R-4026ft
4
OFFICE COPY
PERMIT R- 4026
APPLICATION FOR - CITY OF CUPERTINO NUMBER
INSPECTION DIVISION PERMIT EXPIRATION
REROOF PERMIT PERMIT EXPIRES IF WORK IS NOT STARTED
(408) 252-4505 EXT. 228 WITHIN 180 DAYS OF PERMIT ISSUANCE OR
IN DAYS FROM LAST CALLED INSPECTION.
BUILDING ADDRESS
- BUILDING USE
RESIDENTIAL COM OTHER
OWNER'S
ROOF
.9
NAME / F �— `r
FIRE COVERING
FIRE
AREA CLASS
�~
EXISTING ROOF COVERING
ADDRESS 1D30^/Vr��t �—�7'�
3 �O
NUMBER OF EXISTING COVERINGS
PHONE p—J !
L_
CONTRACTOR'S
n
06-D
TO BE REMOVED - - - TO BE RETAINED
TYPE OF ROOF COVERING
NAME E-4-
ADDRESS G3 j-OWe-*rA- �itrr?.Q ^'��
P fAwA. c [w
EXISTING
41d �53
BUILT-UP ROOF
PHONE
LICENSE2
< <3l
ASPHALT SHINGLES
NUMBER a-
WOOD SHAKES
LICENSED CONTRACTORS DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (crr�JJJo((ommon
wi a Section]000) 1 Division 3 0l [M Business a Pro
cillo wit
S
entl I. lull tlaffect.
{/
License 1 _'/� Lic.Numbar
CIFY)
Date Contractor
WNER BUILDER DECLARATION
I homy affirm that I am exempt from the Contractor's License Law for
the following ra . (sec. 7031.5, Bu+lnesa and Profession. Code: Any city
or count, Which$ rr.ouires a permit to construct, altar, improve, demolim,or
noair my structure, prior to its issuance, also requires the applicant for such
permit to file a signed statement that he is licensed pursuant to the provisions
of the Contractor's License Law (Chapter 9 (commencing with Section ]000)
C
of Division 3 of the Business and Profession Code) or that he Is exempt there
N ]tE
from and the basis for the alleged exemption. Any violation of Section\/'\
7031.5 by any applicant for a subjects the applicant to a civil penalty
permit
of not mor. mat five hpner.d dollar+ (500).1:
KES V
p 1, as owner o1 me property, or my employees with wage• as their sola
Compensation, will do the work, and the structure is not intended or offered
(Sec. ]044, Business and Professions Code: The Contractors LicenseLaw
�Sforsale
do.not apply [0 an owner of property who builds or improves thereon,
and whodoes such workhimselfor through his own employees, provided thatI�
improvements ere not in ended or offered for sale. u, however. the
ptech
ECIE a'9building
pr i TP,.voment b sold within One year of completion, me owner.builder will have the burden of proving [hat he did not build or improve for
our°o..of+.I..).
C.B. R POQTN0
O 1, as owner °1 the property, am exclusively contracting with licensed
to construct the project (Sec. 7044, Business and Professions
dd UU
COntractors
ode: The Contractor's License Low does not apply to an owner OI property
PROVIDE MdhQNSTALLI %0N SPECS.
who build+ or improves tnareun, and who Contracts for such projects with a
conbactor(s) licensed pursuant to the Contractors License Law.
res.on 1 •m exempt under sac. ,B.aP.t. for this
APPLICATION DATE
VALUA7
PERMIT FEE
Owner Data
���
Y
Building
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I nava a certificate of consent to self insure, or a car
tilicate OI Workers' Compensation Insurance, or ancanified copy thereof (Sec
Pe
^/ �f
/
Seismic I
3800. Lab. C.).
/�'
(/
Poli[ No. Company
8 Canifieticopyi+harebyfurnimad. -�
I d is filed the inspection division.
•`nw
F Jy
l
Total
De/II cop, with city
Ly
Applicant
CERTIFICATE OF EXEMPTION FROM WORKERS' N.C.
'L ITAUTHORIZATION
DATE
�{
(TMs section need not be completed it the permit is for one hundred dole
COMPENSATION INSURANCE/I
bra 181001 or Iese.l_
. 1 [artily that me performance 0 me work for which this permit is
issued, I s II o em joy any pars° In any .nner so es to become subject
a
[° th ansetlon Law b �
D
Dae
AT:
If.
NOTICE TO APPLICANT: II, d r making this C r[iti<ste of Exemption,
you should become subject to the Workers'Compensation provisions of the
Labor code. you must forthwith comply with such provisions or this permit
All roofsshall be Inspected prior to any roofing material being
anal. be dNTW revoked.
Ins al If 8 roof IS installed without first Obtaining 8n
1 certify that 1 nava read this application and state that the above inform•
tion is cont. agree to comply with all city end count, Drain once. end
in action, I agree t0 remove all new materials for Inspection.
state isrelating to building construction, end hereby sum Oriee r.p,.s.n.
etivo of this city to enter upon the above mentioned property for inspection
pur(We)
IWaI spree t° sew, in0amnilV and keep harmless tn• Ciry of Cupertino
( L
against liabilities, judgments, costs and expenses which may in my way accrue
81GNATURE OF APPLI ANT DATE
against gait said City in consequence of the granting of this permit.
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
0
I' 1
LJ
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 cougrly 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 lite reroofing is completed.
3. All types of roof shall be inspected prior to ally roof being installed.
4. lr order to receive a final, you must complete steps 1, 2, and 3.
1,) Preiuspection or tear off approval.
2.) 111 progress inspection approved.
3.) Final inspection approval.
a.) Operable smoke detector verilicalion
b.) Spark arrestor inslallalior
5. If plywood is iuslalled, a plywood nail iuspecliou is required.
G. If ally roof is applied without first oblaiuing air inspection, you will be required to remove all rely
material down to the sheathing and a building inspector will inspect all shcalhing at that lime.
WE UNDERSTAND 771E ABOVE POLICY ON REROOFING AND WILL COMPLY WITH THE
POLICY
IIOMEOWNERS NAIAE:
ADDRESS:
REROOFING COMPANY NAME:
APPLICANTS SIGNATURE:
CITY OF CUPERTINO
• BUILDING DEPARTMENT
Rercol/wimvord
/14 G %t't,* !fo X--/ .
/6310 L
I
Cittj of Cupet•19no
SMOKE DETECTOR CERTIFICATE OF COMPLIANCE
1 understand and comply with Section 1210-a of the Uniform Building Code.
Section 1210-a requires when repairs to a single family dwelling exceed $1,000, a smoke
detector will be installed, mounted on the ceiling or wall in each sleeping room and at a
• point centrally located in the corridor or area giving access to room used for sleeping
purposes. If existing smoke detectors comply, no new detector shall be required.
I understand the above requirement and certify that we now have smoke detectors
installed that do comply.
ADDRESS: / 17 3 B �041&A,,f�
PERMIT NUMBER: 7 n�0 G
HOMEOWNERS SIGNATURE: /,0("
DATE:
• winword/smkdet `
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