R-4007/we
ft
a
PERMIT
R-
4007APPLICATION
FOR CITY OF CUPERTINO NUMBER
REROOF PERMIT INSPECTION DIVISION PERMIT EXPIRATION
PERMIT
EXPIRES IF WORK IS NOT STARTED
(408) 252-4505 EXT. 228 WITHIN 180 DAYSOF PERMIT ISSUANCE OR
IN DAYS FROM LAST CALLED INSPECTION.
BUILDING
BUILDING USE
)ADDRESS
C U CaJ
RESIDENTIAL COMMERCIAL OTHER
ER'S
%HAZARDOUS
ROOF
NAME
FIRE COVERING
AREA CLASS
EXISTING ROOF COVE ING
ADDR S
NUMBER OF EXISTING C0 ERINGS
PHONE tC�
ti I 1
1
CONTRA TOR'S
n
(C
;/1
TO BE REMOVED TO BE RETAINED
TYPE OF ROOF COVERING
NAME C
Y l
ADDRESS
CITY a ZII' �/rnn Iv • O - I
XISTING
w t/
BUILT-UP R F
PHON
LICENSE
ASPHA SHINGLES
NUMBER "L tt
WO SHAKES
LICENSED CONTRACTORS DECLARATION
I hereby affirm that I am licensee under provision. of Chapter 9 (common
m9 Section 70001 Division 3 P).p�f(99.{0.�,
ODD SHINGL
with of of In. a".ins .nd coa.,
and mY Iiwns in I ane a fact. 'G
'tel L
Licm)a leu Lic,NumOer Vl
Date DDECLtor
OTHER SSP I n^
OatI -BUILDER OEC LA RATION
` / \
\/
I hereby affirm that 1 . aaemm frim the Contractor's License Lew sty
reason. (Sec. Business and Pltar, i n.pr Coad: city
.1
PROPOSED
countfollowy
Or county which permit, o
req a permit t0 oli
alter, improve, tlamorsucr
repair any a, prior issuance, alsure
prior to in wen
also reown+ theapplicantto
BU T- OF !/
ile a sign
to rile a •rosea statement the,
that hi a licensed pursuant to the
the 7000)
of the
of the Contractor's License Lew (Chaise. (comm enciny with Sacbon
pt tion
t7000)
3oftand Professions or Ins he is here
[ham
Division 301 aha star
pH S CE
fr ..d..mli.d.Cod
from end the th Any n .1 S
tot the .11 aaampts vt penalty
by applicant the ant to
applicant for • permit w0ja<n Ina applitent [o a civil penalty
'
of7031 not
or not more met raw hundred
'h
erty,
W DS KES
❑ I, r my e.1:
owner Of [M1h property, or as [Hair ale
pro employees with
ti he tenee
compensation, will tlr the work, and the structuren$Co is net intended s offered
for )ala (sac. Som, Business ane Code: The oomprovesi License
WOO SHINGLES
f praplom
Lm mho not apply toe of property who builds improves memos,
who or to
nes own employees, provided ,M1rt
such work not
sanduch roes
ed or
are not intended or
int
unn dl
for cele. 11, however,oowner
OTHER PECIFY)
.1 iemen[e
building or improvement a fold with one year pr the owner
year
will have ma burden of proving mu n. em no, Naim or improve for
ovines that of build
purpose
PROVIDE I. REPORT NO.
❑ 1, + Owner the property, s with licensed
,%08 ow
c.lu 044. Business an
to construct the prolan, (sec. Business Jso entl
code
The Ira for'•
of property Code rne
not apply m anowner
and doeswho Octs
PROVIDE MFGR. INSTALLATION SPECS.
or impc ves The outLicense co,
wM10 builes orimprove) with
and contracts for such projects with J
pr a
contractors) pursuant t,
puny Jo, ,o me Contractor's Lica( Law.
Cont
amlam,,
❑ 1 .m ..am,, dna.. s.n. e.aP.c. for his
owns
ppLICATION�DATE
VALUATION
PERMIT FEE
Do,.
