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R-4205 PERMIT APPLICATION FOR CITY OF CUPERTINO NUMBERRee INSPECTION DIVISION PERMIT EXPIRATION REROOF PERMIT (408) 252-4505 EXT. 228 WIPERMIT EXPIRES80 DAYS OF PERM T NOT OR IN DAYS FROM LAST CALLED INSPECTION. BUILDING ADDRESS /•—�,y // BUILDING USE U� Y--e / ' I L ` �/1 RESIDENTIAL COMMERCIAL OTHER OWNER'S If NAME J N I LC � HAZARDOUS ROOF S-e MGI ' FIRECOVERING G AREA CLASS ADDRESS EXISTING ROOF COVERING PHONE Z J r' -Q NUMBER OF EXISTING C9VERINGS CONTRACTOR'SP� V// NAME J �CE{U 1 . TO BE REMOVED TO BE RETAINED ,r,' -Cro TYPE OF ROOF COVERING N r ADDRESS 1 S G�. I' UICITY& �7 �-C,2 EXISTING ADDRES ilb 1I' �� 1 "l7� SES ` ` , . BUILT-UP ROOF PHOEq'GS0 5 22—, � LICENSES7 �d 77 ASPHALT SHINGLES NUMBER WOOD SHAKES LICENSED CONTRACTORS DECLARATION I hereby flimti.d 0O I of liumrld under provision of d Prof.9(common WOOD SHINGLES clop with S«tion ]0001 0l Division 3 0l the Business end P.ofaniom Code,and my lice u is i lu as and affect. License C C..Numbs. 1 Osb � conn«b. — f�fP10 OTHER (SPECIFY) It OWNER BUILDER DECLARATION I here y wing nooaffirm (Soc. I am exempt from the Contractor's License Law for PROPOSED the follon. IS . 7031.8, Business and Professions Coca: Any city Or County which requires a permit t0 Construct,altar, improve, demalish,or hoolr any structure.prior to ib issuance also raouires the applicant for such BUILT-UP ROOF permit to file a signed statement that he is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 at a Business and ged exam conal or y v oa ti exempt coon ASPHALT SHINGLES from end Me Dasls for the alleged exemption.tion. Any violation of Section 1 ' 7031.5 by any applicant for a permit Wbj«[s the applictint to Is civil Pana$,, I r A L� �^RS� of not more that five hundred dollars($500).): WOOD SHAKES / 1�...fill ❑ 1,as owner of the property, ormy employees with wages es their sole J compensation,will co the work, and the structure if not intended or offered WOOD SHINGLES for sale (Sec. 7044, Business and Professions Code: The Convector's License Law do"not apply to an owner of property who builds or improves thereon, and who does such work himself or through his awn employees,Provided Mat , such Improvements a not intended a offered for sale. u, however, Me OTHER (SPECIFY) building or improvement nr t sold within one year of completion, In.owner but der will have the burden of proving that he did not build or improve for Purpose of sola.). PROVIDE I.C.B.O. REPORT NO. ❑ I, as owner of M• progeny, a exclusively contracting with licensed contractors [o construct sbe project (Sec. 7044, Business and Professions Coda: The Cont/«[ors Lice to Lew does not apply to an owner of oruoorty PROVIDE MFGR. INSTALLATION SPECS. who builds or improves [heraun, and who contracts for such projects with a contractor(s)licensed pursuant to the Contrac[oi s License Law. ea❑n .m •.amp[ trona. sec. ,B.sP.c.for this APPLICATION DATEI VALUATION PERMIT FEE Owner Data O WORKERS'COMPENSATION DECLARATION /�� O U Building I hereby affirm that I nava certificate of consent to ael6imure,of a Car /�� 4C)J ) tific.ta of WMy ork.,. Compe91' Inwrenca,/y...