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R-3701 (2) APPLICATION FOR PERMIT R_ 3701 CITY OF CUPERTINO NUMBER INSPECTION DIVISION PERMIT EXPIRATION REROOF PERMIT (408) 252-4505 EXT. 228 WITHIN 180 DAYS OF PERM TISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. BUILDING ADDRESS BUILDING USE (O(JI.`O — 108/]_0 U RESIDENTIALJI�(_ COMMERCIAL OTHER OWNER'S ( I�/ r�� Q� HAZARDOUS ROOF NAME IV TV�T IJ FIRE Rm CLASS G— ADDRESS- /10990 ♦1(U©l (JM1/1'�- 1. AREA CLASS ROOF COVERING PHONE L "4I C/� � ' (�f_ NUMBER OF EXISTING COVERINGS 1 CONTRACTOR'S TO BE REMOVED TO BE RETAINED NAME P ROC4kI n TYPE OF ROOF COVERING ADDRESS DD&ZSE toga;_ 50 7r 5f ezi: (�F711 D, EXISTING PHONE (Lt09) "l / 1 -750) BUILT-UP ROOF LICENSE io ASPHALT SHINGLES NUMBER 1 WOOD SHAKES LICENSED CONTRA DECLARATION under ' 1 hereby ;form x000 I em licensed under provisions of ChapterProfessions 9 ons Code, ins wren Section loom m Dlyi.ion a of m.easiness.ntl vrof.;aion.cod., WOOD SHINGLES mtl my IicmSa i In 1 I .<.ens dbct. u<mcLas t' Sao.Npmba-_� OTHER (SPECIFY) Date r�4, Contractor OWNER-BUILDER DECLARATION I hereby affirm met I em exempt from the Convactoi s License Law for PROPOSED the following reason. (Sec. 7031.5, Business and Professions Coda: Any city or unty which requires a permit to construct, a ter, Improve,demoliN,or ,pats any structure, prior to its issuance,also require.the applicant for such BUILT ROOF permit to the a signed statement that he is licensed pursuant to the provisions of the Contractor i License Law (Chapter 9 (commencing with Section 7000) O f Division 3 of me Business and Professions Code)or that he I.exempt here ASPHALT SHINGLES xep from end the bans 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 dollen($500),): WOOD SHAKES ❑ I,as owner of the property,or my employees with wages as their..is compensation,will do the work, and the structure is not intended or offered for Sala (Sec. 7044. Business and Professions Code: The Contractor's License WOOD SHINGLES Lew does not apply to an owner of property who builds or improve;thereon, and who does such work himself or through his own employees,provided that such improvements are not intended or offered for sale. II, however, the OTHER (SPECIFY) Cltk SMu. building or improvement is sold within one year of Completion, the Owner. build.,will have the burden of proving that he did not build orimprove for Purpose of PROVIDE I.C.B.O. REPORT NO. C31, a of me property, a exclusively contracting with licensed contractors to conatmct•the project (sec. 7044, Business and Professions Cods: The Contlx+or's License Lew does not apply to an owner of property PROVIDE MFGR. INSTALLATION SPECS. who builds or improves tberaun, and who contracts for such projects with a contractors)licensed pursuant to the Contractor's License Law. raamn I am exempt under 5e<. ,e.bv.c.+o.mi. APPLICATION DATE VALUATION PERMIT FEE Owner Date g`g WORKERS'COMPENSATION DECLARATION r A I D Building I hereby affirm that have a grn+lcate of consent t self insure,or a car. � [ifl<.a of Workers'Compensation Inau,once a cer[ili d copy thereof(Sec. 3J'000 Seismic Polio.Lets 1 c /ru y s �.•Q �� SPR - 3 199,. Policy N -A"Company �} coni lie op s nen y furols ed. Total D Certified cop tit ry inspection division. Applicant �la.t ° AA, - 1 ' CESR'TI_FIOATE EMP ON FROM WORKERS' N L, s Sas ElaMl'YI'AUTHORIZATION DATE COMPEE NSASATION I N S URANCE (This;action. need not be Completed if me permit is for one hundred Cal un IS 100)or less.); tilt' ihat n me performance of the work for which this permit is 1. issued, I Nell not employ any Leno on In any manner so as to become subject to Ihs Workers'Compensation Laws of California. Dna AT: If. NOTICE should APPLICANT: o alter making this Compensation p of Exemption, you sM1oultl become aubjaci to ma Workers' CompenSation provisions of Na Labor code,you must forthwith Comply with each provisions or his permit All roofsshall be inspected prior to any roofing material being Nall be deemed revoked. 