R-4774s
_3
-v
OFFICE COPY
PERMIT R_
4774
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
J
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H S -2 CSC
RESIDENTIAL COMMERCIAL OTHER
OWNER's -
HAZARDOUS FIR AREA
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ClassA
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NAME ` -/�% ! (�//,L.f�l- /`/O
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assemblunderstand equine .
Initial I.C.B.O. N
NO��fi
EXISTING ROOF COVERING
ADDRESS
PHONE
NUMBER OF EXISTING COVERINGS
CONTRACTO�R-'SS—
NAME �� (% �G!¢ O // �
TO BE REMOVED TO BE RETAINED
/rYPE
ADDRESS �2 ��
OF ROOF COVERING
CITU & 21P �C(SO S'-pU� /Y�
EXI
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PHONE ! •3p /
BUILT-UP ROOF -
LICENSE r��
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NUMBER .7 5'
ASPHALT SHINGLES ❑
'
LICENSED CONTRACTORS DECLARATION
.I hereby affirm that I em 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
enact' r /
�j /
WOOD SHINGLES ❑
License Class,Lie. Number J "'
Z—/( - i -f <
Date G Contractor C
OTHER (SPECIFY) ' ❑
OWNER -BUILDER LARATION
PROPOSED
I hereby affirm that I am exempt from the Contr ctor's 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
BUILT-UP ROOF
applicant for such permit to file a signed statement that he Is licensed pursuant to the provisions
of the Contractors License Law (Chapter B (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
e civil penalty of not mora than five hundred dollars ($500).):
I, as owner of the property, or my employees with wages as their sole compensation, w111 do
[D 1.
.SHAKES ❑
the work, and the structure Is not Intended or offered for sale (Sec. 7044, Business and Profes-
sionsCcde: The Contractors License Law does not apply to an owner ofproperty who builds or
WOOD SHINGLES ❑
improves thereon, and who does such work himself or through 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) ❑
not build or Improve for purpose of sale.).
I, as owner of the property, am exclusively contracting with licensed contractors to construct
the project (Sec. 7044, Business and Professions Code: The Contractor's License Law does not
PROVIDE I.C.B.O. REPORT NO.
apply to an owner of property who builds or Improves thereon, and who contracts for such projects
with a contortionist licensed pursuant to the Contractor's License Law.
PROVIDE MFGR. INSTALLATION SPECS.
1 em exempt under Sec. ,B 8 P. C. for this reason
Owner Date
APPLICATION DATE
VALUATION
PERMIT FEE
WORKER'S COMPENSATION DECLARATION
,,rVte�
P
I hereby affirm under penalty of perjury one of the following declaration:
-11 have and will maintain a Certificate of Consent to self -Insure for Worker's Compensation,
as provided for by Section 3700 of the Labor Code, for the performance of the work for which this
A! 1
Buildinglill 41
permit Is issued'
�`
,�
Seismic
I have and will maintain Workers Compensation Insurance, as required by Section 3700 of
ie7
the Labor Code, for the performance of the work for which this permit Is Issued. My Worker's
Compensation carrier end Policy number are: C�
i
79
.
Total -
-Insurance
.` PERMITAUTHORIZATION
DATE
Carrie �2�'e� PolleyNo.
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE N.C.I]
: ��y
(This section need not be completed if the permit Is for one hundred dollars ($100) or less.)
L
10
I certify that In the performance of the work for which this permit Is Issued, I shell not employ
any person in any manner so as to became subject to the Workers' Compensation Laws of Cali-
All roofs Sha inspected prior to any roofing material being
fern's.
installed. If a roof is installed without first obtaining an
Data Applicant
inspection, I agree to remove all new materials for inspection.
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become
Applicant understands and will comply with all non point
PP P Y P
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply
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 f coverings to be,Flas "C" or better.
hereby authorize representatives of this city to enter upon the above-mentioned property for In-
spection purposes.
(We) agree to save, indemnity and keep harmless the City of Cupertino against liabilities,
judgments, costa and expenses which may in any way accrue against sem City In consequence
GNATU OF APPLICANT DATE
of the granting of this 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
•
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SUBJECT: REROOFING POLICY FOR THE CITY OF CUPERTINO BUILDING DEPARTMENT
PRIOR TO ISSUANCE OF PERMIT AND INSPECTION PHASE.
1. Prior to permit 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 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 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,) Preinspection 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.
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 THE
POLICY
e A-17 d
HOMEOWNERS NAME:
ADDRESS:
REROOFING COMPANY NAME:
APPLICANT'S SIGNATURE:
CITY OF CUPERTINO
BUILDING DEPARTMENT
Reroof/winword