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R-4070 PERMIT APPLICATION FOR CITY OF CUPERTINO NUMBER Res '4070 INSPECTION DIVISION PERMIT EXPIRATION REROOF PERMIT (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 ADDRESSQ' BUILDING USE ` ✓ / L (f RESIDENTIAL COMMERCIAL OTHER OWNER'S HAZARDOUS (�/ ROOF FIRE NAME AREA CLASS COVERING ADDRESS EXISTING ROOF COVERING�� GIOE> C 7a 3 NUMBER OF EXISTING COVERINGS / PHONE f 7 CONTRACTO TO BE REMOVED TO BE RETAINED NAME TYPE OF ROOF COVERING RESS CIITDY&/ZIIP p EXISTING PHONE�7 fol �� — 76 L 9 BUILT-UP ROOF LICENSE 6 /Q / ASPHALT SHINGLES NUMBER WOOD SHAKES L I CENSED CONTRACTORS DECLARATION I hereby affirm that I em licensed under provisions of Chapter 9 (...them- ino with Section 7000) of Division 3 of the Business and Professions Code, WOOD SHINGLES and my O<nas i t ce and afbct. and Cl .iC.Number Data comrecmr OTHER (SPECIFY) OWNE RBUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Lew for PROPOSED the following reason. solo. 9031.5. Business and Professions Coda: Any city or county which requires a permit to construct, alto, Improv, demolim,o• rapeir any structure,prior to its issuance, also requires the applicant for such =SHINGLES permit to file a signed statement that he is licensed pursuant to the provisions 0i ma Connecmrl License Lew Ithnur 9 (commencing with Section 7000) of Division 3 0l the Business and Professions Codal or that he is exempt mere from and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to e civil penalty of not more that five hundred dollars(S500).i: WOOD SHAKES ❑ 1,as owner of the property,or my employees with wages as their sole compensation,will do the work,and the structure is not intended or offered WOOD SHINGLES for sale (Sac. 7009, Burns..and Pro+osions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and whodoes such work himself or through hisown employees,provided that such improvements are not Intended or offered for sale. If, however, the OTHER (SPECIFY) building o improvement is sold within one year of completion, the owner. builder will have the burden of proving that he did not build or improve for PurpOteof sale.). PROVIDE I.C.B.O. REPORT N0. ❑ 1, as owner of the property, em exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractor's License Low does not apply toanowner ofproperty PROVIDE MFGR. INSTALLATION SPECS. -no bill Ids or improves meraun,and who contracts for such projects with a Contra tor(s)licensed pursuant m the Contractor's License Law. C31 am exempt under Sac. ,B.&P.C.for this ,.soon APPLICATION DATE VALUATION PERMIT FEE owns, Date WORKERS'COMPENSATION DECLARATION Building I hereby affirm that I have a colificate of consent to IL insure, • car S/ offs ell f Workeri Compensation mar or��tifiad y imaof SS�F n/ ` 1( �' J/, Ut Seismic 3800.Lab J� r,��k� /fj�,s (��/P Lr 9 7(9 Policy a •"��ompe y /��L�-�A--=-='liG1 _ s �y� / �/c tie..coo h...bv+ser .ned. h 'IS Total Cotif=c wins ty inspection division. Applicant .I C CERTIFICAT OF EXEMPTION FROM WORKERS' N.C. ElPERMIT AU 'ORIZATION DATE COMPENSATION INSURANCE �) (This section need not be completed if the permit is for one hundred doL ler•($100)or less.) 1 certify Inst in the performance of In. work for which this permit i issued, I shell not employ any parson in any manner so as to become subject to the Workari Compensstion Laws of California. Dere Applicant 72 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 an•II be deemed revoked. All roofs shall be Inspected prior to any roofinj material being I certify that I have read this application and state that the above Informs installed. If a roof is Installed without first obtaining an tion is correct. •ger• to Comply with ell city and county ordinances end IOSPBCtIO agr t0 re ova all new materials for Inspection. state laws matin, to building construction, and hereby authorize repression. I ivas of his city m nth upon me above mntioned property for inspection Furpose• �7 /,� (We),agree liabilities. wva, indemnify entl ken esharmlesswhich thema City of Cupertino Gp against id ityi judgments,coos ntl expanses which may in any way accrw L�7� against tale city m consequence of me granting of this permit. SIGNATU OF APPLICANT DA E 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 __ SUBJECI': REROOFING POLICY FOR 771E CITY OF CUPERTINO BUILDING DEPARTMENT PRIOR TO ISSUANCE OF PERMIT AND INSPECTION PHASE. 1. Prior to permit issuance, you mus[ agree to comply with U.B.C, standards and manufacturers spec's Oil reroofing. 2. New roof coverings shall not be applied vvithout first obtaining all inspection and written approval from the building inspector. A final inspection and approval shall be obtained from the building inspector when lire 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. I,) Preinspectiou or tear off approval. 2.) In progress inspcctiou approval. • 3.) Final inspection approval. a.) Operable smoke detector verification b.) Spark arrestor installation 5. If plywood is installed, a plywuod nail inspection is required. G. If any roof is applied without first obtaining all inspection, you will be required to remove all mew material down to the sheathing and a building inspector will inspect all sheathing at that lime. WE UNDERSTAND THE ABOVE POLICY ON REROOFING AND WILL COMPLY WITH THE POLICY HOMEOWNERS NAME: ADDRESS: REROOFING COMPANY NAN E: APPLICANTS SIGNATURE: CITY OF CUPERTINO • BUILDING DEPARTMENT Rercol7wimvord