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R-4079 PERMIT R_ 4079 APPLICATION FOR CITY OF CUPERTINO NUMBER INSPECTION DIVISION PERMIT EXPIRATION REROOF PERMIT (408) 252-4505 EXT. 228 WHIN 180 DAYS OF PERM T NOT START ce OED 180 DAYS FROM LAST CALLED INSPECTION. BUILDING ADDRESS BUILDING USE t RESIDENTIAL COMMERCIAL OTHER OWNER'S HAZ ROOF NAME ' +"� 1�•Y�e �L`�{1�'.<< - �� FIRE COVERING COVVERING IAREA CLASS ADDRESS ` I CS� /�A I lCh� S} EXISTING ROOF COVERING /p PHONE / — - /� NUMBER OF EXISTING COVERINGS I CONTRAC OR'S/ t / NAME / iNA`Q OI TO BE REMOVED TO BE RETAINED �C/� �7 TYPE OF ROOF COVERING CIT a ZIP i� 13 S / S�r EXISTING PHONE (,go-5) 9 7 - 7 500 BUILT-UP ROOF LICENSE /1 ASPHALT SHINGLES NUMBER "] f 0 WOOD SHAKES LICENSED CONTRACTORS DECLARATION I hereby affirm that I em licensee under provisions of Chapter 9(comment ting with Section TOM) of Division 3 of the Buslne•+and Profession.Cod., WOOD SHINGLES and mY licence b I full and.fla=t. ," License Cla Lic.Number Data J� conn«tor yty OTHER (SPECIFY) OWNER-BUILDER DECLARATION J I hereby affirm met 1 am exempt from the Contractor's Licence Lew for PROPOSED the following reason. (Sec. 7031.6, Business and Professions Code: Any city or county which r cuires a permit to construct.altar, improve, dsmolish,or repair any structure,prior t0 in issuance,also requires the applicant for.ucn BUILT-UP ROOF Permit to fila a signed statement that he is incensed pursuant to Ina provision. Of the Contractor's License Lew (Chapter 9 (commencing with Section 7000) of Division 3 of me Business and Professions Corel at that he is exempt there ASPHALT SHINGLES from and the basis for the alleged exemption. Any violation Of Section 7031.6 by any applicant for a permit subjects the applicant t0 a civil penalty of not more that live hundred dollars( 6o0).): WOOD SHAKES ❑ I'as owner of the property, O my employees with wages as their sole Tn• cOpeelion,Will d0 the work, andthe structure is not intended or offeree for..Ie (Sec. 7044, Business and Proles.ion•Code: The Contractor'•License WOOD SHINGLES Law does not apply to.n owner OI property who builds or improves thereon, -0 Z and who eon wen work not elfint or ed through offered tai•own , ..I.. aIf,however mat OTHER (SPECIFY) su is improvement• are not i ld with Or n. .. for •ale. If, however, tna . t building Or improvement t ant i sold within one Year OI of build me owner builtler will n.vs me burden of proving owing that ata air not build or improve for ' purpose of.ale.l. PROVIDE I.C.B.O. REPORT NO. L O I, as owner of the property, am exclusively contracting with licensee contrac tors to construct ma project (Sec. 7044, Business and Profession+ Code: ThaConv«mr'sLicenseLaw does not apply toanowner ofproperty PROVIDE MFGR. INSTALLATION SPECS. who builds or improves thereun, and who convects for such projects with a contractors)licensed pursuant to the Contractor's License Law. ❑ 1 am exempt under Sec. ,B,&P.C.1—tnia reasonPPLICA IO DATE VALUATION PERMIT FEE Owner Det. to& WORKERS'COMPENSATION DECLARATION C/n JR Building hereby affirm lata have i certificate of consent 1 self-insure,or a car 'I 'fir y� lisscala of Workers'Compensation Insurance e��d copy nn.f(Sec. n � $BISmIC 3800,Lab.Cyh��a��j 5 y� / (f 9 Policy No.�Company $}L: ' _ Ups. l� / 46d ` 8 Certified=op,I.hereby tumimed, HTS Total Certified copy is Rla6.wlh Ag,EiSy in�ctlQ_n Nlyis � /YO Applicant ICJ 1LJ1 1�CC]l'1 CERTIFICATE OF E% MPTION FROM WORKE ' N O 0 PERMIT AUTHORIZATION DATE COMPENSATION INSURANCE � (This section need not be completed it the permit is for one hundred rob / lar•($100)Or les•.) I densly that in the performance o1 the work for which this permit is �� issued,e mall not employ any parson in any manner so as t0 become subject to the Works s'Compensation Laws of California. - NDateOT ADplicem NOTICE TO APPLILAN T: If, after making this Certificate of Exemption, You should become subject to the Work.,.'Compensation provisions OI the Labor Cor., you meat forthwith comply with such provisions or this permit All roofs shall be inspected prlorto any roofing material being Mall be deemed revoked. I certify that I have read this application and state that the above inform. insta 119'CL, if a roof iS Installed without first obtaining an tion b co.r«t. 1 dere» 10 damply with •u city and county prmnances end in BCtlO ,I agree t0 Ove el materials fol Ins CtlOn. .1ale law• rel. to building cons nuction, and hereby authorize ranr...m tetive•o1 this city to enter upon the.boys mentioned property for Inspection �l purpose . ,� 7 /l IWeI agree s, save, indemnify and expenses ep s which the City of ay accrue against liabilities,lodgment•,ce of ane ratingwhich al in any w»accrue etyma said cess m=an»0uanc.of the granting of ten.o.rmit. S ATURE OF APPLICANT qT 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 SUBJECI': REROOFING POLICY FOR TIIE C11Y OF CUPERTINO BUILDING DEPARTb1L-NT PRIORTO ISSUANCE OF PEPJAIT AND INSPECTION PHASE. 1. Prior to permit issuance, you must agree to comply vvillr 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 lire building inspector when the reroofing is completed. 3. All types of roof shall be inspected prior to any roof being installed. 4, In order to receive a final,you must complete steps 1, 2, and 3. 1,) Preinspection or fear off approval. 2.) In progress inspection approval- 3.) pproval3.) Final inspection approval. a.) Operable smoke detector verification b.) Spark arrestor installation 5. If plywood is installed,a plywuod 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 the sheathing and a building inspector will inspect all sheathing at Ulat lime. WE UNDERSTAND TILE All0VE POLICY ON REROOFING AND WILL COMPLY WITH THE POLICY IIOML-OWNERSNAME: My �orneo�ne�S / v\meq. ADDRESS: toy I � 1 To.4�of � REROOFING COMPANY NAME: N—T� APPLICANTS SIGNATURE: 6117-lets • ClTY OF CUPERTINO BUILDING DEPARTMENT Rerool7winword Out of Cupertino SMOKE DETEcm 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, 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 sm Ike detectors installed that do comply. ADDRESS: 22- 3(,.,5 i`c�:r�cvt� Ve2� C�1r f PERNUTNUMBER: #��1,40 7� HOMEOWNERS SIGNATURE: �/l /. DATE: zk 'L�— I winword/smkdet