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R-3847 (2) PERMIT 3847 APPLICATION FOR CITY OF CUPERTINO NUMBER R- REROOF PERMIT INSPECTION DIVISION PERMIT EXPIRATION (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 C ADDRESS �,1 �]�,, �/ BUILDING USE I0�5j 3 , IO 3 1VCOG' T yI OOH RESIDENTIAL ^ COMMERCIAL OTHER OWNER'S cHAZARDOUS ROOF Ko -� -?c3Nn+ N.O.A FIREN© COVERING AREA ADDRESS /0 aao ��� EXISTING ROOF COVERING PHONE IS �� 2- V 3t / NUMBER OF EXISTING COVERINGS CONTRACTOR'STa,� TO BE REMOVED TO BE RETAINED NAME � oo� g • TYPE OF ROOF COVERING CITYasZIa x$53 Say 5even , Si- r '7 EXISTING PHONE l 10%12 71 — / -500 BUILT-UP ROOF LICENSE {5201 ASPHALT SHINGLES NUMBER WOOD SHAKES 9C LICENSED CONTRACTORS DECLARATION I hereby affirm that 1 em licensed under provisions of Chapter 9(common mo wish S«tion 70001 of Diviai.n 3 of In. Besimp and Profession.Cod., WOOD SHINGLES and my license Is in full force antl effect. License Cie.- Lic.Number DataCorr..«m. OTHER (SPECIFY) OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Lew for PROPOSED the following reason. (Sec. 7031.5, Business and Professions Coda: Any city Or County which requires a permit t0 construct,alts, improv., demolish,or repair any structure,prior to its issuance also requires the applicant for such BUILT-UP ROOF permit to fila a signed statement that he is licensed pursuant to the provision, of the Contractor's License law (Chapter fessio s (Commencing or that wi In Section 7000) there of Division 3 Of the Business and alleged exemption. tion. or that he is exempt then.. ASPHALT SHINGLES from end the basin for the apermi exemption. Any ant to of Section )031.5 by any th tfive hu fore permit auONcb the applicant Io a civil penalty 01 n0[more twee five the property, dollen r my em WOOD SHAKES I, ti owns of the property,p he employees with wands as[Hair sola fompenbtic. will do me work,and Profess structure if not intended or License WOOD SHINGLES for isle (Sec. apps Business and Profession,who The Contractor's License Law tlo« not such e0 an owner of through who builtls i. improves thereon, and who ro a such work not elfint Lr ed or offered tela own amalle. If,pl.vhowl ver met man improvement. are not Ind with o neyfor cels. If, however,owner OTHER (SPECIFY) CCI S� e building or improvement is sold within or year of completion, me ownerr bumwill have me burden of proving that he tli0 not build or improve for purppsose of sale.). PROVIDE I.C.B.O. REPORT NO. , Contractors Owner st the property, a exclusively contracting with licensed Code: he Contractor's con,tme se Law pec. tap Bto an o antl f properns cod.: Tne orimprovLicense Lew who not apply o an owner of property PROVIDE MFGR. INSTALLATION SPECS. who build' l improves scant t, and who contracts for such projects with a contractor(am licenced pursuant Se m ma Contractor's License Law. .. I am exempt singer Sec ,Bed P.C.IOr this APPLICATION DATE VALUATION PERMIT FEE Owns. Data by WORKERS'COMPENSATION DECLARATION t to ON Ir BUlldln