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R-3884V -1 APPLICATION FOR REROOF PERMIT CITY OF CUPERTINO INSPECTION DIVISION (408) 252-4505 EXT. 228 10,2-47 V(STA e_UoLL %3LUD. OWNER'S NAME /.0TL'1g —1 y - + E vQ / oa re/l ADDRESS /OA47 VISTG6,NUtl —/5/ISD 3G,- O V 9-0 CONTRACTOR'S OO> NAME 14-// S eeti A U� O—D i'IYL� ADDRESS 33o �`� fJ , CITY 8ISS !-�/tx..cr-rem PHONE 9'7/ — I ��6_ 5/3ooi C3 LICENSED CONTRACTORS DECLARATION I hereby affirm that I em licensed under provision. of Chapter 9 (comm an cag with Section )000) of Division 3 of the Business d Profusion. Coda, and my i license I. I.Ct5•r sad effect. License CIa (� ✓_ Lic. Numbers Oen Contractor OWNER BUILDER DECLARATION 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 t0 construct, altar, improve, demolish,or repair any structure, prior to its Issuance, also requires the applicant for such permit to file a signed statement that he a licensed pursuant to the provisions of the Contractor 2 License Law (Chapter 9 (commencing with Section 7000) of Divition 3 oe f the Business and Professions Code) or that he is exempt there- from and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more that five hundred dollars (5500).1: ❑ 1, n owner at the property, or my employees with wages as their sob compensation, will do the work, and the structure is not intended or offered for tare (Sac. 7044, Business and Professions Code: The Contractor's License Law do" not apply to an owner of property who builds or 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 .old within one year of completion, the owner builder will have the burden of proving that he did not build or improve for purpose of cal e.1. ❑ 1, at owner of the property, am exclusively coniratting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractor's License Lew does not apply to an owner of property w .0 bu ims or improves thareun, and who contracts for such projects With a contraciorb) licensed pursuant to the Contractor's License Law. ❑ 1 em exempt under Sec. ,B.&P.C, for this reason Oyinhr Date WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent t0 selCinsurs. or a car tilicato of Workers' Compensati Iuu nca, or certitiatl� thereof IBec. 3000, Lob. Panic 4ePcc�11 I hdewm I T l/ Fiart i fie is hereby drnished. Car('_ tl< is file t i its intp'ction division. Applicant CERTIFICATE OF EXEMPTION FROM WORKERS' N.C.❑ C COMPENSATION INSURAN E (This section need not be completed if the permit is for one hundred dol bre ($1001 or last.) 1 certify that in the performance of the work for which this permit is issued. 1 mall not employ any parson in any manner so as to become subject to the Workers' Comp notation Laws of California. Dau Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers'Compensation provisions of the Labor Code. you must forthwith comply with such provisions or this permit mall be deemed rooked. I certify that I hoe read this application ands"[. that the soave Informs tion is C. text. I agree to Comply with all City and county Ortllaances and state awe ratting to building construction, and hereby wthoria npnourn atives of this city to anter upon the above mentioned property for inspection pulp..... (We) agree to sere, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in anV way ettrue apinss aid City in consequence of the 9renting of this permit. PRE -INSPECTION: PLYWOOD: INSP. DATE INSP. TEAR OFF INSPECTION: BATTENS: INSP. DATE INSP. PERMIT NUMBER R- 3884 PERMIT EXPIRATION PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. /BUILDING USE V nnas"MOPI At NUMBER OF EXISTING COVERINGS DATE EXISTING BUILT-UP ROOF ASPHALT SHINGLES WOOD SHAKES WOOD SHINGLES OTHER (SPECIFY) PROPOSED BUILT-UP ROO� ) ASPHALT SHINGLES WOOD SHAKES WOOD SHINGLES n ��� � n OTHER (SPECIFY) C�( PROVIDE I.C.B.O. REPORT NO. 431A PROVIDE Ii INSTALLATION SPECS. PERMIT FEE PA10 �7, g3�evV 141995 fib:;.►_ �� M All roofs shall be inspected prior to any roofing material being Installed If a roof is installed without first obtaining an inspection, I agree to rem/ a all new materialsfor inspection. lels- SIGNATURE OF APPLICANT DATE IN -PROGRESS: DATE DATE IINSP. DATE I NOTE: OSHA APPROVED ACCESS TO ROOF SHALL BE PROVIDED FOR INSPECTION OFFICE COPY 0 r1 LJ 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. l,) Preinspeclion 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. G. 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 HOMEOWNERS NAME: ADDRESS: REROOFING COMPANY NAME: APPLICANT'S SIGNATURE: CITY OF CUPERTINO BUILDING DEPARTMENT RerooUwimvord Curt Helvey & Eva Wang 10247 Vista Knoll Blvd. All Seasons Roofing, Inc. Paula Tierney, Operations 0 • 0 CW4 of Cupertino 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 smoke detectors installed that do comply. ADDRESS: PERMIT NUMBER: HOMEOWNERS SIGNATURE: DATE: winword/smkdet 10,N1 M5,1 - moll - yv .