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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 � � I