R-4018 (2) PERMIT
APPLICATION FOR CITY OF CUPERTINO NUMBER Res -4018
INSPECTION DIVISION PERMIT EXPIRATION
REROOF PERMIT
(408) 252-4505 EXT. 228 WITHIN 1180 DAYS OF PERM T NOT
OR
180 DAYS FROM LAST CALLED INSPECTION.
BUILDING ADDRESS BUILDING USE
c2 f�` ,` Q 1
20Zb5 - 2OZ3 NOC-4 J RESIDENTIAL COMMERCIAL OTHER
OWNER' , `
ROOF
NAME
dim ?C�� A FIREHAZAROOUSCOVERING
�
- I AREA CLASS
ADORES V`+ �I EXISTING ROOF COVERING
PHONE \-04 1 5 A 5 2- toif
NUMBER OF EXISTING COVERINGS
CONTRACTORS
� lk6C '1^ /!
NAME ICJ,�I 'O'� ng `a TO BE REMOVED TO BE RETAINED
c,.f TYPE OF ROOF COVERING
ADDRESS
&ZII 066'*3 7 :S�• J.:l , I'Mu t Z EXISTING
PHONE-1-71 — 75Ca BUILT-UP ROOF
LICENSE �J �O I� ASPHALT SHINGLES
NUMBER J WOOD SHAKES �C
LICENSED CONTRACTORS DECLARATION
I hereby affirm that I am 11.....d near provisions.1 Chapter 9(commam
ing with Section 7000) of Division a or the Business and Professions code. WOOD SHINGLES
and my license h i ions'and offset. 46 201 as
Licjtnsa Claes �'w7 Lic.Number
Data Contractor TwCya OTHER (SPECIFY)
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Lew for PROPOSED
the following reason, (Sen. 7031.5, Business and Professions Code: Any city
or county which requires a permit to construct,alter, improve, demoliab,cr
rwsir an,structure.prior to its issuance,also requires the applicant for such BUILT-UP ROOF
permit to Ilia a signed ssetaman That he is licensee pursuant to the provision,
of the Contractor',of the
Lienee Lew ICMpur 9 kom)or hat with Section 70001
from Division 3 or ma efor the and Proalleged
ex m ion.l or ma he is exempt S ma.. ASPHALT SHINGLES
bons mtl the anis lot the allege' asempts th Any ant to
of Penalty
]031.5 by any 'guilehu for a permit$500)."the applicant m e civil penalty
or 0 more that nye the pro erne.s r my a 1'. WOOD SHAKES
❑ I,as owner of ins work, a or he employees why wands as r their mid
tom ale (Sic. will ass the work, and ens structureCode h not intendedto 's License WOOD SH INGLES
for sales(Sec. 7044, Business em Professions Code: The or imp ove$ License
Lew eons not apply to an owner of property who bat lids Or imps oras[Moon,
and wM10 do t rv=n work himself int ltr ed or offered nig own employees,provided that
such ng or i Prov ere his i ld with r. neyfor sale. I1, however,owner OTHER (SPECIFY) �A� S Q�e
building or as
is sold proving
one year of completion, the
builder will neve[na Dearden of proving mat ns did not build or improve lltr
Purpose of sole.). PROVIDE I.C.B.O. REPORT NO.
❑ 1, as owner of the property, a .elusively contracting with li ensee
contrac fora to construct the project (Sec, 7044, Business and Professions
Code: Tho Contractor's License Law does not apply to on owner of property PROVIDE MFGR. INSTALLATION SPECS.
-no
builds or improve. mare.", and who contracts for such projects with a
onnactor(sl licensed pursuant[o The who
License Law,
raes❑on I em exempt under sec. ,',spec.for this pPLICATION DATE VALUATION PERMIT FEE
Owner Data
WORKERS'COMPENSATION DECLARATION A D Build inn
I hereby anirm that 1 have a certificate of consent to self insure,or a csr
Tint."'of Workeri Compensation Insurance,Or certified copy thereof ISac. Seismic
3800,Lab. ..
