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R-3999 PERMIT 3899APPLICATION FOR CITY OF CUPERTINO NUMBER R � INSPECTION DIVISION PERMIT EXPIRATION REROOF PERMIT (408)252-4505 EXT. 228 WITHIN EXPIRES DAYS OF PERMIT ISSUANCE OR 190 DAYS FROM LAST CALLED INSPECTION. BUILDING ADDRESS BUILDING USE 10382 Palo Vista Road RESIDENTIAL XX COMMERCIAL OTHER OWNER'S NAME Bob & Marjorie Ba110U HAZROOF FIREARDOUS eA t COVERING A .){ . CLASS AREA ADDRESS 10382 Palo Vista Road EXISTING ROOF COVERING PHONE 408-253-7688 NUMBER OF EXISTING COVERINGS % two CONTRACTOR'S Heritage Roofin O BE REMOVED XX TO BE RETAINED NAMEg Inc.. TYPE OF ROOF COVERING ADESS CITY&ZIP 3987 First St. 11Ptt Livermore CA EXISTING PHONE 510-447-7508 BUILT-UP ROOF LICENSE ASPHALT SHINGLES NUMBER 595748 WOOD SHAKES X LICENSED CONTRACTORS DECLARATION 1 hereby Nlirm met I am licensee under provisions of Chapter 9(common X - thg worn S«non 7000) of Division 3 of the Business and Professions Cone, WOOD SHINGLES and mY Ilcenea' . VII force ane affect. _ Licam Clap Lic.Number Oats 1i contr= OTHER (SPECIFY) OWNER-BUILDER DEC LA ION I hereby affirm that I am a..mics nom the Contractor's License Law for PROPOSED the following reason. (Sec. 7031.6, Business and Professions Code: Any city county which requires a permit to construct, alter, Improve, deolish.or ropenv sVucture, mprior to its issuance,also requires the applicant for such BUILT-UP ROOF permit t0 or file a signed slltemant that he is licensed pursuant to me provisions of Me Contractor's License Law(Chapter 9 (commencing with Section 70001 of Cirdion 3 or the Business and Professions Code)or that he is exempt ther.. ASPHALT SHINGLES X from end the basis for the alleged exemption. Any violation of Section 7 031.6 by any applicant for a permit subjects the applicant t0 a civil penalty of not more that five hundred dollars( 600. ): WOOD SHAKES ❑ I,as owner of the property, or my employees with wages as their sola compensation,awin do the work,and the structure is not intended or offered WOOD SHINGLES for la (Sec. 7044, Business and Professions Code: The Contractors License Law does 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 wan improvements . not intended o offeree for sole. If, however, me OTHER (SPECIFY) building or improyam sit t mid within uno year of completion, the owner, builder will have the burden of Proving that he did not build or improve for purposeof..Is.). PROVIDE I.C.B.O. REPORT N0. ❑ 1, as owner of the Property, am exclusively contracting with licensed contract.,, to comtruct the project )Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of Property PROVIDE MFGR. INSTALLATION SPECS. who builds or improves thereon, and who contracts for such projects w.in a contractor(s)Il censed Pursuant to the Contractor's License Law. ❑ I am exempt under Sec. ,9.&P.C.for this r...on OkPPLIPTION DATE VALUATION PERMIT E owner Dat. WORKERS'COMPENSATION DECLARATION - l' I0 Building r 1 hereby affirm that I have a certificate of consent to self in rare,or a car. �O Wick of Workers' Compensation Insurance,or a certified copy thereof(Sec. n (5710.00 Seismic E 3800, LeDs$ 4 Y J Policy No 40 -93 6 mp.py St e Fund 7 G J rl Certiliod copy is nby furnuhetl. F 9sL. Total Y© Certified cow to he cit' gFyiOn divisiop L(/fOp W APP cent t �/�-d S CE IFICART TE OF EXEMPTION FROM WORKERSN.C. C ❑ "FlEi3MIT AUTHORIZATION DATE COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dol I...(91 DO)or less.l I certify that in the performance of N. work for which this permit is is,uad, I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California. Dats Applicant 6/1 NOTICE TO APPLICANT: If, 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 roofs shall be Inspected prior to any roofing material being knoll be deemed revoked. I certify that I bare nae this application and state met the above inform.. Installed roof IS I tailed without first obtaining an tion is correct. I agree to comply with all city and county ordinances and inspectio agree for Ball new materialsfor inspection. apt. laws relating to building construction, and hereby authorize .or.. n tatives of this city to enter upon the above mentioned Property for inmection purPoeas. Iola spree to save. indemnify and keep M1armless ma City of Cupertino against liabilities,judgments,Costs and expenses which may in any way Kcrue against said City in consequence of the granting of this permit. GNATURE 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 'I'IJE CITT OF CUPERTINO BUILDING DEPARTMENT PRIOR TO ISSUANCE OF PERIouT AND INSPECTION PHASE. L Prior to permit issuance, you must agree to comply will' 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 the reroofing is completed. 3. All types or roof shall be inspected prior to any roof being installed. 4. hr order to receive a final,you must complete steps 1, 2, and 3. 1,) Preimspection or tear off approval. 2.) In progress imspecliom 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 an inspection, you will be required to remove all mew material down to llre sbeatltiug and a building inspector will iltspecl all sheathing at that lime. WE UNDERSTAND THE AllOVE POLICY ON REROOFING AND WILL COMPLY WITH THE POLICY IIOMEOWNERS NAE: Bob Ballon M ADDRESS: / 10382 Palo Vista Road REROOFING COMPANY NAME: Herit Roofin APPLICANTS SIGNATURE: CITY OF CUPERTINO . BUILDING DEPARTMENT RerooUwinword 1� 1 1 � Cites of Cupertino SMOKE DETECTOR CERTIFICATE OF C0I14PLIANCE i u 1210-a oft Uniform Building Code. 1 understand and comply with Sectio . g IY I Section 1210-a requires when repairs to a single family dwelling exceed 51,000, 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 requiIred. I understand the above requirement and certify that we now have sm Ike detectors installed that do comply. ADDRESS: 10382 Palo Vista Road PERMIT NUNIBER: 11 HOMEOWNERS SIGNATURE: DATE: , Z2'— 9 i winword/smkdet 1 >i