R-4022 (2) PERMIT R_ 4022
APPLICATION FOR CITY OF CUPERTINO NUMBER
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
IN DAYS FROM LAST CALLED INSPECTION.
BUILDING ADDRESS BUILDING USE
L.S.. : RESIDENTIAL-1- COMMERCIAL OTHER
OWNER'S ` �1�
�, A
NAME ,_13CDr1 ` , OMT O ! ` , FIREARDOUS CLASSOING
GL
1 AREAr�' 111
ADDRESS EXISTING ROOF COVERIN
' G
PHONE ^1 I J 25 Z " (o3 NUMBER OF EXISTING COVERINGS I
CONTRACTOR'S -
Tt`,'O{ �"'l ,1q d0- TO BE REMOVED TO BE RETAINED
NAME_ TYPE OF ROOF COVERING
I.
ADDRESS I �i S ?�^ S� SS 95112
EXISTING
PHONE 971 - 7500 BUILT-UP ROOF
LICENSEI Q ASPHALT SHINGLES
"
NUMBER ""'TT�1�
WOOD SHAKES
LICENSED CONTRACTORS DECLARATION
I At thhereS affirm tart I of It need 3 of t provisions of dChapterProle s(commeo-
cine y license action 70001 ere Division D of m.Business and Pra1...ions cera., WOOD SHINGLES
and my Ilcanu la fu in a and effect. )
License Clan_ /c Con Number Contract.,
-
Dsta�.y cDECLA. OTHER (SPECIFY)
✓I, th NER-BUILDER DECLARATION
I hereby rens that I . exam.[ from the Contractor's Code: Lew for PROPOSED
or following which
reqon. Iresc. permit, o construct,n ane Plter, i pr toad: Any city -
re county wniclt require a permit to ,alo realter, improve, damoli uch
repair any structure,prior to its issuance,also requires the applicant for such BUILT-UP ROOF
Permit to Ills t sr's Li statense Law (Ce[he is licensed(commencing
tit the provisions
01 ma Contractor's License Lew (Chapter 9 (commencing wits Section 7000)
from
Division D of the Business ma alleged
Professions Con. or that he is violation of S ctio ASPHALT SHINGLE$
bom end the anis tot tee allermi exemption. Any atLoof Section
Got of o any applicant fora permit subjects the applicant[o a evil penalty
Got not more owns
Rof the property,rob..s my employees
m WOOD SHAKES
1, ea Owner OI [M1e pfo rk, a o he emplur a it nwith wend•as r off epee
tom.Is (Sec. will d me work, and me structure le not intended Contractor's offered
for fees (Sec. )044, Busmen end f Prone rly Code: TherimpoverLicense thereon. WOOD SHINGLES
Lew dose not apply to an owner o1 property who builds to improves provided
that n��'ee'
and who aeras such work himself Or through his own employee;prpvitlad tM1et (SPECIFY)
Wl Qom^
such improvamurn ere not intended or offered for saes. If, however, the OTHER SPECIFY J rti
buildi no or improvement i sold within one year or completion, the owner
builds,will have the burden of proving met he did not build or improve for
Proux.of" J PROVIDE I.C.B.O. REPORT NO.
I.
as owner of the property, em exclusively contracting with licensed
Contactors to construct he project (Sac. 7044. Business and Profession•
Code: The Contractor's License Low does not apply to an owner of property PROVIDE MFGR. INSTALLATION SPECS.
who builds or improves theroun, and who contracts for such Projects with e
comractornf licensed pursuant to the Contractor's License Lew,
reason I am exempt under sec. ,B.bP.c.forme• APPLICATION DATE VALUATION PERMIT FEE
Owner Do,.-
WORKERS'
aeWORKERS'COMPENSATION DECLARATION BUildin
I hereby affirm that I nava a certificate of consent t If-insure,or a car /� p
tificete.1 W.rkari Compensation Insurance,O pncar[i%%"OPY tb roof(Sec. ryp 5 00 m Seismic
SBgq L.b.8t�L7 r� T ' J V
Policy Lab / 1 Company
8 Call I it co v i•nereby I i.n.d. A Total
Certified op i•filed wlb rcdon division.
