R-3859 (2) PERMIT
APPLICATION FOR CITY OF CUPERTINO NUMBER Res 3859
REROOF PERMIT INSPECTION DIVISION PERMIT EXPIRATION
(408) 252-4505 EXT. 228 PERMITNOT STARTED
THIN 180 DAYS OF PERMIRK T ISSUANCE OR
/— U00 IN DAYS FROM LAST CALLED INSPECTION.
BUILDING ADDRESS 1 , f/' `7�/ BUILDING USE
w S. �yTEl-�-jJC RESIDENTIAL y` COMMERCIAL OTHER
OWNER'S //'' ,V/
�
NAME Oki ✓L� 0 1) tZ1 HAZARDOUS ROOF
FIRE 00 COVERING
AREA CLASS
ADDRESS '� EXISTING ROOF COVERING
PHONE ` LJ NUMBER OF EXISTING COVERINGS
CONTRACTOR'S `S 7`/ / TOBERI
NAMEI �' nn TO BE REMOVE TYPE OF ROOF COVERINGED
ADDRESS
ESS -PD 6o x 96 3 a4+-If • '9's-wt/
EXISTING
PHONE—
PHONE "' u rr q`7 BUILT-UP ROOF
LICENSEoCo1 X
ASPHALT SHINGLES V
NUMBER WOOD SHAKES
LICENSED CONTRACTORS DECLARATION
I her-byaffirm that I em licensed under Provisions of Chapter 9(common
cine with section 7000) of Division 3 of the Business d Prof��n�odo. WOOD SHINGLES
and my licenw i 1.51difa end effect ^f
Liunw CI Lic.Number -9
Dat. Cord;ec or OTHER (SPECIFY)
OWNER-BUILDER DECLARA ON
I hereby affirm that 1 am exempt from the Contractor's License Lew for PROPOSED
the following reason. (Sec. 7031.5, Business and Professions Code: Any city
or county which requires a permit to c nstruct, alter, improve, demollsh,or
repair any structure, prior to its issuance,also requires the applicant for such BUILT-UP ROOF
permit to file a signed statement that he is licensed pursuant to the provision,
of Me Contractor's License Lew (Chapter 9 (commencing with Section 7000)
of Division 3 of he Business and Profession•code)o,mat he is exempt there ASPHALT SHINGLES
from and [M1a boil for [ha alleged s=amption. Anse violation o1 Section
7031.6 by ony applicant for a permit subjects Ina applicant to•civil penalty
of not mor.m,t five huntlred daua,s($500).1: WOOD SHAKES
❑ I,as owner Ot he property. or my employees with wages es their thio
compensation,will do the work, and the structure is not intended or offerees WOOD SHINGLES
for axis(Sac. 7044, Business and Professions Code: The Contractor's License
Law does not apply to an owner of property who build.or improve,hereon, ,r11
and Who does such work himself Or through his own employees,provided that
such improvements are not intended or offered for axle. If, however, the OTHER (SPECIFY)
building or improvement is sold within one year of completion, the owner
builder will have the burden of proving that he did not build or improve for
purpo+a of$
ale.). PROVIDE I.C.B.O. REPORT NO.
❑ 1, as owner of the property, am exclusively contracting with licensed
contractors to construct the Project (Sec. 7044. Business and Professions
Coda: The Contractor's License Low does not apply to an owner of property PROVIDE MFGR. INSTALLATION SPECS.
who builds or improve• thereon, and who contracts for such projects with e
cont nctof(s)licensed pursuant to the Con,raaor'I License Law.
reaps l .m .=.mot „ceder sac. ,e.aP.c.for this APPLICATION DATE VALUATION PERMI
Owner Do,. g�
WORKERS'COMPENSATION DECLARATION P A a ® Building
I hereby affirm that I have a certificate Of consent to self insure,o _
tific en of Workers' Compensation Insurance, certified or a cifi d copy hereof(sec. [ DO Seismic
3800,Lab. 1 97y� /1 'ry J
Policy No. l Company -S„� ` F-0�Fl NA 0 1995 Total
Certified copy is eby furni had.
