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R-4130 (2) PERMIT APPLICATION FOR CITY OF CUPERTINO NUMBER R- 413 0 REROOF PERMIT INSPECTION DIVISION PERMIT E I TI NN PERMIT EXPIRES IF WORKORKOT STARTED (408) 252-4505 EXT. 228 WITHIN 180 DAYS OF PERMIT ISSUANCE OR 1 DAYS FROM LAST CALLED INSPECTION. BUILDING ADDRESS yet' � ,,p =ILDING X0165— 0/?,I !xvJz' 7v RESIDENTIAL OTHER OWNER'S NAME M/L . 7 ry) ife-2c ne LAG HAZARDOUS ROOF - i� /��I FIRE COVERING J}' AREA CLASS _�L.� ADDRESS OGS O/L/�i�IVG-e /�-r�2 EXISTING ROOF COVERING NUMBER OF EXIS=TO GS PHONE CONTRACTOR'S NAME WCx.Gh Pir TO BE REMOVED BE RETAINED RE ;7 p TYPE OF ROOF COVERING DD CIT& ZIPE.O go A �S_1583 Hoyrr e �.rwn CI�L�� EXISTING PHONE 7/ 7- 03-3 S BUILT-UP ROOF LICENSE ASPHALT SHINGLES NUMBER G-72N2_8WOOD SHAKES LICENSED CONTRACTORS under DECLARATION here1 With S affirm 7000 I of ivi, ee unser provisions of Chapter ....Code, ciao with Section 70001 of Oivbion 3 of the Business dna Pmfneions cos.. WOOD SHINGLES and" renes hif rya and affect. License Cie.- Lic.Number 7 Dat. Contractor OTHER (SPECIFY) OWNER BUILDER DECLARATION I hereby affirm that I am exempt Rf from the Contractor's License Lew or PROPOSED the following reason. (Sec. 7031.8, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, aemolifn,or r.p.i.an,structure, prior to et.e.+u. also requires the applicant for such BUILT-UP ROOF permit to file a signed statement that is licensed pursuant to the provisions of the Contralto:. License La/ (Ch ser 9 (commencing with Section 7000) of Div;+;on 3 of tuna Bounds. Prof $$ions Code)or that he is exempt there ASPHALT SHINGLES from .ntl tuna belie rear m a age motion. Any violation of Section 7031.6 by any applicant 1 e er 1 blects the applicant[o a civil penalty of not mo..m.e re,.npnid II . OOH: WOOD SHAKES ❑ I,es gwner of me r rty o y employees with wages efo nadir tole .mpamation,ww do m w n m .vucture not intended nerve WOOD SHINGLES Ior uta (sec. )044, Bu$; ass en P faesiom Code: Tree ConnecrorY License Lew does not apply to an own of property who build$or improves thereon, A��++✓,w/ /��I) _ 4 red who doesrove ant work noose. or ed!o r o nes own employees, however, [hat the Cc I wen in, or .mot+ are rept old vita o. offered for fele. n, , the o the OTHER (SPECIFY) builder o. have th bur ;s sold wetness one year or completion,or [ate owner `y builder will have the burden or proving that he die not build or Improve for / purpose of sale.). PROVIDE I.C.B.O. REPORT NO. ❑ 1, as owner of the property, am exclusively contracting with licensee con Vac7ors to construct the prole.[ (Sec. 7044, Business and Professions Code: Tho Contractor's License Lew does not apply to an owner of property PROVIDE MFGR. INSTALLATION SPECS. who builm or improves [hereon, and who contracts for such prolec[f with e cont recurs)licensed pursuant to the Contractor's License Law. ❑ 1 em exempt under Sec. ,B.&P.C,for this r....h APPLICATION DATE VALUATION PERMIT FEE Owher Date WORKERS'COMPENSATION DECLARATION Q Building hereby affirm that I neve a cerffl.e[e of consent to self insure,or a car tificeto of��WLob��o'�rk.e�rv.�/C•o/m! penution Insurance, or a certified copy thereof(Sec. Seismic � Polliice N.j LIIh%ll-lS Company NzJe , vh J pp��Ce.urea copy i+no.b furnished. Total 8 Q�p ",� fJ�C (�i1E)ycopy i+file thi city inspection di.m... Applicant�_1(�}'/-COQ ( CERTIFICATE OF EXEMPTIONFROM WORKERS' N.C. D ElPERMIT AUTHORIZATION DATE COMPENSATION N S URANCE IThb,section need not be completed if the permit is for one hundred do' p ✓ 1 ' Q Lr.