R-3584 PERMIT
APPLICATION FOR CITY OF CUPERTINO NUMBER R- 3884
REROOF PERMIT INSPECTION DIVISION PERMIT EXPIRATION
PERMIT EXPIRES IF WORK IS NOT STARTED
(408) 252-4505 EXT. 228 WITHIN 180 EXPIRE IF F PERMIT NOT
STARTED
E OR
180 DAYS FROM LAST CALLED INSPECTION.
BUILDING ADDRESS BUILDING USE
10460 Stokes Avenue RESIDENTIAL COMMERCIAL ' OTHER
OWNER'S
HAZYuk & El ice Yung FIRE
- ` COVERING
ROOF
NAME - - AREA CLASS
ADDRESS 10460 Stokes AVpnup, Cupertino. Ca. 95014 EXISTING ROOF COVERING
PHONE 4Q8_ 996_0166 NUMBER OF EXISTING COVERINGS
CONTRACTOR'S
Security Roof ing, Inc. TO BE REMOVED X TO BE RETAINED
NAME TYPE OF ROOF COVERING
ADDRESS p P.O. Box 2450, Menlo Park, Ca. 94026CITY EXISTING
PHONE 408- 947-8611 BUILT-UP ROOF
LICENSE5047 ASPHALT SHINGLES
NUMBER
WOOD SHAKES
LICENSED CONTRACTORS DECLARATION
I hereby affirm 7000) of licensed under provisions o1 Chapter s Icommd.,
clop y license
Section Tocol nc Division of the ammen and Pnlopi.na code, WOOD SHINGLES
and my license la In lull c d effect.
License I �`1 Lic:Number
Deis 4/�30iT16 contractor Inc. OTHER (SPECIFY) SIG'h
OWNER-BUILDER DECLARATION 6611''
I h...by affirm mat I am...sup, film the O.ntraceoC. Licensa Law 10, PROPOSED T'��
the following reason. IS«. )0]1.5, Business and Professions Code: Any city C(II Ur � H(IN�
or county which nd.l,. .,Permit to construct,alt«, Implova,eemolim,or ui-Li1
epee, any rtructuis, Prior ts issuance, also re.ri.o the applicant for uch BU I LT UP ROOF
permie to fila t lienee statement Law mss he if (commencing
pursuant to the provisions
01 dna sion 3 of the
License Law ICh.plarfessio s (commencing wi eh Section there
of he
0 of ane Business and alleged
exem conal or that of tionofexempt memo ASPHALT SHINGLES 'I'
from end an applicant
for the .Ilermi gumption. Any ant to a of Section I:YTTD'ttQ$
'031 not o any that
mt re a permit subjects the applicant e0 a civil penalty
01 not mon twee roe the pro dollars r my e.1: WOOD SHAKES
I,as owns of the property. or he employee with wends as Asir sale
for
ale(Sic. 0414 do the work, and me structure h not intended or License WOOD SHINGLES
for Cele(enc. apply Business and Professions Code: The or imp ov is License
Law who
Les apply to an Owner of through
who n em to i es, Pref thereon,at
such who co«such work not int or to rap rare tis own employees,provided that
ui: ng or improv are not and with o. phased for sal.. u, however,owner OTHER (SPECIFY) 1/2" (plywood and
bui der or improvement is role within one year at of build or me Pwter 30# felt
bwla.,0411 n.y.the burden o1 Proving m.7 n.aid not brim or improve for
purpose of fale.l. PROVIDE I.C.B.O. REPORT NO.
0 1, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044. Business and Profession%
C.".: The Contractor's License Law does not apply to an owner of property PROVIDE MFGR. INSTALLATION SPECS.
who builds or improver thereun, end -no contracts f.1 such projects with a
connector(s)Iinn..d pursuant to the Contractor's License Law.
Q 1 em as empt under Sac. ,B.d P.C.for this
season APPLICATION DATE VALUATION PERMIT FEE
Owner Date
WORKERS'COMPENSATIONDECLARATION Building 96.00
1 ho.by affirm that I have a certificate of consent to sell insure,or a car
tificau of Workers Compensation Insurance,or certified copy thereof(Secr seismic .60
0800,Lab.p}yam( State Carp. Ins. Fund 9/22/95 0000.00
Policy NP. `1/5-95 Company (� [/�
Certified copy i.hereby furnished. Total 96.60
/Q.Certified copy is tiled With the city inspection division.
