R-41020,
OFFICE COPY
PERMIT Ree 4102
APPLICATION FOR CITY OF CUPERTINO NUMBER
INSPECTION DIVISION PERMIT EXPIRATION
REROOF PERMIT
(408)252-4505 EXT. 228 WITH IN I50 DAYS OF PERM T�SSUANCE OR
IBO DAYS FROM LAST CALLED INSPECTION.
BUILDING ADDRESS
- BUILDING USE
Zilt 7k6se(,"1/,/ C)V/ x91
RESIDENTIAL COMMERCIAL OTHER
OWNER'S
�
66bll!-4
HAZARDOUS ROOF
NAME
FIRE ,I COVERING .G
AREA CLASS
p
Ueee�e'eh-
dS
EXISTING ROOF COVERINGG
ADDRESS- c
?/P `;76-90
NUMBER OF EXISTING COVERINGS
PHON i-6)
CONT ACT R'S
cat �, V1 fT
TO BE REMOVED TO BE RETAINED
TYPE OF ROOF COVERING
NAME (i/ -/y- 6�T L�
RESS /� ,r�t7 /� /� �I ,y� //,� //'
b a) pK/C/6
CITY 81 ZIP G L -+J- /CP`T /ti l /
EXISTING
BUILT-UP ROOF 9 25
foe/) 3779_IVO
PHONE_(C
SHINGLES
LICENSEASPHALT
ill -7 (—
NUMBER
WOOD SHAKES
LICENSEDm'hot CONTRd DECLARATION
treat I em licensed linear provisions Of dChapterProle s (common
under
I nar•ey Section
cin with Section 70001 of Division ] of the Bmineu and Professions Coda,
WOOD SHINGLES
and my lice. b n 1 fp c pntl ailette
Litm.a Cbu Lic. Number
Data contractor
OTHER (SPECIFY)
W ER -BUILDER DECLAR ON
In.,
1 no.by affirm In., I am ae•mpt from the Contractor's License Law for
PROPOSED
thelollowinp r. . (Sec. 7031.5, Business and Professions Code: Any city
or county which a permit to construct, alto, improve, demoban,or
repair any structure, prior to its Issuance also require, the applicant for such
BUILT-UP ROOF
permit to file a signed statement that he is licensee pursuant to the provisions
he
of the Contractor's License Lew (Chapter 9 (commencing with Section 7000)
of 3 of the Business and Professions Codi or that he is..amp% them
ASPHALT SHINGLES
from and the basis for the alleged exemption. Any violation of Section
7031.5 by any applicant for a permitubjects the applicant to a civil penalty
of not more that five hundred dollars (S500)1:
WOOD SHAKES
❑ 1, as owner of the property, or my employees with wage, as their sole
com pan sat ion, will do the work, and the structure is not intended or offeree
for .&W (Sec. 7044, Business and Professions Code: The Contractor', License
WOOD SHINGLES
Lew 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
suchon
lith improvamems are not Intended or offered for .I., U, howayer, the
OTHER (SPECIFY)
or is sad within one year of completion, the owner
build., will nava the burden of proving that he did not build or improve for
purpose of.al.A.
PROVIDE I.C.B.O. REPORT NO.
(3I, as owner of the property, am exclusively convecting with licensed
contractors to construct the project (Sac. 7044, Business and Professions
Code: TheContractor's License Low does not apply to an owner of property
PROVIDE MFGR. INSTALLATION SPECS.
who build, or improves thereon, and who contracts for such projects with e
contlactor(O licensee pursuant to the Contractor's License Law.
res❑n I •m •.•mot under S.C. ,B.ay.c. lo. this
APPLICATION DATE
VALUATION
PERMIT FEE
owner De,.
WORKERS' COMPENSATION DECLARATION
BuildinglLA1 �
Mraby affirm that I have a certificate of consent to sell inure, or a car
tilica'a of Workers' Compensation Int a Or a c•rtifiee copy In ... of (Sec.
SeismicUff
polio.L.e.s,�S4rU 'i�yyyj3 S%.L1
Policy Na. �-d by I.,nii�
8 Certified copy is hereby mr read.
Certifies i,filed with M1a c' y i tion division.
�ja 0
TOtflI
Applicant ��le 0 cat
VV
EJft1T AUTHORIZATION
DATE
M
CER ICA D E ,IDN PROWORKERS' N.0
COMPENSATION INSURANCE
if i, for hundred dal.
(This section nese not be completed the permit one
leu ($ 100) or Iso..)
Certify to at in the performance of tea work for which this permit is
n
issued, 1 Nell not employ any person in any manner so as to became subject
-
to the Workers' Compensation Laws of California.
Date Applicant
NOTICE TO APPLICANT: If, eftar making this Cartifiute of Exemption,
You should become subject to the Workers' Compensation provisions of the
Labor Code, you must forthwith comply with such provisions or this permit
All roofsshell be inspected priortoany roofing material being
shall be deemed revoked.
Installed If a roof Is Installed without first obtaining an
I certify that I have read this application and state that the above inform.
tion is correct. l agree to comply with all city and county Ord! an... and
Inspection, I agree to remove all new materials for inspection
.1.1. laws relating to building construction, and hereby authorise tapree•m
tativs of this city to enter upon the above mentioned property for inspection
'
Purposes.
IWeagree to sew, indemnify and keep vermin. the City of Cupertino
(We)
�'1<122
.gain., liabilities, judgments, costs and expanses which may in any way ------
City in
SIGNATURE OF AIPPLICANT 1v DA
against said consequence of the granting of this permit.
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
•
SUB1ECf: REROOFING POLICY FOR THE CITY OF CUPERTINO BUILDING DEPARTMENT
PRIOR TO ISSUANCE OF PE•RNUT AND INSPECTION PHASE.
1. Prior to permit issuance, you Must agree to cojgrly with U.H.C. standards and manufacturers spec's
oM reroofing.
2. New roof coverings shall not be applied without first oblainiug all inspection and written approval
from the building inspector. A final inspection and approval shill be obtained from the building
inspector when [fie reroofing is completed.
3. All types of roof shall be inspected prior to any roof being installed.
d. In order to receive a final, you Must complete steps 1, 2, and 3.
1 J Preinspeclioir or tear off approval.
2.) In progress inspcclioM approval.
3.) Final iuspectiou approval.
a.) Operable smoke detector verification
ba Spark arrestor installation
5. if plywood is installed, a plywood jail iuspectiou is required.
G. If any roof is applied without first obtaining an inspection, you will be required to remove all acw
material down to lire shcathijg and a building inspector will inspect all shcathijg at Ilial lime.
WE UNDERSTAND 171E A13OVE POLICY ON REROOFING AND WILL COMPLY WITH TIIL-
POLICY
I ION EO W NERS NAME:
ADDRESS:
REROOFING COMPANY NAME:
APPLICANTS SIGNATURE:
• CITY OF CUPERTINO
BUILDING DEPARTMENT
Reroof/Mimord
citl of cupertim
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 smoke detectors
installed that do comply. q
ADDRESS: ��f
PERMIT NUMBER: / �d,
HOMEOWNERS SIGNATURE:
DATE:
winword/smkdet
0