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R-3928 PERMIT R- 3928 APPLICATION FOR CITY OF CUPERTINO NUMBER Res PERMIT INSPECTION DIVISION PERMIT EXPIRATION (408) 252-4505 EXT. 228 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. BUILDING ADDRESS [^) BUILDING USE LZ + 0' C�AJI.`p ^' -eAL/ei� RESIDENTIAL COMMERCIAL OTHER INNER'S ///111 N /O ! <L S`�aKeS r-T� FI RE ARDOUS I �` COVERING µ AREA V CLASS l ADDRESS EXISTING �., EXISTING ROOF COVERING PHONE �S — ( '7 NUMBER OF EXISTING COVERINGS CONTRACTOR'S C.1 E'— E. Tlt_ „Q 2r TO BE REMOVED TO BE RETAINED NAME L2��c��t � C2 'F 1 �-r'yV1,I TYPE OF ROOF COVERING CITY&ii IITb l �6 •�' " `^ EXISTING PHONE elf-T2 BUILT-UP ROOF LICENSE ASPHALT SHINGLES NUMBER to WOOD SHAKES LICENSED CONTRACTORS DECLARATION I hereby affirm that I em licensed undo provisions of Chapter H I<omman. <inq with S«tion TOM) of Division 3 of the Business and Prof/Ls ions cad.. WOOD SHINGLES and my license is in force and affect 4i a) 7 5 License Cl.ss Lia Num Dar d Date Contractor OTHER (SPECIFY) OWNER BUILDER DECLARATION I hereby affirm that I am exemptfrom the Contractor's License Lew for PROPOSED the following reason. (S«. 7031.5, Business and Professions Code: Any city county which requires a permitto construct.al mp rove, aemol T ti repair any structure,prior to ill issuance, elm r..u' r,the appl keret for such BUILT-UP ROOF permit to file a signed.,element that he Is licensed sir ant to In pr visions of ma Contractor's License Law (Chapter 9 1 ng with Saln'0001 2 of Division 3 of the Business and Proteniom Co that In yyy��r6t-Yjt ln.r. ASPHALT SHINGLES from and the basis for the all." a amp don. ny i la�I «[ion '03t.6 by any applicmt for a a•rmit ubi.c m epplic t tD penally of not more that five nunored dollen(E50 WOOD SHAKES I,as owner of the property, a loya jjj w gas as their sola f compensation, will do the work,an m ructur l i hided or offered for ale (See. 7044. Business and Pro s Cod nIract,i License WOOD SHINGLES Lew don not apply to an owner of r ty who or improv..thereon, and who does such work himself or tE ro his o employees,provided that such Improvemmu are not intended or fered for sale. If, however, the OTHER (SPECIFY) building or improvement sold within a e year of completion, the owner builder will have the burden of proving that he did not build or improve for purpose of$010.). PROVIDE LC.B.O. REPORT NO. D I, as owner of the property. am exclusively contracting with licensed contractors to construct the project (Sac. 7044, Business and Professions Cad.: The Contractor's License Low does not apply to an owner of property PROVIDE fill INSTALLATION SPECS. who builds or improves thereun, and who contracts for such projects with e contrac[or(s)licensed pursuant to the Contractor's License Law. 6 ID ,B.aP.c.far this ....n I .m ...mot under sect PPI-ICA ON DATE VALUATION PERMIT FEE Owner Data 1 E, 19 WORKERS'COMPENSATION DECLARATION X1Building 13 hereby affirm that I have a certificate of consent to selbinmra,o r` ilicata of Workers'Compensation Insurance,or a certified copy thereof IS.C. lJ 600,Lab.Cd. Seismic K l{U Polic]y No. company V G�� I] Cer[if"red hereby furnished.I.hfurnished. ^\'1'� Ut Total CO![I I copv i,filed with he city inspection of✓..ion. y Applicant CERTIFICATE OF EXEMPTION FROM WORKERS' N.C. C ❑ PERMIT AUTHORIZATION DATE COMPENSATION INSURANCE (This section n..tl not be completed it the perms is for one hundred ddb 1 Ian 15100)or ..s.l cefy that in the performance of the work for whtis Dermic it to he I rtisha11 not employ any porton in any menn ar so as[o o or become subject to the WorkerWork.,.'Compensation Laws of California. bete Applicant NOTICE should APPLICANT: If,o after making this ensati n p of Exemption, you mould D«oma subject to the Workers' Compensation provisions of the Labor Coda. you must forthwith comply with such provisions or this permit All roofsshall beinspected prior to any rooting material being shell be deemed evoked. I cvfily that I nave reed this application and she mat the above Informs. Installed If a roof is install Without`first obtaining an tion is correct. I agree to comply with all city and county ordinances and If13PBCtlOn,I fee t0 r@mOVe i W mHtHf1813 fOI I Sp@Ctior state laws relating t4 building construction, and hereby authorize r•preram tatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to eve, indemnify and keep harmless the City of Cupertino agalNt Ii.bili[ize,ludgmene,coat.and..panes which may in any way.ccrw ' awinsl aid City in conwauanca of me gnntinq of this permit. SI NAT E OF APPLI DATE r 114 PRE-INSPECTION: PLYWOOD: IN-PROGRES 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 '1'IIE CI'T'Y OF CUPER'1'INO BUILDING DEPARTMENT PRIOR TO ISSUANCE OF,PERMIT AND INSPECTION PHASE. L Prior to penuil issuance, you must agree to comply with U.B.C. standards and manufacturers specs Oil reroofing. 2. New roof coverings shall uol be applied without first obtaining all iuspecHon and written approval front the building inspector. A lural inspection and approval shall be obtained from lire 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 rural,you must complete steps I,2,and 3. 1,) Preirspectiom or tear off approval. 2.) In progress inspection approval. • 3.) Filial inspection approval. a.) Operable smoke detector verification b.) Spark arrestor installation 5. If plywood is installed, n plywood nail inspection is required. G. If any roof is applied without first obtaining all inspection, you will be required to remove nil new material down to the shcalhiug and a building inspector will Inspect all sheathing at that time. WE UNDERSTAND THE ABOVE POLICY ON REROOFING AND WILL COMPLY Wfl'li TILE POLICY I IOMEOWNERS NAME: PA LL, ✓J lO<F`Fl S�yK ADDRESS: REROOFING COMPANY NAME: APPLICANTS SIGNATURE: • CITY OF CUPERTINO BUILDING DEPARTMENT Reroollwimword i I I Cittl of Cupet 11"0 SMOKE DETECTOR CERTIFICATE OF COMPLIANCE I understand and comply with Section 1210-a of the Uniform Building Code. 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 used for sleeping purposes. If existing smoke detectors comply, no new detector shall be required. I understand the above requirement and certify that we now have sur Ike detectors installed that do comply. ADDRESS: PERMIT NUMBER: HOMEOWNERS SIGNATURE: ' � l DATE: `t I winword/smkdet