Applicant
CERTIFICATE OF EXEMPTION FROM WORKERS' N.C. ❑ PERMIT AUTHORIZATION DATE
COMPENSATION I N S URANCE
(Thu f«tion need not be completed i1 the permit is for one hundred dol
bis(21001 or Ins.) ~
I Certify that in the performance of the work for which this permit is
issued, I shall not employ any person in any manner so as to become subj«t
tothe Workers'Compensation Laws or California.
Data Applicantt
NOTICE TO APPLICANT: 11, after making this Certificate of Exemption,
you mould become subject a.me Workers' Compensation provisions of the
Labor code, you must f..ahwim comply with such provisions or this permit Il roofsshall be inspected prior to any roofing materialbeing
shelf be deemed revok.d.
I Certify that I have read this application and state that the above inform. Installed If a roof Is installed without first obtaining an
tion iy coirela I to.ee to ng construction,
on wild w city and by count, ordinances me jngpeCtlOn,I agree t0 re}GG4(i el eW aterlalafor Inspection.
pun beep relating to no nn conn ruction, and hereby nt, orin npmm
tatives of this city to enter upon the above mentioned property for insp«tion
purposes.
-�
(We) agree s, use, indemnify and keep es which ma City or Cupertino
against liabilities,hies, ludpman a costs and anpamo which may i any way t
against said City,n conp..uenc•of the granting of this permit. TORE OF APPLICANT TE
PRE-INSPECTION: PLYWOOD: IN-PROGRESS:
INSP. DATE INSP. DATE INSP. DATE
'TEAR OFF INSPECTION: BATTENS: FINAL
INSP. dDATE INSP. DATE INSP. DATE
NOTE: OSHA APPROVED ACCESS TO ROOF SHALL BE PROVIDED FOR INSPECTION
OFFICE COPY
0
• Cihi of C�Opertirio
P.C.no.5oa
10100 tare Avenur. C,,pellino,CA 95015-0500
Cnlua lino,CA 95014.7255
telephone: (400) 252.4505
rA%: (4011)252-0757
COMMVNI IV UrVI:rOPMrNI
SMOKIs D1sfL•CTOR CLR_Ill'ICA'CL OF COMPLIANCE
I understand and comply willl Section 1210-a of the Uniform Building Code,
Section 1210-a I"squires when repairs to a single family dwelling exceed $1,000, a smoke
detector will be installed, mounted on the ceiling or wall in each sleeping room and It a
point centrally located ml ele d dcloll-Wois oonlply, no n w dctecloosholhbe required sleeping
purposes. If existing smo c
• I understand the above requirement and certify that we now have smoke detectors
installed that do comply.
ADDRESS: 10460 Stokes Avnue
PLIWIT NUMBER:
IIOMEONVNLItS SICNATURE: / f
DA'I'L:
winword/smk(let
i
SUUJEC'I'; RI;Ii00PINC POLICY POR 'I'lIE Cll'Y 01-, CUI'Ell'I'INO BUILDING DEPAR'I'MEN'r
I'It10R'I"O ISSUANC1 017I'EI(MI'r AND INSI'EC'1'IOIJ PIIASE.
I. Prior to permit issuance, you most aglcc to comply will, U.B.C. standards and umnutac(mers spcc's
oil reroofing.
shall not be applicd Without hist Obtaining all inspection "'I'd %v ritten approval
2. New roof coverings
Doul the building inspector. A final iuspecliou :mel applOval shall be obtained from lire building
inspcclor Ivhcn the lcioofiug is congllcicd.
]. All types of roof shall be inspccicd pi for to any roof bciug installed.
4, lu older to receive a final,Yull nulst complete steps I, 2, and 7.
1,) I'rcinspec(ion or tear off approval.
2.) In proglcss inspection:glproval.
7.) I incl inspection approval.
;I ) Operable smoke detector veiificelion
b.) Spark ancslor installation
5. If plywood is installed, a plywood nail inspcctiou is icquilcd.
G. If any roof is applicd Wilhoul fust Obtaining an inspection, you will be required to remove all new
malcrial dolan to IIIc sheathing and :I building inspcclor Will inspect all sheathing at that lime.
WE UNDERSTAND 'I'lIG ABOVE POLICY ON REROOFING AND WILL COMPLY WITII TILE
POLICY
Yuk & Elice Yung
IIOMEOWNL•R$ NAME:
10460 Stokes Avenue
ADDRESS:
Security ofing, INC.
REROOFING COMPANY NAME:
APPLICAN'PS SIGNATURE:
CITY OF CUPER1'INO
BUILDING DEPAU ML•N'r
Rcl oof/tvi mvo i d
i