O I hereby affirm that I neve a Certificate of consent to sel4imura,o �• tiwcae O1 Workers'Compensation Imuror ecartifiea cavy maeuf�S.c: ��� �� /� r $eIBmIC\ 1 r1 3800, Lao.C—.1L- _�.' y�,/1 ll�_ C-y_JK19r�i' 57, VV� Policy No.7/l.2N�–TI Company ` Nc y7 eCertified copy it hereby furnished. Total Certified cyDy .filed%0 t�J–<Y impaction division. lf)T1 / �F l' Applicant �QN'K-$ eCCQw1 V 3 1 V CERTIFICATE OF EXEMPTION FROM WORKERS' N.C.O PERMIT AUTHORIZATION DATE COMPENSATI O N I NS URANCE (This section need not be completed it the permit is for one hundred dol , L lar.(8100)or Isss.) .� I cer4fy [hat in ma performance of the work for which this permitis ifwad, 1 shell not employ any person in any manner so as to become subject to ma Work.,.Compensation Laws o1 California. Data Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you mould become subject to the Workers'Compensation provisions of the Labor Coda, You must forthwith comply with such provisions or this permit mall be deemed revoked. All roofs shall be inspected prlorto any roofing material being I certify that I have road this application and state that the above iniorme Installed. If a roof Is Installed without first obtaining an shot a cosec[. 1 tones to comply him en city and anenry ordinances repr and inspection,I a e to remove all materials tori spection ebbs of this scity 0 building in*above and nee pr authorize sprpan� wives of ani.city m enter epos mubova�mantionad property fes.inspection Purpose.. (We) agree to save, indemnify end keep harmless the City of Cupertino awing liabilities,judgments,costs and expanses which may in any way eCCrue against said City in consequence of the granting of this permit. SIGURE OF APF 6ATE 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 • IlOOPING POLICY FOR '1'1111 CITY 01' CUI'EIffINO DUILDING DL•pA11TMLNT SUI)Jl',C'I': Itl. PIIIOIt'I'O ISSUANCE 01; I'L•ItMIT AND INSI'ECI'ION I'l1ASG. Prior to perwil issu:ucc, you must `glee to eowply wilh U.U.C. stondards and umnufocturcts specs 1. ou reroofing. . wit 2. Nc+v l f coking ins oll 'lotor. a 11111:11 liilspith on m J app owd 511.111Ibe oblaiucd froinitthe building riou the inspcclor when the 1ciooGng is cooplcicd. 1. All types of roof 51`11 be iiispccicc prior to any roof bewg inslalled. 4, lu oder to icccivc a linal, you uuist eompicle slcps I, 2, and J. 1,) I'rciaspccliou ar lcar olf approv`l. 2.) In progress inspection approval. 3.) final iuspcc"oil approval. • a.) Opmlblc smoke IICICCIar vclirlc`lion b.) Spark aucsior installation 1, 5. If plywood Is installcll, n plywood nail iuspectiou is required. u will be uijed to Vc ml 6. f ally ial Bossu 10111 cils1ca11irng and rst aibuilditaillillng inspcciort'Vill hiospat .111 sl coining `l lhcht'one.'lll new 141: UNDL•ItSI'AIdD 'I'llfi AIIOVE POLICY ON III:ItOOPING AND WILL COMPLY Wlfll 'I'lIL POLICY c^I's'1 0 01 IIOMI;OWNL•ItS NAME:. ADDRESS: ItliItOOPING COMPANY NAME: AI'I'LICANT'S SIGNA'lME: CITY 01° CUPGITINO • WILDING DL•PAICI'MENT Itcrooflwimvol