R-5154 PERMIT _
"APPLICATION FOR CITY OF CUPERTINO NUMBER R 515 4
INSPECTION DIVISION PERMIT EXPIRATION
REROOF PERMIT (408)777.3228 PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN0 ISSUANCE
AYS FROM LAST CALLED
18DINSPECTION.
LDING ADDRESS \n"
RESIDENTIAL COMMERCIAL OTHER
OWNER'S HAZARDOUS FIRE AREA
NAME CD1`-/1'{/�/L "� YES E] 11 yeaunderstand that aClass A -
roof assembly Is required.
NO ❑ Initial LC.B.O.k
ADDRESS ��" L` EXISTING ROOF COVERING
NUMBER OF EXISTING COVERINGS
PHONE
CONTRACTOR'
8/J Q BE REMOVED TO BE RETAINED
NAMEADDRESS
r / TYPE OF ROOF COVERING
s CITY&ZIP,i2� ,e!
� / P / f�s0 EXISTING
� .
PHONE� �-;J �L✓� BUILT-UP ROOF - ❑
NIUMBER Q CENSE ASPHALT SHINGLES
I0ENSEDNNTRACTOIts DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section WOOD SHAKES
7000)of Division 3 of the Business and Professions Code,and my license Is In full force and
effect, WOOD SHINGLES
License Class Llc.Number
Data contractor OTHER(SPECIFY)
OWNER-BUILDER DECLARATION PROPOSED SEP 25 1996
I hereby affirm that I am exempt from the Contractor's License Lew for the following reason.
(Sec.7031.5,Business and Professions Code: Any city or county which requires a permit to
construct,alter.Improve,demolish,or repair any structure,prior to Its Issuance,also requires the BUILT-UP ROOF �,I I r 11
applicant for such permit to file a signed statement that he Is licensed pursuant to the provisions n �'�I I ItxJ
of the Contractor's License Lew(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he Is exempt therefrom and the basis for the alleged ASPHALT SHINGLES
exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to
a civil penalty of not more than five hundred dollars($500).): WOOD SHAKES E]❑1,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 for sale(Sec.7044,Business and Profes-
sions Code:The Contractor's License Law does not apply to an owner of property who bunds or WOOD SHINGLES ❑
Improves thereon,and who does such work himself or through his own employees,provided that
such Improvements are not Intended or offered for sale.If,however,the building or Improvement
Is sold within one year of completion,the owner-builder will have the burden of proving that he did OTHER(SPECIFY) ❑
not build or Improve for purpose of sale.). .
❑1,as owner of the property,am exclusively contracting with licensed contractors to construct
the project(Sec.7044,Business and Professions Code:The Contractor's License Law does not PROVIDE I.C.B.O.REPORT NO.
apply to an owner of property who builds or Improves thereon,and who contracts for such projects
with a contractor(s)licensed pursuant to the Contractor's License Law. PROVIDE MFGR. INSTALLATION SPECS.
❑1 am exempt under Sec. ,B&P.C.for this reason
Owner Date APPLICATION DATE VALUATION PERMIT FEE
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penally of perjury one of the following declaration. �,
❑1 have and will maintain a Certificate of Consent to self-Insure for Worker's Compensation, BUIdmg
as provided for by Section 3700 of the Labor Code,for the performance of the work for which this �.
It permit Is Issued. ZG 0 Seismic
❑I have and will maintain Worker's Compensation Insurance,as required by Section 3700 of
the Labor Coda,for the performance of the work for w ich this permit is issued.My Worker's Total YXIalt
Compensation Insur ce carr er and Poll mbar er .
Carder Policy No.�� PERMIT AUTHORIZATION DATE
CERTIFICATE OF EXEMPTIO FROM WORKERS'
COMPENSATION INSURANCE N.C.0 '
(This section need not be completed If the permit Is for one hundred dollars($100)or less.) ^'
1 certify that in the performance of the work for which this Wrmlt Is Issued,I shall not employ
any person In any manner so as to become subject to there c enaanon e m li- All roofs shall be inspected prior to any roofing material being
forme. a installed. If a roof is installed without first obtaining an
Date Applmant inspection,I agree to remove all new materials for inspection.
No ETO AP ICAN : If,attar making this CertifKIy to of Exemption,yo curd become Applicant understands and will comply with all non point
subje to the Workers'Compensetlon pro ons of taALebor Code,you my forthwith comply pp p y p
with such provisions or this permit shall be deemed revoked. source regulations.
I certify that I have read this application and state that the above Information Is correct)agree
to comply with all city and county ordinances and state Tawe relating to building construction,and All roof co v t Ings class" "or .tter.
hereby authorize representatives of this city to enter upon the above-mentioned property for In. _
spection purposes. l
(We)agree to save,Indemnify and keep harmless the City of Cupertino against liabilities,
. of the gran costa and expenses which may In any way accrue against aeltl City In consequence S U F PPLIC E
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 INSPECTIO�NZ\
OFFICE COPY %
0- ci(�%-
10300 Torre Avenue
Cupertino,CA 95014
ul'
Cupertul o Building Division
(408)777-3228
(408)777-3333 (fax)
March 18, 1997
i
Homeowner
21930 San Fernando Avenue
Cupertino, CA 95014
SUBJECT R5154 Reroof permit
Dear Homeowner:
We have been going through our files in the Building Department, and contacting those
people with permits which have remained "open".
• According to our inspection records, the subject permit has never been finaled. Many
times an inspector will sign the permit in the field, but neglect to report all of the
information to the clerical staff for input into the computer. If your records show the
subject permit as finaled, would you please contact us so we may complete our records?
If the permit is not signed off your permit can be reactivated and an inspection could be
scheduled for final closure of the permit
If we do not hear from you within ten (10) working days, we will dispose of the file and
remove the records from our computer.
Thank you for your assistance.
Sincerely,
CITY OF CUPERTINO
Christy Akatiff, Administrative Clerk
POIII@C on Recvcled Paver ��