R-4095 PERMIT R, 4095
APPLICATION FOR CITY OF CUPERTINO NUMBER
INSPECTION DIVISION PERMIT EXPIRATION
REROOF PERMIT
(408) 252-4505 EXT. 228 WITN IN 180 DAVSOFP RMIT�SSUANLE OR
Is 180 DAYS FROM LAST CALLED INSPECTION.
BUILDING ADDRESS ' BUILDING USE
RESIDENTIAL///l` COMMERCIAL OTHER
OWNER'S
1r'�� � HAZARDOU ROOF
NAME n'1Ic, /ci i 1 FIRE COVERING ''
C n AREA CLASS
ADDRESS� �d7�Y_LV�i I o— � NUMBER OF EXISTING
ROOF COVERING
PHON L� Q
5- L U<> ISTING COVERINGS
CONTRAC OR'S
TO BE REMOVED TO BE RETAINED
NAME TYPE OF ROOF COVERING
ADRESS
CITY&Zlb IT^ EXISTING
A—( BUILT-UP BUILT-UP ROOF X
PHON
LICENSE ASPHALT SHINGLES
NUMBER
WOOD SHAKES
LIC ENSED CONTRACTORS DECLARATION
I withherebyS affirm tart I em licensed antler provision of Lheabr 9(comme,ry
cusp her See9on�OOo of oivhion 8 of vase a the Profession Lode, WOOD SHINGLES
end 0)Y IIc•n I 1 c•and•Ifect.
License Lic.Numbar
Data Connector
OTHER (SPECIFY)
R DER DECLARA ti !O A p
I It affirm that I am exempt from the Contractors License Lew for PROPOSED
A
the following reason. (Sec. )0]1.8, Business and Professions Code: Any city
or county which requires a permit to construct, alter, Improve, demolish,or
repair env structure,prior to its issuance,also requires the applicant for such BUILT-UP ROOF V/tl:
permit 10 me a signed statement met ata is licensed pursuant to the provisions it
of the Contractors License Lew (Chapter 9 (commencing with Section]000) r
of Division 8 of me Business and Profession Coda)or that he is exempt mere ASPHALT SHINGLES/�(!h /'
hon and an basis for the alleged exemption.the
Any ant to
of Section )N
from by easy applicant for a permit empti n. Any ant to a civil penalty vl rr'f/
of not mor•That five hundred dollen($500).): WOOD SHAKES V
❑ I,as owner of the property, or my employees with wages as their tole
compensation,will do the work, and,he structure is not intended or offered WOOD SHINGLES
for sale (Sec. 7044, Business and Professions Code: The Contractor's License
Law does not apply to an owner of property who build$or improves thereon,
and who does such work himself or through his o employees.provided that
such improvement, an no, intended or offeredfar sale. If, however, the OTHER (SPECIFY)
building or improvement is sold within one year of completion, the owner
builder will have ,he burden of proving that he did not build or improve for
pu,po..of sale. ). PROVIDE I.C.B.O. REPORT NO.
El1, s owner of the property, am exclusively contracting with licensed
con Vac tors to c nstruct the Project (Sec. 7044, Business and Professions
Code: ThaContracmrsLicensoLaw doe,no,apply 1.anowner ofproperty PROVIDE MFGR. INSTALLATION SPECS.
who build% or improves thensun, and who contracts for Such projects with a
contractor(s)licensed pursuant to the Contractor's License Lew.
❑ 1 am exempt under S.C. ,B.&P.C.for this
rea..n APPLICATION DATE VALUATION PER"REE
Own., Data
WORKERS'COMPENSATION DECLARATION Builds
P 'N✓hereby 1 rtitiaate ofcontentto self insure,ora ��
hfmat C am ,,:ase .bot eISmic
3800, C,
Certified copy is hereby T' it Total n
Certified yepPq rilCd wiij c tv potion division.
Applicant f 1 t `(1
CE RTI I AT % N F M WO E� PERMIT AUTHORIZATION DATE
Coot be ON INSURANCE
(This stiction need not be completed if the permit is for one hundred dol
Ian(SIOo)or les$.)
I certify tnat in the performance of the work for which this permit is
tothe shell not employ any person in any manner ao as to become tablet,
to ina Workari Com Densation Lms t.1 California.
Deli AT: It.
NOTICE should
APPLICANT: o altar making this Compensation
p of Exemption,
you rhCod become su fort i me mplyWorkers' Compensation provision• a the —�
Labor Code, eYoud r must forthwith tomwv wnM1 Lath Dfoyi.mn.or this permit All roofsshall be Inspected prt6r to any roofing material being
shell b•deemed revoked.
I p.,afv met 1 h.v.read this application and Put.mat he s cru.inform. Installed If a roof is installed without first obtaining an
:to. is correct. 1 agree to comply with all city and county ordinances and inspection,I agree remove all new materialsfor inspection
lite laws slating to building construction. and hereby authorizenpnum
tatives of this city to anter upon the above mentioned property for Inspection
purpose'.
(W•) agree to save, indemnify and keep harmless the City of Cupertino
against liabilities,judgments,costs and expenses which may in any way•ccrue
against sold City in consequence of the granting or this Permit. SIGNATURE OF PLICANT DAT
PRE-INSPECTION: PLYWOOD: IN-PROGRESS:-
INSP.
N-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 POR TILE CITY Of CUPERTINO BUILDING DEPARTrIMENT
PRIOR TO ISSUANCE OF PERMIT AND INSPECTION PHASE.
I. Prior to permit issuance, you must agree to comply with U.B.C. standards and manufacturers spec's
Oil reroofing.
2. Nety 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 front the building
inspector when Ilne reroofing is completed.
3. All types of roorshall be inspected prior to any roorbeing installed.
A. In order to receive a final, you must complete steps 1, 2, and 3.
1,) Preiuspection 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 mew
material down to lthe sheathing and a building inspector will inspect all sheathing at that lime.
WE UNDERSTAND THE ABOVE POLICY ON REROOFING AND WILL COMPLY WITH TILE
POLICY
I IONLEOWNERS NAME:
ADDRESS: L-2 ,
REROOFING COMPANY NAME: � � �
APPLICANTS SIGNATURE:
CITY OF CUPERTINO
BUILDING DEPARTMENT
•
RcroofA inworl
7
y '
i
I
Citl of Ciiperti"D
SMOKE DETECTOR CERTIFICATE OF COMPLIANCE
I understand and comply with Section 1210-a of the Uniform Building Code.
y
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 usedI for sleeping
purposes. If existing smoke detectors comply, no new detector shall be required .
1 understand the above requirement and certify that we now have smoke detectors
installed that do comply. q
ADDRESS:
PERMIT NUMBER:
HOMEOWNERS SIGNATURE: I
DATE: 1 D mow 00
U
winword/smkdet
I . I