artiliad cppv i ' 6r+Un�ne,ci;y,inspacron division. C 'f 1
L.C.IeLiC..C/w�
CE IFICATE OF EXEMPTION FROM WORKERS' N.C. ❑ PEf9M)T AUTHORIZATION DATE
COMPENSATION completed
INSURANCE
(This s tion need not be comPlatltl it the Permit is for one hundred tl01
Iso 151001 or less.) - A�
I cattily that in the Pany person of any
work for as which this permit is axed, I shall not employCompensation
any person in «y manner$0 U[O become subject
1D the Workoi CompenApplic Laws of Celilornia,n
Deb Applicant
you ICEshould
ld APPLICANT: If,o afar making thiom ensatiCertificatep of Exemption,
you sn Cold become subject i the Workers'h such provisions
nsovisihis a the
Labpr cod., you must forthwith comply with spPM1 provisrons ar this permit
thai1 b.tl«used.«ok.d. All roofs shall be inspected prior to any roofing material being
1 unit, that I have..ad this application and stet.mat he above inform• Installed If a roof is installed without first obtaining an
hon is correct. 1 agree to comply with all city and county ordinances and inspection,l agree to removaalj new materials for inspection.
.,at. Iowa rW.ling to building construction, and hereby authorize repr«•n ��e\LJ
,atives of this city t0 enter upon the above mentioned property for inspection C f 1/ \V7(J, /� q-� ,fJ�•
Ou r(oe). �isJ(/(Il`O�IIaA
0_J_ 4�JL/Vi s Y(We),spree to save, indemnify and keep harmless the City of Cupertino
against liabilities,judgment$,costs and expenses which may in any we,
a.cfu•
against said City In cons.auence of the granting at this permit. SIGNATURE OF APPLICANT DATE
• PRE-INSPECTION: PLYWOOD: IN-PROGRESS:
(NSP. 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
•
CITY OF CUPERTINO
BUILDING DIVISION 408-777-3228
RE-ROOF TEAR OFF POLICY
1. You must schedule an inspection for the tear off the day before the date you wish the inspection to be
made. The procedure is to call the Building Division(777-3228)between the hours of 12:30 and 4:00
p.m.for next day inspection.
2. When the roof is torn off, the nails removed or driven in and all of the dry rolled wood has been
replaced, THEN YOU MUST CALL THE CITY BUILDING DIVISION. An inspector will be
notified that the roof is ready, and he will respond to do the inspection as soon as his schedule will
allow. There are special hours for this service between 8:00 a.m. and 11:00 a.m., and between 1:00
and 3:00 p.m.
• IF YOU CALL FOR THE TEAR-OFF INSPECTION AND THE JOB IS NOT READY, THERE WILL
BE A RE-INSPECTION FEE OF $69.00 CHARGED, WHICH MUST BE PAID BEFORE
ANOTHER INSPECTION IS MADE.
retooUwinword
SUBJECT: REROOFING POLICY FOR THE CITY OF CUPERTINO BUILDING DEPARTMENT
PRIOR TO ISSUANCE OF PERMIT AND INSPECTION PHASE.
L 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.
l,) Preinspeclion 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.
G. 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 TIME ABOVE POLICY ON REROOFING AND WILL COMPLY WITH THE
POLICY ^ l�
HOMEOWNERS NAME: C)LI vL-
ADDRESS: UO til�2�
/0 '7 �
REROOFING COMPANY NAME: I�`1 C)o Fl,.J
APPLICANT'S SIGNATURE:
CITY OF CUPERTINO
BUILDING DEPARTMENT
•
Reroof/wimrord
i
i
Cittl of Cuperti"O
r
SMOKE DETECTOR CERTIFICATE OF COMPLIANCE
I
I 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
mounted on the ceiling or wall in each sleeping room and at a
detector will be installed, o g p g
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: 10-7 S. S T-C LL 1
PERMIT NUMBER: 3 S y
HOMEOWNERS SIGNATURE:
DATE:
i I
I
winword/smkdet
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