on I em exempt under sec. ,',spec.for this pPLICATION DATE VALUATION PERMIT FEE Owner Data WORKERS'COMPENSATION DECLARATION A D Build inn I hereby anirm that 1 have a certificate of consent to self insure,or a csr Tint."'of Workeri Compensation Insurance,Or certified copy thereof ISac. Seismic 3800,Lab. .. Policy No.�111.7L4 Company 'F OW C17y r 11 1995 Q O, 00� Total 8 Certified copy is hereby furnished. j ant iMeyp'v is+llaea wigT Tn.'fNW inwacnon division. /• `uN Applicant��V-- FOCMfat CERTIFICATE OF EXEMPTION FROM WORKERS' N.C. C AMIT AUTHORIZATION DATE COMPENSATION INSURANCE (This settiOn Mee not be completed it the permit is for one huner6e d01 Isrs($100)OI las.) I certify sh that m ma performance person of the work for which anis permit is issued, 1 shell n0"employ any penton in MY manner so as to become subject D the Workers'Compensation Leena of California. Dela Applicant NOTICE should APPLICANT: o eller making [nig C.ninon of Exemption, you should dooms subject i the Workers' Compensation provisions a the mit Labor Code, you must forthwith =dangly with such provision or nth permit All roofs shall be inspected prior to any roofing material being sntll be deamsa rwoked. I certify that I have read this application and state that the above Informs. Installed. If a roof Is Installed without first obtaining an tion is correct. I .gree to comply with sea city me county ltrmnanpr and inspe n,I agree to remove all new materials or inspection state Tawe relating to building construction, and hereby .utho,i,, nprosm relives of this city to sour upon m'above-mentioned property IOr inap¢tion purposes. (We) agree m ear., indemnify and keep esharmingwhich may City of Cupertino against liabilities,City i cense judgments,crass the expenses which mer in anY wry ecru• .g.ina said city in consequence of Ln.granting of this permit. NATURE OF APPLICANT � DATE PRE-1 NSPECTION: 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 SUBJECT: REROOFING POLICY FOR TIIE• CITY OF CUPERTINO BUILDING DEPARTMENT PRIOR TOISSUANCE OF PEIMT AND INSPECTION PHASE. L Prior to pencil issuance, you must agree to comply witlu U.B.C. standards and manufacturers specs on reroofing. 2. New roof coverings shall not be applied without first obtaining all inspection and written approval from the building inspector. A final irspecliou and approval shall be obtained from the building inspector wire,, the reroofing is completed. 3. All types of roof shall be inspected prior to any roof being installed. 4. l,,order to receive a rural,you must complete steps I, 2, and 3. I,) Preinspeclion or tear off approval. 2.) 111 progress inspcction approval. • 3.) Final inspection approval. a.) Operable smoke detector verificalioll b.) Spark arrestor installation 5. Irplywood is installed, a plywood nail inspcction is required. G. If any roof is applied without first oblai,,iug an inspection, you will be required to remove all rcry material down to lire slucathing and a building inspector will inspect all sheathing at that time. WE UNDERSTAND TILE ABOVE POLICY ON REROOFING AND WILL COMPLY Wrrll THE POLICY ,\ HOMEOWNERS NAME: N'.'4 `1_ ) ADDRESS: O� O REROOFING COMPANY NAME: /r���l �� 'SRO NQ c APPLICANTS SIGNATURE: I / °'1 K� 5 1 95 • CITY OF CUPERTINO BUILDING DEPARTMENT I Reraof/wimeord '-RPR-21=1995 .'14: 17 � ' TRYLOR.ROOFING _ 408 9711380 P.01� - 0- Cui;iel "ti1�0. r.o.no>i 500. ' Cupmtlnn,CA 75015.0500 Cupn,tlno,CA 05014•1155 . T01rpliunc; (4001157,-4505 7520751 COMMUNITY U@vr.torMENr ' SM I(I"s UGI'L '1' IL'CL-R�I'II�ICA'tL �)P COMPLIANCE I Understand and coluply with Section 1210-,",Or IIle Unironn l3Uilding Code. Section 1210-a rcTlir s 'I'c icl);"rs cicilingrorllwatlllWclle�ch sleepnglroom and olCn detector will be insla I>orposcs1111rcxisolcng s"itclmolcill ehe d detectoos soulply, 6o new detectors shccess to �111be r gtlired.slPepmg • 1 I uudcrstnnd the above rcquirclncnl and certify that we now Have smoke detectors installed that do comply. ADDRLSS: '7�o Com- Sha.c l'L'.ILMIT NUMt1LR: IIOM OWNI'_RS SIGNA'1'UI1,L: ------------- DA'1'Ls: will word/snllc(let I _TnTni 0 LCL