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R-4616 (2)• • OFFICE COPY PERMIT 4 616 APPLICATION FOR CITY of CUPERTINO NUMBERR_ INSPECTION DIVISION PERMIT EXPIRATION REROOF PERMIT (408) 777-3228 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. BUILDING ADDRESS Y ��� /(J RESIDENTIAL ' " COMMERCIAL OTHER OWNER'S f HAZARDOUS FIRE AREA syr // ^ ' .w A/y. �� VES ❑ Class A ^ NAME 1/�(.L/ lrtici /��L"`�e'!� e roof assembly strequired, EXISTING ROOF COVERING ADDRESSl�S / &L 'P'e'e 1�L /� PHONE �Cprig, NUMBER OF EXISTING COVERINGS CONTRACTOR'S �A' A TO BE REMOVED TO BE RETAINED NAME �O C �f- �L� ADDRESSU PE OF ROOF COVERING CITY&ZIP T ACC il ��- EXISTING Z S G PHONE BUILT-UP ROOF ❑ LICENSE /�G{ Com' p NUMBER c T '� / 0 ASPHALT SHINGLES ❑ LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter g (commencing with Section WOOD SHAKES 6], 7000) of Division 3 of the Business and Professions Code, and my license is In full force and effect. a L� e vJ^ 3 Y K pry WOOD SHINGLES ❑ License Class ,��- Lic. Number �'S <CJ �,sA � y S S ��'� OTHER (SPECIFY) ❑ Data comma., 274.1 /G -t'! OWNER -BUILDER DECLARATION PROPOSED I hereby affirm that I am exempt from the Contractor's License Law for the fallowing reason. (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to Its Issuance, also requires the . BUILT-UP ROOF Elapplicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter g (commencing with Section 7000) of Division 3 of the Business and Professions Code) Cr that he Is exempt therefrom and the basis for the alleged ASPHALT SHINGLES ❑ exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): WOOD SHAKES 01, as owner of the property, or my employees with wages as their role compensation, will do FLK the work, and the structure Is not Intended or offered for sale (Sec. 7044, Business and Profes. sions Code: The Contractor's License Law does not apply to an owner of property who builds or WOOD SHINGLES ❑ improves thereon, and who does such work himself or through his own employees, provided that such improvements are not Intended or offered for sale. If, however, the building or Improvement Is sold within one year of completion, the owner -builder will have the burden of proving that he did OTHER (SPECIFY) ❑ not build or Improve for purpose of sale.). I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code : The Contractor's License Law does not PROVIDE I.C.B.O. REPORT NO. apply to an owner of property who builds or Improves thereon, and who contracts for such projects with a contractogs) licensed pursuant to the Contractor's License Law. PROVIDE MFGR. INSTALLATION SPECS. 1 am exempt under Sec. ,B & P. C. for this reason Owner Date APPLICATION DATE VALUATION PEPIMIJT FEE WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declaration: ❑ 1 have and will maintain a Certificate of Consent to self -Insure for Worker's Compensation, Building as provided for by Section 3700 of the Labor Code, for the performance of the work for which this Issued. T C• permit is C]I have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit Is issued. My Worker's �x + 2 1 95 0V Seismic Compensation Insurance carrier and Policy number are: Ur ,& Total (xUr-hN r Carrier Policy No. PERMIT AUTHORIZATION DATE CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE N.C.O (TMs section need not be completed It the permit Is for one hundred dollars ($100) or lass.) I certify that In the performance of the work for which this permit is Issued. I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of Car- All roofs shall be inspected prior to any roofing material being fornia. installed. If a roof is installed without first obtaining an Date Applicant inspection, I agree to remove all new materials for inspection. NOTCE ecome cate of Exemyou ANT: 11, after making this llLabor I. 'Compensation Compensation Applicant understands and will comply with all non point subject the provisions of the Code, Musttion,uforthwishoulthbcomply with such provisions or this permit shall be deemed revoked. source regulations. I certify Nat I have read this application and state that the above information is Correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and All rogf coverings be class "C" or better. in- hereby authorize representatives of this city to enter upon the above-mentioned property for In- spection purposes. (We) agree to save, Indemnify and keep harmless the City of Cupertino against liabilities, /,� judgments, costs and expenses which may In any way accrue against said City In consequence SIGNATURE OF APPLICANT D of the granting of this permit. 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 ACCESSTO ROOF SHALL BE PROVIDED FOR INSPECTION OFFICE COPY ' 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 HOMEOWNERS NAME: ADDRESS: REROOFING COMPANY NAME: APPLICANT'S SIGNATURE: CITY OF CUPERTINO BUILDING DEPARTMENT 0 RerooOwinword U 1(e "dl vl y�ly0 Z