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R-3914 PERMIT R_ 3914 APPLICATION FOR CITY OF CUPERTINO NUMBER REROOF PERMIT INSPECTION DIVISION PERMIT EXPIRATION (408) 252-4505 EXT. 228 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. BUILDING ADDRESS - BUILDING USE 2_6674 . RESIDENTIAL COMMERCIAL OTHER OWNER'S ��►--777��,, /�.T z_. HAZARDOUS ROOF N E ;,A /'� _ FIRE COVERING AREA CLASS ADD RESS00 �Z.n�. F �i �sifo ��-A ovEXISTING ROOF COVERING PHONE L oz 2 " NUMBER OF EXISTING COVERINGS CONTRACTOR' X!C� PG- ADDRESS � M�L _1 Q� TO BE REMOVED TO BE RETAINED NAAO� 11 �.V �TVC77 T E OF ROOF COVERING ADDRESS CITY 81 ZI EXISTING PHONE BUILT-UP ROO LICENSE ASPHALT SHINGLES \ NUMBER WOOD SHAKES LICENSED CONTRACTORS DECLARATION I he,",affirm that I am licensed undo.....Won.of Chapter 9(commas 6n9 with Sacdon 70001 of Division a of the Bu.in.n and ProLmmn.Code, WOOD SHINGLE and my license I.in full force and effect / license Clan LIC.Number_ OTHER(SP D.le Contractor / Oe, I mBUILDER DECLARATION I hereby.ream mat I . exempt from thesa Contractor'. Code: Law for PROPOSED or fumy followir,9 which re. (Sec. permit, Business and Professions Code: Any city ,s county whim requires a persue[ to construct,re alter. improve,a t to, / r.rm any etmctugn prior to its issuance,i elm requires that to the p for such B 1 T OOF \ r\ permit to Rb a signed Li etse Law that b.r licensed pursuant it ma provisions of [ba Oomncm:. License Lew ICnepsProfessions (comm encint with exempt There) \IJkL` fr Division 3 of the Burin...and gedexmCode)or sun he is exempt Mare- A LT$1� from an an epos for the alleged exemption. Any violation of Section //kk ]031.5 by my mpli<ent for a permit subjects the applicant to a civil Penalty ore That five hundred dollar,(Sboo1.1: WOO SHAS I as owner of the property,or my employees with wares as their sole I ps Mtion,will do me work,entl me structure if not intended or offered f reels ISec. ]oda. Buainen era Pro as no Code: The Contractor'.License OD SHINGLES L don not.poly to an owner of property who builds or improves thereon, .n who does such work himself or through his own employees,provided that .UC, improvement. , not intended p offeree for sale, If, however. In. OTHE (SPECIFY) Eui'ding or improvement is sola within one veer of completion, the owner builder will have the burden of proving that he did not build or improve for Purpose of,stee). PQOVIDE I.C. .O. REPORT NO. ❑ I, e. owner of [M1e he project ( exclusively contracting with 1p//�Rf`1 ///ss contra to construct ma prolate (Sec. 704 4, Blo aro and Profession.proprty Coda: Tree orContractorsve% License Law does not soots loan owner of property INSTALLATION SPECS. who builds or improve thequn, dna who contracts fore La projects with e cmva.s am ..shwa pu.mebs m ma Contractor's license Law. ❑ em exempt under Sac. ,B.&Pecs for this pe- TION DATEND TION PERMIT FEE Ower Dr,. WORKERS'COMPENSATION DECLARATION lAQ Bffllftln I hereby affirm that I have a certificate of consent to self insure,or a carft 199 [ilicste of Workers' Compensation Insurance.or a Certified cops theraol lea N 3800.L.b.C.). •eSP�T,o�D� �_ Seismic Policy No. Company BCertified copy I.hereby furnished. WA.'e Total Certified copy is filed with the City inspection division. '—\r� �� Applicant CERTIFICATE OF EXEMPTION FROM WORKERS' N C PERMI 'AUTHORIZATION DATE COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dOI. tare(S 1301 or.,Ins.' 1 certify that in the performance of the work for which this permit i. seed, 1 .hell not employ any paean in ,say man ar.o e.so become su blocs t0 me WOrke/�Compensation La W.of California.n Dote Applicant NOTICE TO APPLICANT: 11, after making In,, Certificate of Exemption, You should become subject to the Workers' Compensation provision. of the Labor Code.you must forthwith comply with such provisions or this permit All roofs shall be inspec pr orto any roofing material being .he be deemed revoked. I certify that I nava read this application and.Ire that the above informs Instal IE1Q If a roof I lleCf without first obtaining 8r, tion is correct. I agree to comply with all city and county ordinances and Inspection,I a e Ove all new materialsfor inspection. .,at. laws relating to building construction, and hereby authorize ,epneem tatives of this city t0 enter upon the above-mentioned property for inspection p.rposas. n Iwai spree to live, indemnify dna keep harml.0 [M City of Cupertino 4 against liabilities.Judgments,costs and expense.which may In any we,a,C= aoainst Baia City in Consequence of the granting of that permit. GNATU ANT DA 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 POR THE CITY OF CUPERTINO BUILDING DEPARTMENT PRIOR 7'O ISSUANCE OF PERMIT AND INSPECTION PHASE. 1. Prior to permit issuance, you oust agree to comply wilh U.B.C. standards and manufacturers spec's om reroofing. 2. New roof coverings shall not be applied without first obtaining all inspection and written approval front the building inspector. A final inspection and approval shall be obtained front tine building inspector when the reroofing is completed. 3. All types of roof shall be inspected prior to ally roof being installed. 4. ht order to receive a final,you oust complete steps 1,2,and 3. 1,) Preinspectiom 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 am inspection, you will be required to remove all new material down to(lie sheathing and a building inspector will inspect all sheathing at that lime. WE UNDERSTAND 771E ABOVE POLICY ON IIE-1100FING AND WILL COMPLY WITII TIIE POLICY HOMEOWNERS NAME: /n`R= 75e V'r ADDRESS: �o�Z �iRC��tcA fir'' REROOFING COMPANY NAME: ~ APPLICANTS SIGNATURE: CITY OF CUPERTINO • BUILDING DEPARTMENT Reroof/winword