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R-4526 PERMIT R_ 4526 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 BUILDING ADDRESS 180 DAYS FROM LAST CALLED INSPECTION. RESIDENTIAL COMMERCIAL OTHER OWNER'S /1 HAZARDOUS FIRE AREA A. / i VES ❑ II yess assembly is req that. Class A NAME �/�/ ll�n root assembly is required. /� NO ❑ Initial I.C.B.O.fl ADDRESS,2D_Y­Y�1 ty, nEXISTING ROOF COVERING PHONE ` `� T NUMBER OF EXISTING COVERINGS CONT/R/A+CT/OpR'Sc^ Y y'\'` f TO BE REMOVED 1 TO BE RETAINED NAME` y ADDRESS —I /� ,r, TYPE OF ROOF COVERING CITY a zIP`. 7✓ V k r EXISTING PHONE v BUILT-UP ROOF NUMBER H 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 effect. WOOD SHINGLES E]License Class 3 Lic.Number �� Date Contractor OTHER(SPECIFY) E] NER-BUILDER RATION PROPOSED I hereby affirm that I am exempt from the Contractor's License Law 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 ru,O. ethe 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 Lew(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 SHINGLESIt� ❑ 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).): ❑I,as owner of the property,or my employees with wages as their sole compensation,will do WOOD SHAKESPT E]the work,and the structure is not intended or offered for sale(Sec.7044,Business and Profes- 7 xx sions Code:The Contractor's License Law does not apply to an owner of property who builds or WOOD SHINGLES 1 9 � ❑ 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 CPfti 9,, is sold within one yea,of completion,the owner-bulkier will have the burden of proving that he did OTHER (SPECIFY)'/- ❑ not build or improve for purpose of sake.). Cf•(��Ar� ❑I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Coda: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 contractogs)licensed pursuant to the Contractor's License Law. PROVIDE MFGR. INSTALLATION SPECS. ❑1 am exempt under Sec. ,B&P.C.far this reason Owner - Date APPLICATION DATE VALUATION PERMIT F E WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declaration: ❑1 have and will maintain a Certificate of Consent to self-insure for Worker's Compensation, Building as Provided for by Section 3700 of the Labor Code,for the performance of the work for which this � permit is issued. �/I SBISmIC ❑I have and will maintain Worker's Compensatio Insurance,as required by Section 3700 of �o' If the Lobar Cade,for the performance of the work f whit ihl permit Is Issued My W rs Compo as nc ca rler and P y number re: "l-'r 1(O� O Total Carri Policy No. I V PERMITA HORIZATION DATE CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE N.C.O (This section need not be completed if the permit is for one hundred dollars($100)or less.) 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 subject to the Workers'Compens ti n Laws of Calf All rOOfS all b InS ected prior CO y r Ofl star I b Ing fornixinstalled. If a roof is installed without first btaining an Detain y Applicant inspection,I agree to remove all new materials for inspection. NOTICE TO APPLICANT: If,after making this Certificate of Exemption,you shout atom Applicant understands and will comply with all non point subject to the Workers'Compensation provisions of the Labor Code,you must forthwit comp, PP P Y with such provisions or this permit shall be doomed 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 r f coverings t class"C"or better. hereby authorize representatives of this city to enter upon the above-mentioned property far In- ) hereby purposes. (We)agree to save.indemnity and keep harmless the City of Cupertino against liabilities, judgments,costs and expenses which may in any way accrue against said City in consequence SIGNATURE 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 SUBIECI': 12EROOPtNG POLICY FOR '1'I1L CI'T'Y OF CUPERTINO BULLDING DEPARTMEYi PRIOR TO ISSUANCE OF PERMIT AND INSPECTION PRASE. 1. Prior to peraril issunuce, you must agree to comply %vith U.B.C. standards and manuf cturers spe_s Oil reroofing. 2. New roof coverings shall not be applied witinoul 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 or roorslrall be inspected prior to any raorbcing installed. d. In order to receive a final,you Must complete steps 1,2, and 3. 1,) Preinrspecliair or tear of approval. 2.) In progress inspcction approval • 3.) Final inspection approval. a.) Operable smoke detector verification b.) Spark arrestor iuslallatiou 5. irplywood is installed,a plywood nail inspection is required. G. If any roof is applied without first obtaining an inspection, you will be required to remove all new P material down to the slnclhing and a building inspector will inspe^_t all shc.lhing at Ibat Lime. WE UNDERSTAND 'I,ILI: ADOVE POLICY ON IZE•RGOFING AND WILL COhLPL': WITH TILE POLICY 1101viE-OWNERS NANLE: ADDRESS: REROOFING COhLPANY NAME: ' 1 , APPLICANTS SIGNATURE: CITY OF CUPERTINO BUILDING DEPARTMENT Rcroof/nsiinrord C y JF - I eitij of curnitim SMOKE DETECTOR CERTIFICATE OF COMPLIANCE I understand and comply with Section 1210-a of[lie Uniform Building Code. Section 1210-a requires when repairs to a single family dwelling exceed SI,000, a smoke detector wiil be installed, mounted all the ceiling or wall in each sleeping roam and at a point centrally located in the corridor or area giving access to room used' for sleeping purposes. If a::sting smoke detectors comply, no new detector shall.be required. I understand the above requirement and certify that we now have sin Ike detectors installed that do comply. - - ADDRESS: G S Glf � PEIUvIIT NUNIBER: S 2Axg HOMEOWNERS SIGNATURE: DA•fE: winword/smkdet i