Policy No.�111.7L4 Company 'F OW C17y r 11 1995 Q O, 00� Total
8 Certified copy is hereby furnished. j
ant iMeyp'v is+llaea wigT Tn.'fNW inwacnon division. /• `uN
Applicant��V-- FOCMfat
CERTIFICATE OF EXEMPTION FROM WORKERS' N.C.
C AMIT AUTHORIZATION DATE
COMPENSATION INSURANCE
(This settiOn Mee not be completed it the permit is for one huner6e d01
Isrs($100)OI las.)
I certify sh that m ma performance person
of the work for which anis permit is
issued, 1 shell n0"employ any penton in MY manner so as to become subject
D the Workers'Compensation Leena of California.
Dela Applicant
NOTICE should
APPLICANT: o eller making [nig C.ninon of Exemption,
you should dooms subject i the Workers' Compensation provisions a the
mit
Labor Code, you must forthwith =dangly with such provision or nth permit All roofs shall be inspected prior to any roofing material being
sntll be
deamsa rwoked.
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. I .gree to comply with sea city me county ltrmnanpr and inspe n,I agree to remove all new materials or inspection
state Tawe relating to building construction, and hereby .utho,i,, nprosm
relives of this city to sour upon m'above-mentioned property IOr inap¢tion
purposes.
(We) agree m ear., indemnify and keep esharmingwhich may
City of Cupertino
against liabilities,City i cense judgments,crass the expenses which mer in anY wry ecru•
.g.ina said city in consequence of Ln.granting of this permit. NATURE OF APPLICANT � DATE
PRE-1 NSPECTION: 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 TOISSUANCE OF PEIMT AND INSPECTION PHASE.
L Prior to pencil issuance, you must agree to comply witlu U.B.C. standards and manufacturers specs
on reroofing.
2. New roof coverings shall not be applied without first obtaining all inspection and written approval
from the building inspector. A final irspecliou and approval shall be obtained from the building
inspector wire,, the reroofing is completed.
3. All types of roof shall be inspected prior to any roof being installed.
4. l,,order to receive a rural,you must complete steps I, 2, and 3.
I,) Preinspeclion or tear off approval.
2.) 111 progress inspcction approval.
• 3.) Final inspection approval.
a.) Operable smoke detector verificalioll
b.) Spark arrestor installation
5. Irplywood is installed, a plywood nail inspcction is required.
G. If any roof is applied without first oblai,,iug an inspection, you will be required to remove all rcry
material down to lire slucathing and a building inspector will inspect all sheathing at that time.
WE UNDERSTAND TILE ABOVE POLICY ON REROOFING AND WILL COMPLY Wrrll THE
POLICY ,\
HOMEOWNERS NAME: N'.'4 `1_
)
ADDRESS: O� O
REROOFING COMPANY NAME: /r���l �� 'SRO NQ c
APPLICANTS SIGNATURE: I / °'1 K� 5 1 95
•
CITY OF CUPERTINO
BUILDING DEPARTMENT
I Reraof/wimeord
'-RPR-21=1995 .'14: 17 � ' TRYLOR.ROOFING _ 408 9711380 P.01�
- 0- Cui;iel "ti1�0.
r.o.no>i 500. '
Cupmtlnn,CA 75015.0500
Cupn,tlno,CA 05014•1155 .
T01rpliunc; (4001157,-4505
7520751
COMMUNITY U@vr.torMENr '
SM I(I"s UGI'L '1' IL'CL-R�I'II�ICA'tL �)P COMPLIANCE
I Understand and coluply with Section 1210-,",Or IIle Unironn l3Uilding Code.
Section 1210-a rcTlir s 'I'c icl);"rs cicilingrorllwatlllWclle�ch sleepnglroom and olCn
detector will be insla
I>orposcs1111rcxisolcng s"itclmolcill ehe d detectoos soulply, 6o new detectors shccess to �111be r gtlired.slPepmg
• 1
I uudcrstnnd the above rcquirclncnl and certify that we now Have smoke detectors
installed that do comply.
ADDRLSS:
'7�o Com- Sha.c
l'L'.ILMIT NUMt1LR:
IIOM OWNI'_RS SIGNA'1'UI1,L:
-------------
DA'1'Ls:
will word/snllc(let
I
_TnTni 0 LCL