R-4908 (2) APPLICATION FOR CITY OF CUPERTINO NUMBER R- 4908
INSPECTION DIVISION PERMIT EXPIRATION
REROOF PERMIT (408) 777-3228 PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
BUILDING ADDRESS
1568 Stelling Road
RESIDENTIAL COMMERCIAL OTHER
OWNER'S HAZARDOUS FIRE AREA
YES 0 If yes—I understand that a Class A
NAME Nelson roof assembly is required.
NO Initial I.C.B.O.k
ADDRESS 21350 Blue Hills T.nne Saratoga EXISTING ROOF COVERING
PHONE 408-996-2540 NUMBER OF EXISTING COVERINGS One
CONTRACTOR'S
NAME Heritage Roofing Inc. TO BE REMOVED TO BE RETAINED
ADDRESS TYPE OF ROOF COVERING
y clTYazIP3987 First St. "Ptt Livermore, CA 94550
EXISTING
510-447-7508
PHONE BUILT-UP ROOF ❑
LICENSE
NUMBER 595748 ASPHALT SHINGLES ❑
LICENSED CONTRACTORS DECLARATION
I hereby affirm that I am licensed under provisions of Chapter g(commencing with Section WOOD SHAKES Aid ° !tom'/yy^�j_�
7000)of Division 3 of ha Business and Professions Code,and my Incense is in full force and L
effect. WOOD SHINGLES ❑
License Class C39 Lis.Number 595748 OTHER SPECIFY
Date 3/26/97 Contractor Steve Dunn (SPECIFY) ❑
OWNER-BUILDER DECLARATION - PROPOSED
I hereby affirm that I am exempt from the Contractors License Law for the following reason.
(Sec.7031.5,Business and Professions Code: Any city or county which requires a permit to
construct,alter,Improve,demolish,or repair any structure,prior to Its issuance,also requires the BUILT-UP ROOF E
applicant lot such permit to file a signed statement that he is licensed pursuant to the provisions �J
of the Contractor's License Law(Chapter g(commencing with Section 7000)of Division 3 of the 11)
Business and Professions Code)or that he Is exempt therefrom and the basis for the alleged ASPHALT SHINGLES A51exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to
a civil penalty of not more than five hundred dollars($500).8 WOOD SHAKES �� 2g
C 1,as owner of the property,or my employees with wages as their sole compensation,will do ftV
the work,and the structure is not Intended or offered for sale(Sec.7044,Business and Profes. Cp u�
sions Code:The Contractor's License Law does not apply to an owner of property who builds or WOOD SHINGLES
improves thereon,and who does such work himself or through his own employees,provided that urcH / 0
�N
such improvements are not intended or offered for sale.If,however,the building or improvement
is sold within one year of completion,the owner-builder will have the burden of proving that he did OTHER(SPECIFY)
❑ V
not build or Improve for purpose of sale.).
❑I,as owner of the property,am exclusively contracting with licensed contractors to construct
the project(Sec.7044,Business and Professions Code:The Contractor's License Law does not PROVIDE I.C.B.O.REPORT NO.
apply to an owner of property who builds or improves thereon,and who contracts for such projects
with a contractor(s)licensed pursuant to the Contractor's License Law. PROVIDE MFGR.INSTALLATION SPECS.
01 am exempt under Sac. ,B 8 P.C.for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION APPLICATION DATE VALUATION PERMIT FEE
'
I hereby affirm under penalty of perjury one of the following declaration: -
❑I have and will maintain a Certificate of Consent to sell-insure for Worker's Compensation, Building
as provided for by Section 3700 of he Labor Code,for the performance of the work for which this
permit Is issued.an Seismic
I XLabor and will maintain Worker's Compensation Insurance,as permit is isby Section 3700sued.My Worker's o1 April 1997 6800.00
the Leber Code,for the performance of the work for which his permit Is issued.My Worker's
Compensation Insurance terrier and Policy number are: Total
Carrier State Fund Policy No.285-97 664 PERMIT AUTHORIZATION DATE
G=` CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE N.OQ Gi{
(This section need not be completed it the permit is for one hundred dollars($100)or less.) C�'��J
I certify that in the performance of the work for which this permit is issued,I shall not employ
any poison In any manner so as to become subject to he Workers compensation Laws of Cali. All roofs shall be inspected prior to any rooiirTg matericli being
ferule. installed. If a roof is installed without first obtaining an
Date Applicant inspection,I agree to remove all new materials for inspection.
NOTICE TO APPLICANT: If,alter making this Certificate of Exemption,you should become Applicant derstands and will comply with all non point
subject to the Workers'Compensation provisions of the Labor Code,you must forthwith comply PP P Y P
with such provisions or this permit shall be doomed revoked. source r nations.
I certify that I have read this application and state that he above Information is correct.I agree
to comply with all city and county ordinances and state laws relating to building construction.and All roof verings fob as
better.
hereby authorize representatives of this city to enter upon the above-mentionetl property for in
spection purposes.
IWe)agree to save,indemnity,and keep harmless he City of Cupertino against liabilities,
of the grantinggts and of this perrmitsas which may in any way accrue against said City in consequence IGNATURE O APPLICANT 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 INSPECTIONi`
OFFICE COPY 7
w
SUBJECT: REROOFING POLICY FOR THE CITY OF CUPERTINO BUILDING DEPARTMENT
PRIOR TO ISSUANCE OF PERMIT AND INSPECTION PHASE.
1. 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.
t 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.
WE UNDERSTAND THE ABOVE POLICY ON REROOFING AND WILL COMPLY WITH THE
POLICY
HOMEOWNERS NAME: NPI con
ADDRESS: 1568 Stalling Road
' 7
REROOFING COMPANY NAME: Herita Roofin Inc.
' APPLICANT'S SIGNATURE:
CITY OF CUPERTINO
BUILDING DEPARTMENT
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Reroof/winword