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R-5376 (2) PERMIT R_ APPLICATION FOR CITY OF CUPERTINO NUMBER 5 3 7 6 . INSPECTION DIVISION PERMIT EXPIRATION REROOF PERMIT (408)777-3226 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR WI180 DAYS FROM LAST CALLED INSPECTION. BUILDING ADDRESS %.10011 LO 1 RESIDENTIAL COMMERCIAL OTHER OWNER'S IHAZARDOUS FIRE AREA 11 1 C YES E] -If yes-I understand that a Class A NAME N I?J(ar1r rP�1r•P C'� NO L oof assembly is required. I.C.B.O.# ADDRESS I03 / 0L/%rn gYrL^+r�'-'��t'? EXISTING ROOF COVERING PHONE aLS _ NUMBER OF EXISTING COVERINGS CONTRACTOR'S �J NAME r�,�1 l ./'CJ4 S TO BE REMOVED TO BE RETAINED ADDRESS [� /y� PE OF ROOF COVERING CITY&ZIP 7A166�- q/eol/ng h EXISTING PHONE T/o 1721)QLt-)G BUILT-UP ROOFis ❑ LICENSE NUMB ❑ ,�� ER LICENSED CONTRACTORS DECLARATION ASPHALT SHINGLES hereby affirm that em licensed under provisoryof 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' /� L,' / WOOD SHINGLES License Class G? / Lia Number rp23�V ❑ /0—IY-9-7 - k,-„ Crort OTHER(SPECIFY) ❑ �� Date Contractor OWNER-BUILDER DECLARATION PROPOSED hereby affirm that em exempt fromNEE the Contractor's DELL License Lew 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 requires the BUILT-UP ROOF ❑ i applicant for such Permit a lila a signed statement that he Is licensed pursuant to the Provisions of the ss an dols License Lew(Chaplet h(commencing with Section 7000)of Division 3 of the Business entl Professions Code)or that he is exempt therefrom and the bass for the alleged ASPHALT SHINGLES exemption.Any violation of Section hundred by any applicant nt for a permit subjects the applicant to r N; e civil penalty of not more men live by employees dollayees th wage: WOOD SHAKES ❑I,as owner of the property,or to ded oyeee with wages as their sole compensation,will do ❑ the work,and the structure is not intended or offered for sale(Sow owner of Business and utds or cions Cotle:The,antmcto d License Lawdoes not apply toenowner ofproperty whoidedtor WOOD SHINGLES ❑ improves mermen,and'who tleen such work himself or through his own employees,Improvement ed that such improvementsars not plebe ,the offered for sale, ill however,meenOfbuilding Prov Improvement ntbuild sold or prove for purpose sual .owner-Builder will have the burden of proving that he tlld OTHER(SPECIFY) ❑ not build or Improve for purpose of sale.). - ❑I,as owner of the property.am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:The Contractors License Law does not PROVIDE I.C.B.O.REPORT NO. apply to an owner of property who builds or improves thereon,and who Contract$for Such projects with a cntractor(e)licensed pursuant to the Contractor's License Law. PROVIDE MFGR.INSTALLATION SPECS. j�l am exempt under Sec. ,B&P.C.for this reason WORKER'S COMPENSATION DECLARAATIOTIO N APPLICATION DATE VALUATION PERMIT FEE I hereby affirm under penalty of perjury one of the following declaration: P A 10 - Fj I have and will maintain a Certificate of Consent to self-insure for Worker's Compensation, BUlldln as provided for by Section 3700 of the Labor Code,for the performance of the work for which this /� permit is Issued. E/ T 18 up Seismic ❑ have and will the performance Worker's Compensation the workfor Insurance,as required by Section 3700 of t�4 �f� the Labor Code,for the petormand of the work for which this permit Is Issued.My Worker�IIY � Jr' Compensation Insurance carrier antl Policy number are: ,Jf. LL/ �, VL Total Carrier Policy No PERMIT AUTHORIZATION DATE CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE N.C.E] 17 (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, shall not employ any person In any manner so as to became subject to the workers'Compansetlon Laws of Call. All roofs shall be inspected prior to any roofing malbrial being forma. installed. If a roof is installed without first obtaining an Date Applicant inspection,I agree to remove all new materials for inspection. NOTICE become subject to theWorkers'Compensation ANT. 11,shot provisions loftheficate of Laborr Code,you must forthwith comply Applicant understands and will comply with all non point with such provisions or this permit shell be deemed Favored. source regulations. I certify that I have read this application and state that the above Information Is correct.)agree to comply with all city and county ordinances and state laws relating to building construction,and All roof coverings to be class' better. hereby authorize representatives of this city to enter upon the above-mentioned property for In. spection purposes. �� /�—^� (We)agree to save,indemnify and keep harmless the City ai Cupertino y Inagainst Iiabilenas ce c 7 ofthe gran,Costa and permit. 9 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 i SUBJECT: RE_ROOFaiG POLICY FOR Tr-E CITE OF CUPERTI IO BUILDD�G DEPARPwIENT PRIOR TO ISSUANCE OF PERMIT AND INSPECTION PILOSE. 1. Prior to permit issuance, you muss; agree to comply with U.B.C. standards and manufac. tors sPec's on re:cofine. 2. Ne:v, roof coverings shall not be applied :vthout first obtaining all insperion and %vrinen approval from the building inspector. A final inception and aooroval 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 comolete steps 1,2, and 3. 1,) Preinspection or tear off approval. 2.) In progress inspection aopro',-J. 3.) Final inspection approval. a.) Ooemble stroke detector vertf[cation b.) Spark arrestor installation 5. If plywecd is installed,a plywood nail inspection is required. 6. If any roof is applied without first ooutining an inspection, you will be required to remove all ne:v material down to the sheathing and a building inspector will in_rcect all sheathing at that time. WE UNDERSTAND THE ABOVE POLICY ON REROOFING AND WILL COMPLY Vv= TIFF POLICY FONIEOWNERS NAME: ADDRESS: REROOFING CO1v1PANY NAME: APPLICA,`TS SIGNATURE: CITY OF CUPERTINO BUILDING DEPARTMENT Reroaflwinword ®` 10300 Torre Avenue . Cupertino,CA 95014 Ciiy nC -cliper t1110 Building Division 1 (408)777-3238 (408) 777-3333 (fax) March 20. 1998 Homeowner 10370 Cherrytree Lane Cupertino, CA 95014 SUBJECT: REROOF PERMIT Dear Homeowner: We have been going through our files in the Building Department, and contacting those people with re-roof permits remaining "open". Our records show that either you or your roofing company have not: (1) called to schedule a final inspection, or (2) missed getting • the sign-off after calling us for a final. Sometimes an inspector will return to a job and sign off the permit in the field, but neglect to inform staff for input into the computer. If this is the situation and your permit card shows the final sign-off, would you please contact us so we may complete our computer records? If the permit is not signed off, please call to schedule an inspection for final closure of the permit. Because of the large volume of paperwork within the building department, we cannot separately monitor the progress of each permit. We ask that you give this notification your immediate attention. If we do not hear from you within fifteen (15) working days. we will expire the permit and remove the records from our computer. Thank you for your assistance. Sincerely, CITY OF CUPERTINO Christy Akatiff, Administrative Clerk • Printed on RCCYCIed R$Jet