WORKERS' COMPENSATION DECLARATION
" I.
�/T /\
BUIIdI
I hereby erferm that I have J certificate of consent ,o sell
//��
U v
tificm. of Work.,. Compensation In+urance, or <eniliad copy thereof (Sac.
38, L.D.
00
�yr✓,. Igg
l i
Seismic
Policy Nb!-i-Va-„mpen�"S:F.4rnvl-FS
Car till a c t'i ltal py is w�'[ru�r,Die. Cao.
LV/-
Total
py is mp lion division.
I �(N�
Applicant �KTE`
PE AUTHORIZATION DATE
F X`if
CERTIFICA"SST--E��GYVO�FGEVXEMPTION FR�M WORKERS' N
COMPENSATION INSURANCE C
(This section need not be Completed it the permit is for one hundred dol
Hip I11/00) or Ism.)
'
Icertifythat in the performance of [he work for which this permit is�
shelln
eo e, 1 ell not employ Person in any manner s0 as to become subject
yllwilikk
thorkers' Compensationion ion Laws or California.
to ma W
Dale ant
NOTICE NT: 11, this
APPLICANT: Biter of Epion,
you rCod De<oma su bract ,na Work ori
should Workers' Compensationof me
o nsati n provisions
Lebon edea, i h such rovisi ns
man forthwith comply with each provisions or this permit
All roofs shall be inspected prior to any roofing material being
shall be tl(mae evoked.
ed r
I cmafy tee' I has rhea mie applecpion ane $Hite that the above informs
Installed. If a roof Is Installed without first obtaining an
Had if w. correct. I mor.e m ng con with .II hand andher county ordinances and
to [action, a hereby fixe proem
bof
Inspection, I agree to remov II new materials for inspection.
iv his city
of this city m anter upon the above mentioned property Ipr inspection
enter Property
�/I
purposes.
purpo
(Wel agree )ave, indemnify and keep ma City of Cupertino (
�1V.3/�/
���� q_4��
s. t, ane gXPaM( wham may in mY way enema
against ., Which
iiy
SI
NATURM�F APPLICANT
DATE
said ce of
i consequence
•wisp sem City in <on(arm<e or me granting at this permit.
PRE -INSPECTION:
PLYWOOD:
IN-PROGRESS:-
N-PROGRESSINSP.
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
SUBJECT: REROOFING POLICY FOR THE CITY OF CUPERTINO BUILDING DEPARTMENT
PRIOR TO ISSUANCE OF PERfvBT AND INSPECTION PHASE.
1. Prior to perruit issuance, you crust agree to comply with U.B.C. standards and manufacturers spec's
om reroofing.
2. New roof coverings shall riot be applied without first obtaining all inspection and writleriapproval
from the building inspector. A final inspection and approval shall be obtained from the building
inspector wheu 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.
l,) Preinspection or tear off approval.
2.) In progress iuspcctiori approval.
• 3.) Final iuspecliou approval.
a.) Operable smoke detector verification
b.) Spark arrestor iustallatiou
5. If plywood is installed, a plywood uail iuspecliou is required.
G. If any roof is applied without first obtaining a'r inspection, you will be required to remove ail 'rely
material down to lire sheathing and a building inspector will inspect all sheathing at that lime.
WE UNDERSTAND TILE ABOVE POLICY ON REROOFING AND WILL COMPLY WITH TM,
POLICY _.
HOMEOWNERS NAME:
P
ADDRESS:
REROOFING COMPANY NAME:
APPLICANTS SIGNATURE:
•
CITY OF CUPERTINO
BUILDING DEPARTMENT
Rerool/wimeord
Cittl of curerti"O
SMOKE DETECTOR CERTIFICATE OF COMPLIANCE
1 understand and comply with Section 1210-a of the Uniform Building Code.
Section 1210-a requires when repairs to a single family dwelling exceed 51,000, 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.
PERNUT NUMBER:
HOMEOWNERS SIGNATURE:
DATE:
• winword/smkdet
(n t-11,56 0 (r O COLI
-
4 Q 0 -7
W,