R-39761�
W
OFFICE COPY
PERMIT
R- 3976
APPLICATION FOR CITY OF CUPERTINO NUMBER
DIVISION PERMIT EXPIRATION
REROOF PERMIT
OINSPCCE�fCT•IOCCN p PERMIT
(4O8) ZJZ-4JOS EXT. GLV OT STARTED
180 DAYS OPIRES IF FIPERM TORK IS f'I ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
BUILDING
- BUILDING USE
i9into
to
RESIDENTIAL COMMERCIAL OTHER
OWNER'S
HAZARDOUS ROOF
NAM
FIRE t( COVERING
AREA r+ CLASS
Q
EXISTING ROOF COVERING
ADDRESS
I
NUMBER OF EXISTING COVERINGS
PHONE L
l
CONTRA�{?�Q 'S
E �1a'7
TO BE REMOVED TO BE RETAINED
TYPE OF ROOF COVERING
NAME ^ �L– C>�' IZ1) F I�� t, (_7
ADDRESS
p
EXISTING
BUILT-UP ROOF
PHONE
ASP GLES
LICENSE
NUMBER
WOOD SHAKES
LICENSED CONTRACTORS DECLARATION
I hereby affirm that 1 am licensed under provisions of Chapter 9 (commm�
ing With Section )000) of Division 3 of the Business and Professions Coda,
OD SHIN
and my license is In full force and effect.
License CleatLip-Number
Det. Contractor
OTHER (SPEC Y)
OWNER BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Low!or
PROPOSED
,he following reason. (Sec. 703 1.6, Business and Profession$ Code: Any city
or c linty which requires a permit to construct, altar, improve, demolith,or
repair any structure, prior to its is$ Once, also requires the applicant for such
BUILT-UP
Pto fila a sipnetl netemenl that he I$ licantad pu nuant tp he provislorn
o1 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 there
SPHALT SHINGLES '
from and the breis for the alleged exemption. Any violation of Section
7031.5 by any applicant for a permit subjects me applicant to a civil penalty
01 not mon that five no ndred dollars (3500).1:
❑ I, as owner of he property, or my employees with wages as their sola
compensation, will do the work, and the structure is not intended or offered
for sale (Sec. 7044, Business and Professions Cada: The Contractors License
WOOD SHINGLES
Law does not apply to an er of property who builds or improves thereon,
and who do" such work himself or through his own employees, provided that
sec^ improvements are not intended or offered for sale. If, however, the
OTHER (SPECIFY)
building or improvement is told within one Year of completion, [M1e owner
broving that he did not build or improve for
e I
PROVIDE I.C.B.O. REPORT NO.
f owner of the property, am exclusively contracting with licensed
c0 n= `s to construct the pr0%ect (Sac. 7044, Business and Professions
•: TheCom.Kto:sLmanse Law does nw.pproto.nowner pfp.pp.rty
Cro
PROVIDEMFGR.INSTALLATIONSPECS.
w builds or improves thereon, and who contracts for such projects with
Vectors) licensed pursuant to the Contractor's License Law.
❑ am exempt undo. se=. P.C. for this
PPL ATION AT
VALUATION
PERMIT FEE
,Bed
own.
Dat.
ry
WORKERS' COMPENSATION DECLARATION
^// R [J�
BUlldin
I thereby affirm that I have a certificate of consent to seR-insure, or a car.
Workeri Compensation
{. ei
[iIiceta of Insurance, or a certified copy thereof (Sec.
3804 Lab. C.1.
r n
G/,
t7
Seismic
Policy Company
Certified
Certified is hereby lu
LU
~Cti
/�I1
copy mins ed.
8 Certified copy it filed with the city inspection division.
�/I/
/•ii
LI
``�/
Total
Applicant
PERMIT AUTHORIZATION
DATE
CERTIFICATE OF EXEMPTIONFROM WORKERS' N.C. ❑
COMPENSATION N S URANCE
(This section nand not be completed it the permit is for one hundred dol
I... (3100) or
I cattily that i o1 the work for which this permit is
met m me performance
shall
issued, I shall rept employ any person any manner a0 as tp become subject
person
to me Workeri Compamation Laws 01 Glifornie�n
Data Applicant
NOTICE TO APPLICANT: 11, after making this Certificate of Exemption,
Vow mould become subject t0 the Workers' Compensation provisions of the
Cache. you tutus forthwithforthwithcomply with such provisions or this Permit
All roofs shall be inspected prior to any roofing material being
snail
,hall be deemed
id levoked.
I certify that I have rend this application and state that the above informs
Installed If a roof IS Installed without first Obta' ing n
tion is correct. I agree to comply with all city and county ordinances and
Ins action, I a ree to re ova all w mater'alsfor i ect n.
p g p
state laws reating to building construction, and hereby aumo,izo rso as eo
tatives of this city to enter upon the above-mentioned property for inspection
purposes.
waj agree to save, indemnify and keep harmless the City of Cupertino
..
sell-
against liabilities, judgments, coats and expenses which may In any way KLrue
.Winst said City in consequence of the granting of this permit.
SIGNATURE OF APPLYANT UrATE
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
e
SUBJECT: REROOFING POLICY FOR "1'11E CITY OF CUPERTINO BUILDING DEPARTMENT
PR10R TO ISSUANCE OF PER1vWr AND INSPECTION Pf1ASE.
1. Prior to pencil issuance, you umst agree to comply with U.D.C. standards and manufacturers spec's
Oil reroofug.
2. New roof coverings shall not be applied without First obtaining all inspection and written approval
Flout [lie building inspector. A final inspection and approval slmll 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. lu order to receive a final, you must cmuplete steps 1, 2, and 3.
I,) Preinspecliou or tear off approval.
2.) In progress inspection approval.
• 3) Final inspecliou approval.
a.) Operable smoke defector verification
ba Spark arrestor installation
5. If plywood is installed, n plywood nail inspection is required.
G. If nny roof is applied without first obtaining mr iuspeclion, you will be required to remove all new
material down to the sheathing and a building inspector will inspect all sheathing at that lime.
WE UNDERSTAND 171E ABOVE POLICY ON REROOFING AND WILL COMPLY Wf171 THE
POLICY
IIOMEOWNERS NAME:
ADDRESS:
REROOFING COMPANY NAME:
APPLICANT'S SIGNATURE:
•
CITY OF CUPERTINO
BUILDING DEPARTMENT
Reroof/winword
1
.�%• - �• � tom- ♦�
e�
J
0
Citta of Cupet-Ibio
SMOKE DETECTOR CERTIFICATE OF COMPLIANCE
1 understand and comply with Section 1210-a of the Uniform Building Code. i
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:
PERMIT NUMBER:
HOMEOWNERS SIGNATURE:
DATE:
0
winword/smkdet
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