R-4046 (2) PERMIT R_ 4046
APPLICATION FOR CITY OF CUPERTINO NUMBER
INSPECTION DIVISION PERMIT EXPIRATION
REROOF PERMIT
(408) 252-4505 EXT. 228 PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
IN DAYS FROM LAST CALLED INSPECTION.
BUILDING ADDRESS /J BUILDING USE
75?g5 1&t4giCrp'1.4J //f RESIDENTIAL COMMERCIAL OTHER
OWNER'S
/// HAZARDOUS ROOF
NAME�— /pl 4.AYL[/ Q/Y[/ FIRE COVER
AREA &—rCLASS ING
ADDRESS —� EXISTING ROOF COVERING
PHON /.f _2_ — 7/7 6 NUMBER OF EXISTING COVERINGS /
CONTRACT��RR'S/,
y` � TO BE REMOVED TO BE RETAINED
NAME ��-�"T TYPE OF ROOF COVERING
ADDRESS /9470,', (i►1 dc�
EXISTING
PHO
--$
PHON0. q Its 1 56 —f 76 y 57 BUILT-UP ROOF
LICENSEASPHALT SHINGLES
NUMBER 2-610 9`1 WOOD SHAKES
LICENSED CONTRACTORS DECLARATION
1hereby affirm that I am licensed under provision$of Chapter 9(common
cing Wim Section 7000) of Division 3 of the Business and Profession.Code, WOOD SHINGLES
and my cense Is full f e and etfac t. ��
License Cll��q _moi Lic.Number
Dec. " Contractor y OTHER (SPECIFY)
OWNER-BUILDER DECLARATI
1 .rebv affirm her a am exempt from the Contractor. License Lew!or PROPOSED
the fhollowing....... (Sec. 7031.6, Business and Professions Code: Any city
or county which require. a permit to construct, alter, improve, d"ricltsh,Cr r Q
repair any n.uclove, prior to its issuance,also require.the applicant for such BUILT-UP ROOF ^r
permit to ills a signed statement that he ts licensed pursuant to the provisions
of the Contractor', License Law (Chapter 9 (commencing with Section 7000) Q4
or
Division 3 of the Business and Professions Coda)or that he is exempt there- ASPHALT SHIN&ES'D"7 ,l.'
from and the basis for this alleged ...motion. Any violation of Section /�
7031.5 by any pp int fore permit subjects the applicant m a civil penalty
of not more that five hundred dollars( 600).): WOOD SHAKES YUF 19.E
❑ I,as owner of ma property, or my employees with wages as their sole LUfj
compensation,will do the work, and the structure is not intended or offered WOOD SHINGLES �yT/Nn
for sale (Sac. 7044, Business and Professions Code: The Contractor's License
Law does not apply t0 an owner o1 property who build$or impr Ove$thereon,
and who do"such work himself or through his own employees,provided that
such improvements are not intended or offered for ..I.. If, how"er, he OTHER (SPECIFY)
building or improvement i sold within o . vee of c mpletion, me ownerr
builder will neve the burden of proving that he did not build or improve for
purpose of sal..). PROVIDE I.C.B.O. REPORT NO.
❑ I, es owner of the property, r e.clusivaly contracting with licensed
contractors to construct the prolan (Sac. 7044, Business and Professions
Code: The Contractor's License Law does not apply to an owner of property PROVIDE MFGR. INSTALLATION SPECS.
who build. o improve*thereon, and who convects for such projects with a
contractor(s)liensed pursuant to the Contractor's License Law.
❑ I am exempt under Sec. ,B.GP.C,for this
reason APPLICATION DATE VALUATION PERMIT FEE
Ow Dau
her WORKERSCOMPENSATION DECLARATION Building asels
1 hereby affirm the, I have a certiti .l. f consent to self intuit,0,a car L.
,ificeta of Worker)Com pen.a,..n In yy or certi bge)co�,y thereof lS/ J �6�5 ��/f/f ��y Seismic
Polis No. ��p_q %Ie-Ce D/!', J_-{_ _msµ 0{J LJL/
Policy Na ��GG moan/ ' A'�•�"'ra/TIFF//��Lll9R/7i(14ti
15CC.nified copy is herby f cion d. on Total
O-Cartifils IF s dw' tpa ci�'�(�spa dog d('vki
APPlic.nt _moi 4L'CG f N
CERTIFI ATE OF EXEMPTIO FROM WORKERS' N C ❑ PERMIT AUTHORIZATION DATE
COMPENSATION INSURANCE
(This$action head not be completed if the permit I.for one hundred dol
la
r.(S10D)or I"..,
1 certify that in the performance of the work for which this permit is
to Workers', I keel not employ any Lenn
on In any manner ass as to become subject
to the WorkCompensation Lew.of California..
Data Applicant
NOTICE TO APPLICANT: o alto making this Certificate of Exemption,
ubecomesubjectyoshould become subject t the Workers' Compensation provisions of the
Labor Code, you must forthwith comply with such provisions or this permit All roofsshall be Inspected prior to any roofing materialbeing
.Cell be deemed revoked.
I certify that I neva rend this application and state that the above Informs. installed If a roof Is installed without first obtaining an
tion is correct. I egreat to comply with all city and county ordinances andinspection, gra o remove all new materials for inspection.