Applicant �(/
CERT( ICATE OF EXEMPTIONFROM WORKERS' N D ElL/)' AUTHORIZATION DATE
COMPENSATION I N S URANCE �
(Thea• ction need not be completed if the permit a for no hundred dal
1 certify Drmat in me performance of me work for which mit permit is l
issued, 1 shall not employ any person in any menn er fo e•to become subject
to ma Workers'Compensation Laws of California.
Dela Applicant
NOTICE TO APPLICANT: 11, after making his Certificate o1 Exemption,
you should become subject to the Worker.' Compensation provisions of the
Lebo'Code, you must forthwith comply with such provisions or this permit All roofs shall be inspected prlorto any roofing material being
shelf be deemed ravoked.
I certify that I neve read this application and Bete that the above inform.. installed If a roof is installed without first obtaining an
tion if correct. I agree to Comply with all city and county ordinances and inspection,I agree to remove all new materials for inspection
.late I sys relating to building construction, and hereby authoriza .or...In
tat
rpof this city to ants'upon iabove mentioned property for impaction
purpose.. b
Pu.pue.
(We)liabilities,spree uve, indemnify antl xpe es whi h me Ciry 01u ..no
ageln•t sidti c nm Que c0•if and granting
f this may In enV way an<fue
.wenn said Crtv in nonapuance of the aantlno of this permit. SIG TORE OF APPLICANT JIDATEI
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 ___
SUBJECT: REROOFING POLICY FOR TIIE CITY OF CUPERTINO BUILDING DEPARTMENT
PRIOR TO ISSUANCE OF PERtvBT AND INSPECTION PHASE.
1. Prior to permit issuance, you must agree to co,nply with U.H.C. standards and manufacturers spec's
Oil reroofing.
2. New roof coverings shall not be applied without first obtai,i,g 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 Iles(connplete steps 1,2, and 3.
1,) Preiuspeclion or tear off approval.
2.) 1, progress inspeclio,approval.
• 3.) Final iuspectio, approval.
aJ Operable smoke detector verificatioll
b.) Spark arrestor i,stallatio,
5. If plywood is i,slallcd, a plywood ,all inspection is required.
G. If ally roof is applied without first oblaini,g mr inspection, you will be required to remove alI ,cW
material down to the sheathing and a building iuspector will inspect all sheathing at that(lure.
WE UNDERSTAND 171E ABOVE POLICY ON REROOFING AND WILL COMPLY WITH THE
POLICY \
IIOMEOWNERSNAME: �e� �orr�- 1O' A
ADDRESS:
REROOFING COMPANY NANIE:
APPLICANTS SIGNATURE: 5 .l
•
CITY OF CUPERTINO
BUILDING DEPARTMENT
Rcroof/Wimrord
-'-RPR-21-1995 14 17 TAYLOR ROOFING 408 9711380 P.01
I. .. Clf�{ ofCujiertil�� :.
r.o.Dox 500
CppclUno,CA 950IS•0500
10100 Tni�r.Avl`nuC
C��pci tlno,CA 55014'.1255
Te1rpLgnC; (400) 252-4505
rAX: (4011)252.0751 -
COMMUNITY UEVrlorMENT "
1
5 1; pgl'� 'It CL'_R�I'I l ICA I C 01" COMM LIAN11
1 undolOnd and comply with Section 1210-a.01'tile Unirorm "Lj"'ng Code.
Section 1210-a requires ITvii of nted11on �he cicil 1 ggle ror11w0 Ivi lllUcheslccpulglroom and atCn
dcteclor will be inslallec,
jog I
purposes.tllrex sting slmokin ed det,do0s couW1 , m new detectorhe colvidf or egs oshaR be`req lired.sleepmg
•,. Il underslnnd the above rcquirclncut and ccrliry thal we now have smoke detectors
in5lDllcd lhal Jo congily. �� � f—
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Al)DILLSS:
'2,.q p 22
pl:jtMIT NUMBER:
IlOMJ30WNfilIS SIQNKI'URL:
DATE:
winword/snikdel
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�- • •'APR-21-1995 ' 14: 17 TAYLOR ROOFING 408 9711380 P.O1
- cltq b`f Ct4j)&-tJM0
P.O.00+Sao .
