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R-3841 PERMIT 3841 APPLICATION FOR CITY OF CUPERTINO NUMBERR-14 PERMIT INSPECTION DI-10PERMIT EXPIRATION PERMIT EXPIRES IF WORK IS NOT STARTED (408) 252-4505 EXT. 228 WITH I N IBD DAYS OF PERMIT ISSUANCE OR too DAYS FROM LAST CALLED INSPECTION. BUILDING ADDRESS ,. ,,_I_ / I r BUILDING USE �66 ��X-a wY1 VN` T RESIDENTIAL COMMERCIAL OTHER OWNER'S ^ NAME �uF"' N/�'PA'S ' 'til FIRE HAZARDOUS COVERING 1< RHE ADDRESS lob w� ��'��r/11 'r • LASS EXISTING ROOF COVERING PHONE him 7X"1 — I 0 IO NUMBER OF EXISTING COVERINGS ' CONTRACTOR'S ,! �11� � n R NAME Jjgn:j - oo�l AC/t TO BE REMOVED TO BE RETAINED TYPE OF ROOF COVERING ADDRESS, (ii (� 17ZVk C)r EXISTING CITU&21P PHONE 9i�Ol71l / Ll'X BUILT-UP ROOF x LICENSE V15�� ASPHALT SHINGLES NUMBER l WOOD SHAKES LICENSED CONTRACTORS DECLARATION I hereby storm ena I of lipntetl under provision of Chapter on,(comman.' ting with Section 70001 0} Division 3 m the egnn«.and Prof...,.on.Co..,cod., WOOD SHINGLES and my license Qtr II torp and efface. tw 5",1,1130 � 1 LI<anse Cla Lic.res'p, 'x1 t1 O� OTHER (SPECIFY) Do,. moi= Q Contr«tor OWN ER BUILDER DECLARATION \ I hereby affirm that I am exempt from the Contractor's License Lew r PROPOSED the following reason. (Sec. 7031.6, Business end Professions Code: Any city or county which requires a Permit to Construct, alter, Improve, demoli.h,or Q repair env.,nu.I.ra.pilot to its issuance, also require. he applicant for such BUILT-UP ROOF permit to lila•signed!tenement the\he is licensed pursuenl to\he previsions of the Convectors License Lew (Chapter g (commencing t with ..tion t7000) he,. of Division 3 of ena Business ena 9 it exemption. tion. or that of ti exempt tnero' . ASPHALT SHINGLES from end the basis for the 1 ' apmp\ian. Any violation of 5«tion 7031.6 by any eppl.c em sear a permit subjects the applicant to a civil penalty of no\more that five hundred Polar,($5oo).h WOOD SHAKES 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 or offered yy00D SHINGLES for sale (Sec. 7064, Business end Professions Code: Th a Contractor',License Law who does applsuch to an owner of property is o n employees, i es,Pro.ded that (-I` 1 V I Lo who tlo t aucn work owns Or throughart his employees, ....I ..P., \ .nF./11 ...h improvements a not intended or offered for sale, u, however, the OTHER (SPECIFY) IAO 1 building or improvement is sold within one year of completion, the owner- build•r will have the burden of Proving that he did not build or improvfor 3�_I � Purp...of..I.Jl PROVIDE I.C.B.O. REPORT NO. p I, as owner of the property, am exclusively contracting with licensed contractors to construct the pro!«t (Sec. 7044. Business and Professions �A cmc The Contractor License Lew does not apply to on owner of Property PROVIDE MFGR. INSTALLATION SPECS. /tl who bunvv d. or improves theraun,end who contracts for such projects with e contnctorlJ licensed pursuant to the Contractor's License Law. rets On 1 .m .x.mpl anter sec. s.aP.c.for this APPLICATION DATE VALUATION PERMIT FEE own.. Dene WORKERS'COMPENSATION DECLARATION �, A Building I is of affirm that 1 neve i n Insurance. . consent to nlLinaura, W \iliceta O}Workers'Compensation Inaurenc ,Or Iin d copy thereof(Sec. 5►000 Seismic t 3800,Lab. ((��11`` �^ /1/�� Policy No. -1'l ompenv Slln /yr i� ® cernnetl copPy e. r wrni.n.d. �jJ Total Certiaf�ied�c�e,(p� s •p�f+w�reu r nis trey inspection division. Applicant E 1 MYVYV wfw /'- C RTIFICATE OF E%E TION FROM WORKERS' N D ❑ ' PE, AUTHORIZATION DATE COMPENSATION N 6 URANCE (Thi..action need not be completed it the permit is for no hundred dol an($100),.,les..! [w�{•�/aaerrr..a 1. I s y that in the performance Person of the work for which this permit is iRued, 1 shell not employ any person in enY manner tanto become subject ((( \o the Works s Compensation Lew.of California.n Dote Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Worker,' Compensation provisions of the Lebo'Cad., You must forthwith comply with such provision or this permit .hell be deemed rev.k.d. All roofs shall be Inspected prlorto any roofing material being I certify the' 1 nave read this epplic.lian and let.that the above informs installed. If a roof is Installed without first obtaining an non Is pry«t. I .glea to comply with .d city and count,ordinances and inspection,I agree to remove all new materials for inspection. nets laws relating to building construction, and hereby authorise represent te\iv.s of this city to enter upon the above-mentioned property for inspection purpose.. (We) spree to uva, indemnify and keep M1.rmless the City OI Cupertino against liabilities,judgmerim costs and expenses which may in any cosy ec<rua against said city in consequence of the granting of his Permit. SIGNATURE OF APPLICANT V 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 THE CITY OF CUPERTINO BUILDING DEPARTMENT PRIOR TO ISSUANCE OF PERMIT AND INSPECTION PHASE. 1 1. Prior to permit 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 the building inspector. A final inspection and approval shall be obtained from the 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. I,) Preinspection 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 an inspection, you will be required to remove all new material down to the sheathing and a building inspector will inspect all sheathing at that time. WE UNDERSTAND THE ABOVE POLICY ON REROOFING AND WILL COMPLY WITH THE POLICY "vim, q�l o HOMEOWNERS NAME: 1' I�"y 1�1�,©+may rY I" "Vj v ADDRESS: REROOFING COMPANY NAME: n APPLICANT'S SIGNATURE: CITY OF CUPERTINO BUILDING DEPARTMENT Reroof(winword • C414 of Cupertino 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, 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: 22364-w 111W1� PERMIT NUMBER: �?� HOMEOWNERS SIGNATURE: DATE: / • II i winword/smkdet •