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 agree to comply with all city and county ordinances and Ins action,I agree to remove all new materials for Inspection. wait Imo relating to building construction, and hereby eu NLnte represent purpo of this city to enter upon ma above mentioned property for inspection tt '�' 1 -t q;. pur(We) \Y1 j- J� h1 (We)l ague to awe, indemnify and xkeep harmless the City of Cupertino against liabilities,judgments,cum and gr Panus which may In any way accrue • against uitl City in consequence of the granting of this permit, SIGNATURE OF APPLICANIV DATE 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 -4789969068 CONTEMPO CUPERTINO F-979 T-650 P-003%003 APR 26 195 15:27 APR-X21-19% 14=17 TAYLOR R00FIM 408 9711380 P.01 CIN O1 CWI)C T.O.Dot SM CutwllTnn,CA SWIS-75aa 1LLTaa Tm�r.AvC„uc Cxnnallno,CA 550H•12S5 Tck�,++vne:teaal 251,45% rABt(4041252-625) .. CpMMVNiTY 1WVR0ri+t1NT 1 u11dCTstand 1+Td caluply Will, St. 1210-a or the UnirornT Building Code c ,000, a smoke Section 1210-a requires.whet, Mpairstto a saeigi {QYSilvy t!`inleacl sleel5i+tgceed (room mud at a • datector will be installed, mounted o room used for point central 'oi?tcslmokilt ed delectoos col"Oy, to new deteetorslsaU be equireJslee(!ing • Purposes. 1 6 1 pltdCTSlan(I t1tC 1�ovc requirement au(I :cerliry that wa uow.have smoky detectors installed 0111(1*cotitply. Cupertino 10840 Northoak ;Sg6are, ADDILSSS: P1rRMIT NUMUEIt: . . �p I ibnrl�awNl l�s.;stcrin'fU]iL: . 4/26/95 OKMA wiuwoidlsnTkdcf' I i APR-21-1995 14:17. TAYLOR ROOFING .. 408 9711380 P.01 I I I • C�lr� of Gvel-fillo •I P.O.Box sUo <upertino,CA 950IS•0500 1111!111 lour.Ave"'A , Co+millno.CA 95014,1255 55 Ialrp6unc:( 1 to%:laNq 252U751 COMMUNI'fYUEVEIOrMENT i All j SM�ICS UG'1'L• alt' CLIt'i'IFICATE P C M 'LIANCG i 1 understand ind coill plY with Seclion 1210.11 oftIIe Uniform Building CodJBIC e- Section 1210 a requires when rep Iirs o '1 Ile c+cit+>gf or11wall`inleachlln esleep nglroom alsd Olen dcleclol' will be installed, ninunle givingcl oolrsleeping poillt ltlod ![Iiooshill be redElied_ pulposcslf cxisliug tile deecloscouglly, o new detector • 1 lnulersland the above rcquirc1l'a"t an(1 certify plat we now have smoke detectors • i❑slollcil [11111 do comply. ADDRESS: 2 l'LwIT.NUMAE-!• :, 3 D IIOMEOWNE,ItS SIGN41:FU avifiiv01 d/sntkdcl' .. i APR-21-1995 14: 17 TAYLOR ROOFING 408 9711380 P.01 I • Clf1� of CN�)C1'f1110 •. P.O.0o+sao C�itcitlnn,CA 950150500 10,1(Ifl In�tr.Awslue Cuyc,Ilno,CA 95014.1255 Tclt;It6nnc: (400125),4505 rnx:14 0111 251-075J . COMMUNITY OCV(lOrMONT i I I a r. � nM �f IANCG I $ICI's UF1'F TO :LITS I underslaiJ oud comply wish Section 1210-a of the Uniform Building Code. Scction 1210-a requireslw"ounlc llrs ont�he c 11 lcil l Sle f orlllwn11 in c1chcSleeping iroom and smoke dctcctor will be installcc , pai res1111fexlocatslins d it,ced detectorsle comply, no new detecloroshall lbetIequired- sleeping • 11 I undcrsland the nbovc rc(luircnlenl and certify that we now have smoke detectors .I installed that do comply. A S AI)DIWSS1 PF RMiT NU M.0 FR: IdOMJ30WNfiNA liS S1C '1'URE: . . UA`1 L: a I wiiwor<I7smkdcl T/1T/11 Il rA1 -. RPR-21-1995 14:17 TAYLOR ROOFING 408 9711380 P.01 ! l _ I • ., Clfq 0{ CUJ)C1'f1f10 r.o.no.Sao Cuoclunn,CA 95015.0500 10700 I m�r.Avennr. Cupcillno,CA 75011.7755 ktirphnl'c;(400( 252-4505 fAX:(4011(25 bU75J CommVNI'fY UCv@lorMENr • s SMOICI UE1'L �R CL'•It'1'tl ICA:I'6 F C WI IANCG i I understand and comPlY will' Section 1210-a of[lie Uniform 13011ding Code. .11g Section IZIO-a requires wlioiilittedllon the aeilingf or11wnUWnlleach sleePlinglr000i a1sd o"it cn dcleclof Will be illslalled, mounted point ses'tllflly existing d ill ed delectoos comply, no new de ectoroie cc' Shalllbe iegt' eJ.sleeping • IJull7o l understood the arcquircntenl and certify that we now have smoke defectors bove •I iuslollcd that do comply. � v ' ADDRESS: prLILMIT NUMBER: kIOMI�OWNI�RS S1GNA'1'URL: UA.l'L: ' wiliword/smicdcl 1 s i 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. 1,) Preinspection 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. 6. 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 r^\r HOMEOWNERS NAME: I � � ��� HO' ' 1� ADDRESS: to <2 9 0 A art- -��1v1 REROOFING COMPANY NAME: T APPLICANT'S SIGNATURE: CITY OF CUPERTINO BUILDING DEPARTMENT • Reroof/winword