Culmiuno,CA 95015.05on
10,100 rnuc Avenue
Cupei Ilnc,CA 95014'-1505
lelcl'
rA%:OKI 251-0757
COMMUNITY,D@V@tOrMENr -
SM ICIi UG'1'C 'T01` > Cott l Il'fCAVIE F. M 'LIANCG
I understand and conlhly will, Scclion 1210-a of file Uniform I3uilding Code.
lln
Section 1210-a rcqull.Qswmounle'cllrs on ohe if dell Ic rorllwyallvinlench sleep u�lroom and olCn
dcleclor will be iusla
point
lasesi4tlf exisolnl(cd ill Ole,g 511101<ed dc(ecloos comply,r ,If cif no new detectors shall lbe required-sleeping
• 1 I
I enders{and file nbovc rcquircnlenl and certify tllal we now have smoke deleclors
installed Olat do comply.
X0254 N04-rAGLEr 5Q
ADDRESS: 2-1
I'LIlMIT NUNII3LIt:-_
IIOMfOWNERS SIGNA')'UItG:
FA'I'L:
winword/snllalcl I
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TnTnl 0 M1
;• RPR-21-1995 14: 1? ROOFING 408 9711380 P.01
CItof CUlIcrt1110
Cupmlinn,CA 95015.0566
10)00 lour.Avenue '
Cuperl6to,100109;.155
4505 .
Tclrphanc:( I
Wt(40111252-0753
COMMUNITY aFVr:LOrMENr -
SMo10-, laum T01t CL'Ifl1'1- LQ
M.'LinNCG
I understand Ind ccnlply will, Section 1210-a of tl,e Unifann Juilding Code.
in I
Section 1210-a rUlUiresw1l cnnitedlon lrs obe aril I. "IlclSllgic f orl1lwaUill wclle chcsleepriuglroom alsd ate❑
led,detector will be insla
Igor 7toscs111if cxisotcng sliclmoked deotectoos comply, n0 new detectors Shallbe required.
• I I
have sm0lce detectors
1 understand the above requirement and certify tllal we now
installed Thal do comply. C1 ��,t/D I (-,;,*
ADDRESS: do2,Va ND)eTffGLG,d
`R -- O Z Z
I'LILMITNUM.ULIT:
ilOMpOWNCIIS SIGNA'I'URL:
Un'1'L:
wiiiword/smkdcL
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TnTni 0 ln4
.. ;KAPR-21-1995 , 14:17 TRYLOR ROOFING 408 9711360 P.01
r Cif j 0'f CWj)Ql't1H0
... P.o.Box 5430
CupciUnn,CA 95015.0500
,0,100 1611c Avenue
cupci h %CA 95014.7755
' Telrphviic;(1001 257-4505 .
rAXi tANq 717.075{
COMMUNITY U@VGIOPMCNi .
SM�i' UG1L 7OiL' CL'R'IlIICnI'GUPC MPLIANCG
I understand and comply will, Section 1210-', of tllc Uniform l)U"Jing Code.
in
ke
Section 1210-a rcqu1111edwn cnmindllol, the cicll ntle lorllwnll�to 'IlnlexheStepp(inglr000I and of a
detector will be insla
pointo "allcx sling slmokill ed dehe �ectioos comply no pew de ectorosl�111be used for Sleeping
• purposes. If
I ulndcrsland lie above rcquircmenl nud certify that we now have smoke detectors
installed that do comply.
� 20
ADDRESS: � J ZZ
1'LILMITNUM.0Eft
:
IIOMI;OWNI�ILS SIGNA'1'URG:
wiIIwor<I/slnkdcI
TnTni 0 Q1