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R-3984 (2) PERMIT R_ 3984 APPLICATION FOR CITY OF CUPERTINO NUMBER INSPECTION DIVISION PERMIT EXPIRATION REROOF PERMIT (408,252-4505 EXT. 228 WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. • BUILDING ADDRESS BUILDING USE to 1 k RESIDENTIAL COMMERCIAL OTHER OWNER'S HAZARDOUS ROOF NAME A�'1!l 71-049 SQC FIRE D COVERING AREA CLASS ADDRESS EXISTING ROOF COVERING NUMBER OF EXISTING COVERINGS PHONE CONTRACTOjf '.S— A P 5�1` �` TO BE REMOVED TO BE RETAINED NAME `I1 \_�'� A TYPE)DF ROOF COVERING ADDY CITa SS IP �� V�ti t"�. l-� EXISTING PHONE q b 3 4h BUILT-UP ROOF LICENSE :PtROPOSED LES NUMBER AKES LICENSED CONTRACTORS DECLARATION I hereby affirm that 1 am litmus linear provisions of Chapter s ons Code, cine suites Section full of an don 3 of the Business and Professions Code, IN LE$ and my Cienu if In lull torts and effect. Salines clan Contractor PE FYIAll Dote Comracwr OWNER BUILDER DECLARATION If I hereby affirm that I em exempt from the Contractor's License Lew for IM following reason. Ise<. )0]1.6, ensinafs antl Pmbesions Catle: Any city or c unty which requires a permit t0 construct,alter, Improve, 0emolish,Or ripe,any structure, prior to its issuance, also requires the applicant for such permit to 'I.a signed statement that he is Iicansed pursuant to the proviflonsofhe Contractori License Law (Chapter 9 (commencing with Section)0001Lero+ Division 0 of me Business end Professions Code?or that ate is exempt mare SHINGLE �'{� N berm •ata the basis for the aliens exemption.the Any ant to Section )031.6 by any th t ive hu for a permit subjects me applicant t0 a civil penalty or not mora met five the property, dollars r my e.): $ I, ti owner OI ma property, or he smpture is with wages as Mair fold ,or (Sec. will do thesin work, and ma structure is not intendedntrto 's offeree for lila (Sec. 7044, euansf andnet f property Code: The Contractor's License WOOD SHINGLES Lew woes not apply to an owner o+ hr property who builds to improves maroon, dna who noes ant work himself or ed or offered niown amalle. 11, provided that wan ng or iamrov ere his ;Manses o. neyfor fele. It, however.hownerthe OTHER (SPECIFY) buil dery or have Pyemia 'd sole within one veer of complexi or ma builasr will have the burden of proving that he did not build or improve toe P of PROVIDE I.C.B.O. REPORT NO. I, as owner of the property, am exclusively contracting with licensed ontra< n to construct the project (Sec. )044, Business and Profession$ Code: TheContracm:sLicense Law does nmapply toanowner ofproperty PROVIDE MFGR. INSTALLATION SPECS. who builds or mprovas thereun, and who contracts for such projects with e contrw tor(s)licensed pursuant to the Contractor's License Lew. On m I am exempt ands. sec. ,B.aP.c,for i` tea PPLICATION DATE VALUATION PERMIT FEE Ow Date her WORKERS'COMPENSATION DECLARATION 1Ag� Buildin ---r.--- I hereby affirm that I have a certificate of consent to self insure,or a car �e''(L/MI� tificeb of Workers Compensation Insurance,or a certified Copy thereof(sec. fill�� Seismic 3800,Lab.Cd. �Y C/p Policy No. Company � 8 Certified copy is narabv tisn.a. LUN 000 Total Certified copy if filed with t oath city impaction division. Applicant CERTIFICATE OF EXEMPTION FROM WORKERS' N D ❑ PE MIT AUTHORIZATION DATE COMPENSATION INSURANCE (This section nue not be completed if the permit if for one hundred sol- Ian If a00)or that i I certify Inst m tate ,any Person of the work for aswhich [ria permit if iouee, I snail not employ ion Lenon In any Manner so as to become subject to the Workers Compensation Laws of California. Data AT: If, NOTICE should APPLICANT: o he Workers'making this Cartiensati n p of Exns ofithe Lau moats b coma subject w the mply Comph such provisions ns or ham of ma Labor Code,vera moot forthwith comply with such oroyiaon.ar this permit All roofs shall be Inspected prlorto anytoofing material being shall has seemed revobd. I certify that I neve read this aopllution and stat.mat the above inlorma Installed. If a roof is installed without first obtaining an non Is correct, l tarn to comply with all city and county ordinances and ins, I I agree to remove all new materials for inspection. mu laws relaxin, xo building construction, and narabv autho rice npresem tatives of this city to enter upon the above-mentioned property for inspection purPo.ef. Z IW 1 eprse to live, indemnify and keep harmless the City of Cupertino against Ilabilities,judgments,costs and expenses which may In any wry etcrw against Said City in consequence of the granting of this permit SIGNATU OF APPLICANT DAT PRE-INSPECTION: PLYWOOD: It 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 POR THE CITY OF CUPERTINO BUILDING DEPARTMENT PRIOR TO ISSUANCE OF PERMIT AND INSPECTION PHASE. L Prior to pennit issuance, you ums( agree to comply will' U.B.C. slaudards and manufacturers spec's Oil retooling. 2. New roof coverings shall not be applied without first obtaining all inspection and written approval from the building inspector. A final iuspectiou and approval slmll be obtained from the building inspector wlren the reroofing is completed. 3. All types of roof shall be inspecled Prior to any roof being installed. 4, lit order to receive a final,you must complete steps 1,2, and 3. l,) Preinspection or tear off approval 2.) In progress inspection approval. • 3.) Final iuspectiou approval. a.) Operable smoke detector verification b.) Spark arrestor installation 5. If plywood is installed,a plywood nail inspection is required. G. Ir any roof is applied without first obtaining air iuspection, 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 'PILE ABOVE POLICY ON REROOFING AND WILL COMPLY WITH THE POLICY IIOMEOWNEItS NAME: p.lM LL v r r �v� S ADDRESS: l7 -A n �� REROOFING COMPANY NAME: Dg APPLICANTS SIGNATURE: • Cfl'Y OF CUPERTINO BUILDING DEPARTMENT Reroof/winword I I Citta of Cupertino SMOKE DETECfOR 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 sm Ike detectors installed that do comply. ADDRESS: I o �0 PERMIT NUMBER: rz,— 3 ci 8 HOMEOWNERS SIGNATURE: — DATE: Z k Si I winword/smkdet I I