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R-4406 (2) f PERMIT APPLICATION FOR CITY OF CUPERTINO NUMBERRoa 4406 INSPECTION DIVISION PERMIT EXPIRATION REROOF PERMIT (408) 252-4505 EXT. 228 YETHIN 180 DAYS OF PERM T NOT OR 180 DAYS FROM LAST CALLED INSPECTION. BUILDIN ADDRESS �--� - BUILDING USE / G i RESIDENTIAL COMMERCIAL OTHER O E FVS� 5 itU I^C l HAZARDOUS ROOF NAME — 4 COVERINGFIRE AREA I CLASS ADDRESS �I / EXISTING ROOF COVERING PHONE O V NUMBER OF EXISTING COVERINGS CONTRACT R'S \ TO BE REMOVED---I— TO BE RETAINED NAME r_j1` V TYPE OF ROOF COVERING ADDRESS CITY&Zlh c v EXISTING PHONE- 7_S ^J Q/ BUILT-UP ROOF LICENSE 6 '-7 ASPHALT SHINGLES NUMBER LICENSED CONTRACTORS DECLARATION WOOD SHAKES n� I hereby affirm Met I o0)licensedun tl tlar pion of Chepb rovisr 9 Ica .1.9 with Section 70DO) of Divi.ion 3 of Ma Bu.)ne. ne Professions C ya, D SH INGLES and my license 1.In f 11 fo��<a fact. Lienee LIa N.mbe' \ R (SPECIFY) Data Contractor bVJNeR BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law forOSED the following reason. (Sec. 7031.5, Business and Profession.Code: Any city or county which requires a permit to construct, altar, improve, demoliM,or repair any structure,prior to Its issuance,also requires the applicant for such I LT-UP ROOF permit to ills a signed statement that he is licensed pursuant to the provisions of the Contractor. License Lew (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code)or that he is exempt Mere ASPHALT SHINGLES from end an basis for the f perms exemption.the Any violation of Section from d any applicant for a permit empti n. Any ant tp e civil Section of not more that five hundred 1011.,.($500).): WOOD SHAKES ❑ I,as owner of the property, or my employees with wages as their sola cam pen.btion,will do the work,and the a,,u"u,. is not intended or offered for sole (Sec. 7044, Business and ProfmsionsCode: Th.Contnctnn License WOOD SHINGLES Law dose not apply to an owner of property who builds of 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, he OTHER (SPECIFY) building Or improvement is sold within one year of completion, Me Owner Iullder will have the burden of proving that he did not build or Improve for purposeof sate.). PROVIDE I.C.B.O. REPORT NO. C] I, as owner of the property, am exclusively contracting with licensed Comrectors to construct the oral act (Sec. 7044, Business and Professions otle: The Cool+actor's License Law does not apply to an owner of property PROVIDE MFGR. INSTALLATION SPECS. who builds or improves thereon,and who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law. ❑ 1 am exempt under Sec. ,B.&P.C.for this reason APPLICATIONDATE VALUATION PERMIT FEE owner Date WORKERS'COMPENSATION DECLARATION P A I ID /© f*_�Q tlJ Building I hereby affirm that 1 have a certificate of consent to set insure,or a car tific.xa of�W�Lob,�Qorks,.� ��Co��m//p'ensation Imran e,or certified c Pv thereof ISec. S@ISi111C PolO'�Ov No.fxs�s Company or(_;,e, G p�,p 'I p�Eartified copy I.hereby furnlshcd. JfF2E® �+ RE Total Q Certified c py t%r ed with tba �y�In ban o division. Applicant 1 4 S d t lrl tlo x—� 0) r ,( .. CERTIFICATE OF EXEMPTION FROM WORKERS' r Ft ' IT UTHORIZATION DATE COMPENSATION INSURANCE N.C. ❑ (This section need not be completed if the permit is for one hundred hob Ins 151001 or less.l certify MM I cefy at in the performance of e work for which this vermix I. io e, 1 anal not employ any Lenon any manner.o es to become subject to the Workers'Compensation Laws of California. Data Applicant NOTICE should APPLICANT: If,o hire. making this Certificate of Exemption, you .houltl become subject i the Workers'Compensation ns or this a Me Lobar Code,ed r must forthwith comply with such provisions or this permit All roofs shall be inspected prior to any roofing material being Mali be tlaematl evoked. 1 certify that I bve reatl this apOlicbtion end saae Ma M..Day.mmrm. installed. If a roof is installed without first obtaining an :ion is correct. I .gree to comply s with all city and county ordinances and inspeF4i I agree to a v@ all new materials for tion. to laws r.lbting to building [ruction, and hereby authorize repre.am (\l tetives of this city to enter upon Me above mentioned property lot Inspection \ purposes . we) agree to save, indemnify and keep harmless the City of Cupertino .gains,liabilities,judgments,costs and expenses which may in any way accrue against said City in consequence of the granting of this permit. SIG E OFA PLICAI T DA 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 • SUBJECT: REROOFING POLICY FOR THE CITY OF CUPERTINO BUILDING DEPARTMENT PRIOR TO ISSUANCE OF PER,2&QT AND INSPECTION PHASE. 1. Prior to permit issuance, you must agree to comply with U.B.C. standards and tnanufacnuers sec's an reroofing. 2. New roof coverings shall not be applied without first obtaining all insect ion 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. AVE UNDERSTAND THE ABOVE POLICY ON REROOFING AND WILL CObfPLY WITH THE POLICY HOMEOWNERS NAME: rc ADDRESS: /. . REROOFING CObIPANY NAVE: APPLICANT SIGNATURE: CITY OF CUPERTINO BUILDING DEPARTMENT • Rerooflwinword