(s100)o.IMS.), pp ( / zZ� I certify that In the performance of ma work for which Ti+ pa root is �� `1 (C I: J issued, I shell not employ any parson in any manner so as to become subject 'n to the Workers'Compensation Laws of California. Deb Appem 2 1995 NOTICE TO APPLICANT:NT: 11, after making this Certificate of Exemption, bFP you should become subl«t to the Workers' Compensation provisions of the Labor Coad. you must forthwith comply with such provisions or this permit All roofsshall be inspected prlortoany roofing material being Snell be deemed revoked. I certify that I have read this application and state that the above;nformainstalled If a roof'is IniStalled-without first obtaining an Hon is correct agree to comply with all city and county ordinances me InapeCtl00�1 agree to remove all new materials for Inspection. .let. I•ws rel.ting to building construction, and hereby authorize ropresem Tway of this city m an...upon the above mentioned property for inspection �. ou rpo.es. —•�Y) a (We) agree to $ave, indemnify and keep harmless the City of Cupertino uainR Ii.bili Hes,judgments.costs and expense which may in my way accrue `�- against boa City;n consequence of[ate granting of this permit. SIGNATURE OF APPLICANT 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 I Citi] of C>apertino SMOKE DETECTOR CERTIFICATE OF CONLPLIANCE I understand and comply with Section 1210-a of the Uniform Building Code. I Section 1210-a requires when repairs to a single family dwelling exceed $1;000, a smoke detector will be installed, mounted on the ceiling or wall in each sleeping room and at a point centrally located in the corridor or area giving access to room used for sleeping F / purposes. If existing smoke detectors comply, no new detector shall be required. I understand the above requirement and certify that we now have sm Ike detectors installed that do comply. ADDRESS: 1 0 (,o D fZ-Pry G-- PERIVUT NUMBER: HOMEOWNERS SIGNATURE: DATE: i I • winword/smkdet I SUBJECI': REROOFING POLICY FOR TILL• Cl'I'Y OF CUPERTINO BUILDING DEPARTIAENi' PRIOR TO ISSUANCE OF PERivUT AND INSPECTION PHASE. 1. Prior to pertttit issuance, you must agree to coutply with U.B.C. standards and manufacturers spec's on reroofing. 2. New roof coverings 51,311 not be applied without first obtaining all inspection and written approval front 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 Illus(complete steps 1, 2, and 3. I,) Preinspection or tear off approval. 2.) ❑t progress inspection approval. • 3.) Final inspection approval. a.) Operable smoke detector verification b.) Spark arrestor installalioll S. 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 Rel material down to the sheathing and a building inspector will hispect all sheathing at Wal little. WE UNDERSTAND THE ABOVE POLICY ON REROOFING AND WILL COMPLY WITH TILE POLICY IIOIAEOWNERS M E: ADDRESS: REROOFING COMPANY NA,VIE: \�/�V APPLICANTS SIGNATURE: • CITY OF CUPERTINO BUILDING DEPARTMENT Reroof/winword v ' CITY OF CUPERTINO BUILDING DIVISION 408-777-3223 RE-ROOF TEAR OFF POLICY I. You must schedule an inspection for the tear off die day before lire date you wish die inspection to be made. The procedure is to call lire Building Division(777-3228)between die hours of 12:30 and 4:00 p.m.for next day inspection. 2. When the roof is torn olr, the nails rcmoved or driven in and all of lie dry rotted wood has been replaced, THEN YOU MUST CALL 111E CITY BUILDING DIVISION. An inspector will be notified drat the roof is ready, and he will respond to do the inspection as soon as his schedule will • allow. There are special hours for fids service between 8:00 am. and 11:00 am., and between 1:00 and 3:00 p.m. IF YOU CALL FOIL TIlE'I'EAR-OFF INSPECI'ION AND TILE JOB IS NOT RL•ADY,TllEitE WILL BE A RE-INSPECI'10N FEE OF $69.00 CIIARGED, WHICH MUST BE PAID BEFORE ANOTHER 1NSPECIJON IS MADE A rerooUwiuward • Citll of curerii»o SMOKE DETECTOR CERTIFICATE OF COMPLIANCE 1 understand and comply with Section 1210-a of the Uniform Building Code. Section 1210-a requires when. repairs to a single family dwelling exceed $1,000, a smoke • detector will be installed, mounted on the ceiling or wall in each sleeping room and at a point centrally located in the corridor or area giving access to room used' for sleeping purposes. If existing smoke detectors comply, no new detector shall be required. I understand the above requirement and certify that we now have smoke detectors installed that do comply. ADDRESS: PER1VUT NUMBER: HOMEOWNERS SIGNATURE: DATE: I • winword/smkdet I