R 6336•
OFFICE COPY
PERMIT R- 6336
APPLICATION FOR CITY OF CUPERTINO NUMBER
INSPECTION DIVISION PERMIT EXPIRATION
REROOF PERMIT (408)777.3228 PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
BUILDING ADDRESS
Op"�"�,�. J
-2- vlZ7 r% (� (/
RESIDENTIAL COMMERCIAL✓ OTHER
OWNER'S
HAZARDOUS FIRE AREA
YES ❑ If yes— I_ understand that a ClassA
NAME
roof assembly Is required.
NO ❑ Initial I.C.B.O. q
ADDRESS
EXISTING ROOF COVERING
PHONE
NUMBER OF EXISTING COVERINGS /
CONTRACTOR'S
/��—j / 72 /Pr�� / �O , ,/'.
NAME /V (gz V[ L�/V /T /7 ^i—/
TO BE REMOVED ( 70 BE RETAINED
ADDRESS
TYPE OF ROOF COVERING
CITY & ZIP- / S/T7lW �i /�'Z /Lir%✓/w
.
EXISTING -
PHONE �A/ rO� GI 9 Iq , !1% .3 %
BUILT-UP ROOF Q
CENSE
NUMBER
ASPHALT SHINGLES
LICENSED CONTRACTORS DECLARATION
hereby affirm that I em licensed under provisions of Chapter 9 (commencing With Section
WOOD SHAKES
700 0) of Division 3 of the Business and Professions Code, and my license Is In full force and
effect. / �j % /�y7
License ClassLlc. Number �75� l� --f� Q� V
WOOD SHINGLES
�O�-
OTHER (SPECIFY) ❑
Dale Contractor
OWNER -BUILDER DECLARATION
PROPOSED
I hereby affirm that I em exempt from the Contractors License Lew for the following reason.
(Sec. 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
BUILTUP ROOF
applicant for such 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 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 all penalty of not more than five hundred dollars ($500).1:
❑ I, as owner of the property, or my employees with wages as their sole compensation, will do
WOOD SHAKES ❑
the work, and the structure Is not Intended or offered for sale (Sec. 7044, Business and Proles.
alone Cade: The Conitsctor's License Law does not apply to an owner of property who builds or
Improves
WOOD SHINGLES ❑
thereon, and who does such work himself or lh rough his own employees, provided that
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) El
build or Improve for purpose of cele.).
❑I, as owner of the property, am excluslvelyy.�gypcarectl�WIIIPI a aetl c000AAAtttr or8t0 construct
the project (Sec. 7044, Business andProf011�ns The Conr tore eLawtloeanot
apply to an owner of properly who but sa Im rov lh 'itchand conlr ,t rsuch projects
p j
PROVIDE I.C.B.O. REPORT NO.
with a contractor(s) licensed pursue nt� ,(e Con sCtor'9Llcense ew.
❑ em exempt under Sec. 8 or this reason
III if
PROVIDE MFGR. INSTALLATION SPECS.
Owner RA IO
WORKER'S CMPE SATION DECLARATION
APPLICATION DATE
VALUATION
PERMIT FEE
I hereby affirm under penelry of pe i one of the following declaration-
❑ I have and will maintain a Certlfic to of Consent to self -Insure for Worker' C mpensatlon,
_
z-/
��
provided for by Section 3700 o1 the Lbb ode for thea or which this
permit
permit is lssuetl. (��
.�) T
Building
-7
El I have and will maintain Worker's 00 pensafion Insurance, as required by Section 3700 of
Seismic
the Labor Code, for the performance of the work for which this permit Is Issued. My Worker's
�f
Total 0
Compensation Insurance carrier and Policy number are:
v
Carrier Policy No.
PERMIT AUTHORIZATION
DATE
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE N.Cu
(TMs section need not be completed If the permit Is for One hundred dollar. ($100) or lees.)
I certify that in the performance of the work for which this permit Is Issued, I shell not employ
`
All roofs Shall be Inspected prior to any roofing material being
any person In any manner so as to become subject to the Workers' Compensation Laws of Cell-
fornla.
installed. If a roof is installed without first obtaining an
Data _�eC/ 4PPIIcantT
inspection, I agree to remove all new materials for inspection.
NOTICE APPLI ANT: If, after making this ertlll a of emption, you should became
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply
pP p y point
Applicant understands and will comply with all .non
with such provisions or this permit shall be deemed revoked.
Source regulations.
I certify that I have read this application and state that the above Information Is correct.I agree
to comply with all city and county ordinances and state laws relating to building construction, and
All roof coverings to be class "C"or better.
hereby authorize representatives of this city to enter upon the above-mentioned property for In.
ep(Wepurposes.
(Wel agree to aeve, and keep harmless the City of Cupertino liabilities,
)
expenses a
code and permit. a which may In any way accrue against said Clry In consequence
y Inst ence
SIGNATUREfflF SIGNATUREAPPLICANT .DATE
ofjudgmemm,gran
of the granting of permit.
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
of
Cupertino
Plan Check Division
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax(408)777-3333
Building Department
Subject: Reroofing policy for the City of Cupertino.
1.
Prior to permit issuance, you must agree to comply with 1994 UBC Standards and
manufactures specifications on reroofing.
2.
New 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 from the building inspector when the reroofing is completed.
3.
All roofs shall be inspected prior to any roofing installation.
4.
To receive a final sign off from the City the following steps are required.
1) Preinspection and/or tear off approval.
2) In progress inspection approval.
3) Final inspection approval.
•
a) Spark arrester installation.
5.
If plywood is installed, a plywood nail inspection is required.
6.
Any roofing which is applied without first obtaining an inspection, will require the
removal of all new material down to the sheathing so that the proper City inspection
can be performed.
We understand the above policy on reroofing and will comply with this policy.
Homeowners Name: "/L��(—�) �/L (�'�i5��/ £� SiX AL67S 11,a 7 -
Address: e2aaoZ S� l/L�2S (�G2/�- 1 Ve�( .
Reroofing Company Name: JiiA/(�
Applicants Signature:
Joe Antonucci
• (Chief Building Official)