R-4078APPLICATION FOR CITY OF CUPERTINO
REROOF PERMIT INSPECTION DIVISION
(408)252-4505 EXT. 228
PERMIT R- 4078
PERMIT EXPIRATION
PERMIT EXPIRES IF WORK 15 NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
ISO DAYS FROM LAST CALLED INSPECTION.
UUILUING//AA/UUKtb5 ��I�////�)�)�)� 4 BUILDING USE
1� e n v y T� LqIDFNTIA� COMMERCIAL OTHER
OWNER'S yam„ A J _
t 7�_�f� _\\��/wA�I� HAZARDOUS�^^�yl/ ROOF
NAME FIRE = COVERING
AREA CLASS
ADDRESS \y, IN EXISTING ROOF COVERING
NUMBER OF EX
PHONE IS OVERINGS _
CONTRAC�'�1R�^
TO f3E REMOVED TO BE RETAINED
NAME f TVPF OF RnnF COVFRINR
RESS
CITY & ZIP
LICENSE I ...1
NUMBER
1 hereby affirm that I em licensed under provisions of Chapter 9 (common
cing with Secsjon �O0),=ivision 3 of me Bolmeu•end,Pfofaspo1 Coda,
and my lice a l0 kill f and affect. �-•1`C�) J'3fC
Licen • Cla Lic. Number
Data I 1 Contrwtoy,
aJ,L_ J OWR
NER BUILDER OECLAA-T�N�" � JI
I hoot affix 1. I s exempt from the Contractor's License Lew o
the fon owing reason. (Sec. 7031.5. Business and Professions Coate: Any cit
or county which requires a permit to construct, alter, improve, demousn,or
reoai. any Iuctars, prior to s issuance, also requires me applicant for such
permit to fiOm u
Is a signed statement that he is licensed pursuant to the provisions
al the Contractors License Law (Chapter 9 (commencing with Section 7000)
of Division 3 of the Business and Professions Coder or that he is exempt then
from and the basis for the alleged exemption. Any violation of Section
7031.6 by any applicant for a permit subjects the applicant to a civil penalty
of not more that five hundred dollars (55001.):
❑ I'as owner of the property, or my employees with wages as their sole
compensation, Will do the work, and the structure is not intended o offered
for sola (Sec. 7044, Business and Professions Code: The Contractors License
Law aeras 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 are not intended or
offered for sale. If, however, the
building or improvement is sola within one year of completion, the owner
builder will have the burden of proving that he aid not build or improve for
purpose of sale.).
❑ 1, as owner of the property, am exclusively contracting with licensed
ontractor: to construct Na Project (Sec. 7044, Business and Profeoiom
Coate: The Contractor's License Lew does not apply to an owner of Property
who builds or improves 1her.un, and who contracts foe such projects with e
contractor(s) licensed pursuant to the Contractors License Lew.
Cl1 em exempt .nater Sec. ,B.&P.C. for this
rseeon
Owner Date
WORKERS' COMPENSATION DECLARATION
I hereby affirm Inn I have cerlificne of consent to self insure, ora ar
[mute s� �npe 4n .l nsun Ce. lif'aa C9157,
hereat I a .
3800, L Cl I QI'/ \ `i 1 r aJ
Policy LN 1 Coen
nifiatl copy
is hereby fu rni
Cartif "ad
}ilea witM1 [ cit insDe[tlo�d,ADphCERT'1trE CONSlToIN ANC(This section need not becmedtthePemundna aob
lees 1$100) or less.)
I certify that in the performance of the work for which Snit permit is
issued, I Nell no[employ any person in any manner so as to become subject
to the Workari Compensation Laws of California.
DataAppl icen[
NOTICE TO APPLICANT: If, alter making inb Certificate of Exemption,
you should become subject to the Workers' Compensation provisions of ins
Labor Code, you mus[ forthwith comply with such provisions or this permit
shall be deamed revoked.
I certify that 1 have read this application and state that the above informs.
tion is correct. I agree to comply with all city and county ordinances and
slate laws relating to building construction, and hereby authorize radiation
,.lives of this city to enter upon the above mentioned property for inspection
Purpose'
.
(We) age. 1p .est indemnify and kap 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.
EXISTING
BUILT-UP ROOF
ASPHALT SHINGLES
WOOD SHAKES
WOOD SHINGLES
OTHER (SPECIFY) P
PROPOSED J1JN ry 6 n r
BUILT-UP ROOF
CI'y Uh ! 190
ASPHALT SHINGLES lyUrt t
WOOD SHAKES
WOOD SHINGLES
OTHER (SPECIFY)
PROVIDE I.C.B.O. REPORT NO.
PROVIDE MFG R. INSTALLATION SPECS.
APPLICATION DATEI VALUATION I PERMIT FEE
Building
eismic
PERMIT AUTHORIZATION DATE
All roofs shall be inspected prlorto any roofing material being
Installed If a roof isin ailed without first obtaining an
ins action I agree to re OVe II new aterialafpr lr)ppection.
% 2
SIGNATURE OF APPLICANT DATE
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
•
SUBJECT': REROOFING POLICY FOR 771E CITY OF CUPERTINO BUILDING DEPARTMENT
PRIOR TO ISSUANCE OF PERIvRT AND INSPECTION PHASE.
1. Prior to perruit issuance, you must agree to comply 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 lite building inspector. A final inspection and approval shall be obtained from lite building
inspector when lire reroofing is courplcied.
3. All types of roof shall be inspected prior to any roof being installed.
d. In order to receive a final, you "lust complete steps 1, 2, and 3.
1,) Preirrspeciiou or tear otT 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 uail inspection is required.
G. If any roof is applied without first obtaining an inspection, you will be requited to remove all new
material down to lire sheathing and a building inspector will inspect all sheathing at that little.
WE UNDERSTAND TT1E ABOVE POLICY ON REROOFING AND WILL COMPLY WITH TILE
POLICY
IIOMEOWNERS NANIE:
ADDRESS:
REROOFING COMPANY NANIE:
APPLICANTS SIGNATURE:
• CITY OF CUPERTINO
BUILDING DEPARTMENT
Remol7winword
0
•
I
Icuverlim
SMOKE DETECTOR CERTIFICATE OF COMPLIANCE
I 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,
detector will be installed, mounted on the ceiling or wall in each sleeping room
point centrally located in the corridor or area giving access to room used' lot
purposes. if existing smoke detectors comply, no new detector shall be required.
I understand the above requirement and certify that we now have sm Ike
installed that do comply.
ADDRESS:
PERNUT NUMBER:
HOMEOWNERS SIGNATURE:
DATE:
winword/smkdet
a smoke
and at a
sleeping
detectors