� y}�1iad ca{Nvire.aof 1 ac. U V�J L/ $@ISmIC 3800, Lsoetela �1/TIG lU Policyom an II Corisby rn'sbtl. Total f t Car vA�b I- ,Inspndpn tliviaion. APDIICant �,/ A CER AT OF EXEMPTION ROM WORKERS' N C PERMIT AUTHORIZATION DATE I C COMPENSATION INSURANCE //�''``` (This section need not be completed if the permit is far one hundred dol <��p/ Ian(9100)or lan.l /�- 1 certify that in the performance of the work for which this permit is issu ad, 1 shall not employ any person in any manner so as t0 become subject /� �^ ` � to aha Workers'Companution Laws of California,ra yl l//� �� V�Vl.� Deb Applicant P1 NOTICE TO APPLICANT: It, atter making this Certificate of Exemption. P Al pP you should become subject to the Workers' Compensation provisions of the Labor Coda, you man forthwith comply with such provision,or this parmit All roofsshall be inspected prlortoany roofing material being shoo be deametl revoked. ((�� I cont, that 1 have read this application and hna that the above informs installed If a roof s t�etp I It first obtaining an stat is torrill I earn to comply with all airy and county ordinances and inspection,I agree t0 OVa all new materials for inspection. arab saws Meting to entr building construction, and hereby pr anth0 fixe pmam purpose . ure s of Mb city to enter upon the abovementionetl propos,for inspection (t l')"y ur V�rCr{I IrVU Dur(V j V IWt liabilities,agree [o uve, in ts,COS S antl keexpe harmless thema City of ay ertino accrue against sidti judgments,cotta and expenses which may in any way accrue against said City in conawuance of the granting of this Permit. SIGNATURE OF APPLICANT DATE ' 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 SUBIECI': REROOFING POLICY FOR 'I'IlE CITY OF CUPERTINO BUILDING DEPARTMENT PRIOR TO ISSUANCE OF PERMIT AND INSPECTION PHASE. 1. Prior to peauit issuance, you must agree to comply with U.B.C. standards and manufacturers spec's on reroofing. ' 2. New roof coverings shall not be applied without first oblainiug all inspection and written approval from the building inspcctor. A final inspection and approval shall be obtained from lire building inspector wire,, the reroofing is courpicted. 3. All types of roof shall be!,,spooled prior to ally roof being installed. f;„,r'• d. In order to receive a final,you Must complete steps 1,2, and 3. l,) Preinspectloit or tear elf approval. 2.) In progress inspection approval. • 3.) Final Inspection approval a.) Operable smoke detector verilication b.) Spark arrestor Installation p • 1 5. if plywood is installed,a plywood nail iirspectiou is required. G. Ir any roof is applied n•ithoul first obtaining au inspection, you will be required to remove all liew material down to lire s1leathi,,g and a building inspector will inspect all sheathing at that time. WE UNDERSTAND TILE ABOVE POLICY ON REROOFING .AND WILL COhIPLY W1TI1 ME POLICY rCR/ / S r HOMEOWNERS NAME:: � S rN !.l ADDRESS: `ralli2 Mff L1 REROOFING COMPANY i`IAhIE: APPLICANTS SIGNATURE: CITY OF CUPERTINO • BUILDING DEPARTMENT Reroof/Mimord ti i tiff of CN(?2)'I7YS0 SMOKE DETECTOR CERTIFICATE OF COMPLIANCE I understand and comply willt Section 1210-a oCthe Uniform Building Code. ; Section 1210-a requires when repairs to a single family dwelling exceed $1,000, a sntokb detector will be installed, mounted oil the ceiling or wall in each sleeping room acid at a • point centrally located in the corridor or area giving access to room used' for sle pmg < purposes. If existing smoke detectors comply, no new detector shall be regwl ed I understand the above requirement and certify that we now have smoke detectorsx'is installed that do comply. ADDRESS: 77ss` PERMIT NUMBER: HOMEOWNERS SIGNATURE: DATE: ru winword/sntkdg