d APR-21-1995 14:17 TAYLOR ROOFING 40B 9711380 P.01 Clfq of CtL1pC111110 r.o.00%soo CupciWln,CA 95015.0500 10100 I'n�lc Mi Clq na dno,CA 950 14.1255 10U 252-4505 iclrpliunc: l I I rAR:(4olq 252.0751 (;QMMUNITY pCVraoplfll - SMOICI' nr't I C101i'CLII'I'1171Cn'I C CZ COM LIANCG i I unJerstand and comply with Section 1210=a of the Uniforiil Building Code, Sectioo11210-11elutstallediles Wmountedlours tlohe cicilingf orr11wall ill eachcsleepJuglroom and ilea i will deter point. ses1111f exisoliug siill moked dcle �ectoos comply, no new detecloosh�Ihbe 1egtlireJ.sleeping • I>n po t understand the above requirement and certify flat we now lave smoke Jeleclors • installed lhat do Comply. fill S ?II S C ue E I 1'L ICM11UN1Uclt ✓/yam - IT - -- i 1lom.I�0WVNf ILS SIGNAI'UItG: b A:1 L: willWo,r lstitk let }_ T(1T111 Il f]1 APR-21-1995 14:17 TAYLOR ROOFING 408 9711380 P.01 j i 1 • Cit of C"pertillo •� r.o.av+sao C�I,c,Uno,CA 95015.0500 in 100 &vm Avenue Cupc,dnv,CA 75011.1255 Talrphvn0; (4001251,450' 1 rAX:(40111 251.0757 ComMUNITY 101WWrMENT I � I SM�ICI" UG'1'LOil CLRTII J('AhG ��h �QML,IANC ' t ill, Scclion 1210-a of the Uniform I)uilding Code. undcrsland and comply w Section 1210-i1 wilcil lohe cl11 eil lIg orWAR i lleachexceed sleep iq room and Rt olEn detector will be inslallcc, pai ToCCOHlfly located ill <od dclt.1 comply, 6o new w dcicetorosilall1be11sleeping ed11ired. I 1 • I uudersland the above rcquirelnenl and certify that we now have suTolce defectors • insloiicd that do c01111)Iy. Sc i ADDRESS: pIrIiM IT NUM.l3 Ltt:. 1lOMrOWNEIIS SIGNA'hUI _ 1 ' � ., wimvortlls1i11<dcl, ; : _ c APR-21-1995 14:17 TAYLOR ROOFING 408 9711380 P.01 Citq of Ct fl)0 tlflo r.0.0o*wo Cupcillno,CA 95015.0500 10,1011 rOIC Avcnuc •', Cupcllno,CA 950N-1255 Tdc'111rtntc;(40125).-4505 rAX:(40111 751-0753 COMMUNITY UEVCLOrMLNI I Icl U81'IsCT Il CLR'i'Il it C;f� P '�m,UANCG SMS,' I understand and cenglly with Section 1210-a of the Uniform J3ujiding Sh11 Code. o euiresvn11Ill , cllcpilm ection 1210-a ke rqpted0n the acii1>Sor .111 ICICIIsreengrooandf a detector will be installcr , 1t0r Tlosesl(1If exisoliug slmol<ed deleclole colridos c mply,illno new deI doosh�IhUe require) sleeping • II I understand the abavc rcquirenlcul and certify that we now have smoke deleclas • installed that do conglly. oA1G5Q• I ADDRESS: I'LItM IT NU M.0 6R: HOME OW I-.Rs SMNA1'URL:. DATE: I winivord/smlcdet ;• APR-21 1995 14. 17 .. - TAYLOR ROOF-I NG 409 9711380 P.01 Of CU.iicl iflo r.o.I)OX soo .Cuj,ctlinn,CA 95015.0500 r`t 'Cupel lln°'CA, x .. 7elrpholic:(4001251-4511.5 _ . rAR:(10111 152.0757 COMMUNITY UEVEIOPMENT ', _ - ' , SM�ICG UG1'S TOR CLII'1'II ICA'I'C OI' COMPLIANCLV I understand and colnPly with Section 1210-a of the Unifonu Iluilding Code- xcee Section 1210-5 reViresi mountedlrs on the cicilil Sto , f 01, wa l inleacheslcEpIR room and at`n dcicclor will be installer , Min t1sed Igor noscs111lf Y located oliat slain dedie �ectoos couylly,r or nrcn no new deleeloriving access oshall be reit