.,at. laws relating to building construction, and hereby authorize represent
t"ives of this city to enter upon the above-mentioned property for inspection
purposes.
(wit) sewm /�
I agree ,o , indemnify end keep harmless e City of Cupertino �[,/ ,N� �J
against liabilities,judgments,coats and expenses which may in any way accrue
' against said City in consequence of the 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
SH.190NO ' . .
SMOKE DETECTOR CERTIFICATION
I understand and agree to comply with Section 1210 (a) of the
Uniform Building Code.
In general, Section 1210(a) of the Uniform Building Code requires
that when repairs to a single family dwelling exceed $1, 000, smoke
detectors must be installed in various locations in the building in
accordance with the requirements for a new group R, Division 3
• occupancy. A copy of Section 1210 is attached. If existing smoke
detectors comply, no new detectors shall be required.
I understand the above requirement and certify that smoke detectors
have been installed that comply with Section 1210 (a) of the Uniform
Building Code.
�
Address:
Permit Number: 02—IKO`r
rrvv��
Homeowner Signature: � /�� J�Date: 9f
Note: Project will not be granted final approval without this
signed certification.
Please return this form to the SHELTON ROOFING COMPANY, INC.
1988 Leghorn .Streat Mountain View, CA 94043.
•
Sec. 1210. (a) Smoke Detectors. 1. General. Dwelling units, congregate resi-
dences and hotel or lodging house guest rooms that are used for sleeping purposes
shall be provided with smoke detectors. Detectors shall be installed in accordance
with the approved manufacturer's instructions.
2.Additions,alterations or repairs to Group R Occupancies.When the valu-
ation of an addition, alteration or repair to a Group R Occupancy exceeds $1,000
and a permit is required, or when one or more sleeping rooms are added or created
in existing Group R Occupancies,smoke detectors shall be installed in accordance
with Subsections 3. 4 and 5 of this section.
3. Power source. In new construction, required smoke detectors shall receive
their primary power from the building wiring when such wiring is served from a
commercial source and shall be equipped with a battery backup.The detector shall
emit a signal when the batteries are low. Wiring shall be permanent and without a
disconnecting switch other than those required for overcurrent protection. Smoke
detectors may be solely battery operated when installed in existing buildings; or in
buildings without commercial power; or in buildings which undergo alterations,
repairs or additions regulated by Subsection 2 of this section.
4. Location within dwelling units. In dwelling units, a detector shall be in-
stalled in each sleeping room and at a point centrally located in the corridor or area •
giving access to each separate sleeping area. When the dwelling unit has more than
one story and in dwellings with basements, a detector shall be installed on each
story and in.the basement. In dwelling units where a story or basement is split into
two or more levels, the smoke detector shall be installed on the upper level,except
that when the lower level contains a sleeping area, a detector shall be installed on
each level. When sleeping rooms are on an upper level, the detectorshall be placed
at the ceiling of the upper level in close proximity to the stairway.In dwelling units.
where the ceiling height of a room open to the hallway serving the bedrooms ex-
ceeds that of the hallway by 24 inches or more,smoke detectors shall be installed in
the hallway and in the adjacent room. Detectors shall sound an alarm audible in all
sleeping areas of the dwelling unit in which they are located.
5.Location in efficiency dwelling units,congregate residences and hotels.In
efficiency dwelling units, hotel suites and in hotel and congregate residence sleep-
ing rooms,detectors shall be located on the ceiling or wall of the main room or each
sleeping room. When sleeping rooms within an efficiency dwelling unit or hotel
suite are on an upper level, the detector shall be placed at the ceiling of the upper
level in close proximity to the stairway. When actuated,the detector shall sound an
alarm audible within the sleeping area of the dwelling unit, hotel suite or sleeping
room in which it is located. •
SUB1ECf: REROOFING POLICY FOR 7llE CITY OF CUPERTINO BUILDING DEPARTrb1ENT
PRIOR TO ISSUANCE OF PERMIT AND INSPECTION PHASE-
1. Prior to penult issuance, you ,lust agree to connply with U.B.C. standards and ma,urncturers spec's
Oil reroofing.
2. New roof coverings shall not be applied wilhoul first obtaining all inspection and written approval
from the building inspector. A final inspection and approval shall be obtained from the building
inspector winen llne reroof ig 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.
l,) Preiuspection or fear off approval.
2.) In progress inspection approval.
• 3.) Final inspection approval.
a.) Operable smoke detector verification
b.) Spark arrestor iuslallatimn
5. If plywood is installed, a plywood nail inspection is required.
G. Ir any roof is applied without first obtaining an inspection, you will be required to remove nll new
material down to the shcalhing and a building inspector will inspect all sheathing at Wal lime.
WE UNDERSTAND THE ABOVE POLICY ON REROOFING AND WILL COMPLY WITH TILE
POLICY
I IO1vIEO W NERS NAME: ...Ltl�ll/!ZL Pi �/�l
ADDRESS:
REROOFING COMPANY NAME:
APPLICANTS SIGNATURE: a
•
CITY OF CUPERTINO
BUILDING DEPARTMENT
RerooUivinword