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R-5639 PERMIT APPLICATION FOR CITY OF CUPERTINO NUMBERR_ 5639 INSPECTION DIVISION PERMIT EXPIRATION REROOF PERMIT (408)777-3228 PERMIT EXPIRES IF WORK IS NOT STARTED ' WITHIN 1B0 DAYS OF PERMIT ISSUANCE OR WI180 DAYS FROM LAST CALLED INSPECTION. BUILDING ADDRESS D � / f CiG Iv RESIDENTIAL COMMERCIAL - OTHER OWNER'S HAZARDOUS FIRE AREA ��x�� YES L] If yes-I understand that a Class A NAME !/ r NO � i assembly is requiredIni;ial LC.B.O.M ADDRESS /3Q 5— S��/.�,o EXISTING ROOF COVERING PHONE e 1. NUMBER OF EXISTING COVERINGS / CONTRACTOR'S NAME S TO BE REMOVED TO BE RETAINED ADDRESS �a'9 Z /� _ _/, // _ _ TYP OF ROOF COVERING CITU 8 ZIP / GGA" /.J''��/ (o > EXISTING PHONE �T�g 2 �7 4r�� 7�/�/ BUILT-UP ROOF ❑ CENSE NIUMBI I J �j ASPHALT SHINGLES ❑ LICENSED CONTRACTORS 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 affect. WOOD SHINGLES Cl License Clas Lie.Number Dale Contra OTHER(SPECIFY) OWNERBUILDER DEC RATION PROPOSED I hereby affirm that I am exempt from the Contractor's License Law for the following reason. 7_ (Sac.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 applicant for such permit to file a signed statement that he Is licensed pursuant to the provisions • of the Contractor's License Law(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 �^ ❑I,as owner of the property,or my employees with wages as their sole compensation,will do W ❑ the work,and the structure is not intended or offered for sate Sec.7044,Business and Profes- sions Code:The Contractor's License Law does not apply to an owner of property who buildsor WOOD SHINGLES Improves thereon,and who does such work himself or through his own employees,provided that ❑ /;�s^ L-/ 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) Elnot build or Improve for purpose of sale.). ❑I,as owner of the property,am exclusively contracting with licensed contractors to construct �A the project(Sec.7044,Business and Professions Code:The Contractor's License Law does not PROVIDE I.C.B.O.REPORT NO. �V apply to an owner of property who builds or Improves thereon,and who contracts for such projects with a contractors)licensed pursuant to the Contractors License Law. PROVIDE MFG R. INSTALLATION SPECS. LI1 am exempt under Sec. ,B&P.C.for this reason Owner Date - APPLICAItr�r�pr�p VALUATION PERMIT FEE WORKER'S COMPENSATION DECLARATION g"'�V-r9` I hereby affirm under penalty at perjury one of the following declaration: ♦i .,.r ❑I have and will maintain a Certificate of Consent to self;nsure for Worker's Compensation, 'I�� nA ^� Building -.-/y f— asprovided for bySection 3700ofthe Labor Code,for the performance of the work for which this �/ 24 4 permit is issued. n Seismic t ❑I have and will mai m Worker's Comp adon Insurance,as required by Section 370001 CITY L L �(�d r 4 t .41 he Labor trona th Parlor lice oft work r a which this permit is issued.My Worker's CI l I Ur uUNLH I d Compensation ce ca nc P0' y number are: Q Total f/ Carrier Policy NoA e r' PERMIT AUTHORIZATION DATE CERTIF ATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE N.C.[] ) (This section need not be completed It the permit Is for one hundred dollars($100)or less.) O Ly•� certify that In the performance of the work for which this permit Is issuetl,Lshall not employ any person In any manner so as to become subject to the Workers'Compensation Laws of Cali- All roofs shall be inspected prior to any roofing material being fornia. installed. If a roof is installed without first obtaining an Date Applicant inspection,I agree to remove all new materials for inspection. NOTICE TO APPLICANT: If,atter making this Certificate of Exemption,you should become A understands and will Comply with all non point subject to the Workers'Compensation provisions of the Labor Code,you must forthwith comply pp P Y P with such provisions or this permit shallibe deemed revoked. 5 rCe re ulatioIRS. 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 laws relating to building construction,antl All r0 vert sto be cies "C"or better. hereby authorize representatives of this city to enter upon the above-mentioned property for Im spaction purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against liabilities, ' judge granting iof andthis expenses which may in any way accrue against said City In consequence SIGNATUREOF PPLICANT 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 ACCESSTO ROOF SHALL BE PROVIDED FOR INSPECTION OFFICE COPY SUBJECT: REROOFING POLICY FOR THE CITY OF CUPERTINO BUILDDNG DE?P.RT;MENT PRIOR TO ISSUANCE OF PERVQT AND INSPECTION PHASE. 1. Prior to pe mit issuance, you must agree to comply with U.B.C. standards and manufacturers sec's on rercoFing. New roof coverings shall not be applied without first obtaining all insec[ion and wrinen accroval 2. from the building inspector. A final inspection and approval shall be obtained from [he building inspector when 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. 1,) Preinsection or tear off approval. 1) In progress inspection approval. 3.) Final inspection approval. a.) Operable smoke de:e^_:or verification • b.) Spar's arrestor installation 5. If plywood is installed, a plywood nail inspection is required. 6. If any roof is applied without first obtaining an inspection, you will be required to remove all new material down to the sheathing and a building inspector will inspect all sheathing at that time. WE UNDERSTAND ThE ABOVE POLICY ON REROOFING AND WILL COMPLY WITH TEE POLICY Q HOMEOWNcRS NAME: REROOFING CONIPA`lY NAME: APPLICA,`TS SIGNATURE: CITY OF CUPERTINO BUILDING DEPARTMENT • Reroof/wimv6rd CITY OF CL-PERT240 BUU-DING DIVISION 403-777-3223 RE-ROOF TEAR OFF POLICY I. You must schedule an inspection for the tear off the day before the date you wish the inspection to be made. The procedure is to call the Building Division(777-3223)between the hours of 12:30 and 4:00 P.m.for ne:n day inspection. 2. When the roof is tom o$ the nails removed or driven in and all of the dry rotted wood has been replaced, THEN YOU MUST CALL TrIE = BUILDING DIVISION. An inspector will be notified that the roof is ready, and he will respond to do the insoc.:on as soon as his schedule will .. allow. There are spec-'al hours for this service between 8:00 am. and 11:00 a.m., and between 1:00 and 3:00 p.m. IF YOU CALL FOR THE TEAR-OFF INSPECITON AND THE JOB IS NOT READY, Th'z�E WU_T • BE A RE-INSPECTION FBZ- OF $69.00 CHARGED, WHICH MUST BE PAID BEFORE -AN07'rIER INSPECTION IS MADE. reroof/winword . i t i •