Iired.sleePmg I t ••. I unElcrsland the above rcduircmcnl and certify that we now have smoke detectors installed lhal do Conglly. ADDRESS: 3B4'� I'SItMIT NUMBER: HoMf OWNERS SIGNA'1'UIIG;" - s 2` r DA'I'S: winword/sInkElcl ; I • I TnTAI P_01 i i RPR-21-1995 14: 17 TAYLOR ROOFING 408 9711380 P.01 i Cita of C"pertillo r.o.not Sao CupclUno,CA 9501Yo500 10,100 Inllc MOW Cupclllno,CA 95011.9255 Tclrphunct(4001 252-4505 I WA (40111252-075J COMMUNITY OCVCIOrMCNr; I - - SMOICi" D1 iisC'F.7it �GK'l'lrtrr"l: �l-C- M 'LQANCC - — - I 1 Understand and comply with Section 1210-a of the Ullirornl llu"ding Code. a smoke I Section 1210 a requires whcu repairs to a single ramily dwelling exceed $1.,00 , cictedoclwl�tllycloc, ted In Ili er coe�ridortlor arcalgivomg IccessPic tol roonlluseJ for sleeping point. purposes. Irexuling ernol<ed defectors comply, 110 now detector shall 6c required. • 1 rcquiMiienl and certify that we now (lave smoke delectors uudcrslaud the above • Installed thiel 00 conlply. �j s�73 Note � 1� J ADDRESS! pl:[LMITNUMBER: - ` y 1dOM[>OWNG1tS S1GNA'1'UIIL17 : 14 774 W 17 i • s ��7�f.7s.. 4k-E3Cr1e� winivord/snllidcl' i -• _ mini n_nn O OT/95 11:11 . „�`9�8 5�1 6e99 HYATT SACRAMENTO 4-4 NORTHPOINT HOA f�j002.. .. S 14ORTH70INT HnR P.02 \ �' Th_rS: •:..rtt•K. i1�8 9711:siJN P.Hi � `., • •�'t'i(ti�'iL1�i.41�1C1`�111� :r-'1• ` �' P.C.boo Soo , ,CS.^.Im4.A-Pw: ¢gv.tlne.Cr•4S0,f•CS00 � .• . . CIIIIOII�W.S+•rSGif•Jtl9 '� �, i• ' iclel'�'N�C:(mel or•�;3 1 ' i r. wS-WS1• i 51 Gr:n r up;ls wrlasicrti nlry U011110 Mill Section 1210•n VNIM Wufor:n':luIldir.g CoJe. r > Secliau i;<in 2 rcnuires%imll ro(:nlr8lb r•sivlylo.taml�y d:vellin�,ccwetl 31.006, c mnoke •: C!elCelVi'µ7I! ere 1(1$llti:cd, =uuted On it,*ee131p Ar Wnis in ar.6 S!ezpiuf,COOMA veld {1t u '••1 i;oint eeil:rvliy fosateJ .R ISM e4rlido( or nfor, Sivin, a;.c:ss to :00r.1 vrd for rleeping Inlrnvs s. 1f4sislltlg S:lrokixl dcrec(v1s ev{npt9.ivo new dotaatat shall be I'Muiled. ( '•• ! I!11•JCrpnln! lI S ll?DYC LM(Uire1:IW1r .Utd GEf a} rhAi wr raw I•:vs smoke dalmaois inanikd Ihnl do mnr(•ly. I tipA�liaWyf'!kS$IONA'ruRLT: �t :e:.cc�`�3 'V AIM 1 . '+�;� • X4.1:' . •� ., ,1 .. .. i h RPR-21-1995. 14: 17 TAYLOR, ROOFING 408 9711380 P.01 _ I Cit 0f CMIlC1#0104 r.o.nv.500 CapclUnn,CA 95015.0500 TOIIHI Inur.Avenur. - Cigreillnv,CA 75011.7255 irlr,p6nnc;IA00) 252-4505, - I I M%:(40111252-0753 COMMUNrrY UCV@IOrMENl' i i w w SMTUE L �'rnft CL'!L'I Il71CATE F C M °LIANCL ! 1 undcrsland and comply will, Section 1210•n of t11e Uniforlll T)Uilding Code- I I Section 1210 a r ilalallcdWmounledilcil llotrloha sil ccil,Sf orlilwnll`inleachlln esleepJuglroom and Okn dcicccess to t or po1nt scsllllf c elol at d '11'ced delecloos comply, n0 new de ectorr shall I be edltil- sleeping cd- • pin o l bove requircnlelll and certify ,hal we nolo have smoke Jelecta's understand the a •I insloilcd Thal do Comply. ' IOSE3 AJOR'TNOAK 54 . ! ADDRESS: pI;RM iTNU M,u cli: IIOMr0WN(_RS.SAll IGNAI'URL: i DATE: winwotd/snikilcl `' ., •., . . '.