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R-4531 (2) APPLICATION FOR CITY OF CUPERTINO NUMBER PERMIT R- 4531 INSPECTION DIVISION PERMIT EXPIRATION REROOF PERMIT (408)777-3228. PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 100 DAYS OF PERMIT ISSUANCE OR • 180 DAYS FROM LAST CALLED INSPECTION. BUILDING ADDRESS �� RESIDENTIAL COMMERCIAL OTHER owNER'S HAZARDOUS FIRE AREA /j YES ❑ If yes—I understand that a Class A NAME S r2 V!)I 4- roof assembly is required. ' NO ❑ Initial I.C.B.O.If /en_� � ADDRESS l0EXISTING ROOF COVERING PHONE — ¢� / NUMBER OF EXISTING COVERINGS / CONTRACTOR' [� NAME TO BE REMOVED / TO BE RETAINED /rNJ ADDRESS n TYPE OF ROOF COVERING CITY&ZIP EXISTING PHONE y0y• �.572�I7 BUILT-UP ROOF ❑ LICENSE NUMBER ASPHALT SHINGLES ❑ LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section WOOD SHAKES 7000)of Division 3 of the Business and Professions Code,and my license Is In full force and effect' _ WOOD SHINGLES E]License Class Lia Number / OTHER(SPECIFY) ❑ Date Contractor ' OW NER-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 ❑ applicant for such permit to file a signed statement that he Is licensed pursuant to the provisions • of the Contractor's License Law(Chapter 9(commencing with Section 70N)of Division 3 of the t Business and Professions Code)or that he Is exempt therefrom and the basis for the alleged ASPHALT SHINGLES YD� exemption.Any violation of Section 7031.5 by any applicant for a permit Subjects the applicant to a civil penalty of not more than live hundred dollars($500).): ❑ WOOD SHAKES -ElI,as owner of the property,or my employees with wages as their sole compensation,will do the work,and the structure Is not Intended or offered for sale(Sec.7044,Business and Profes- sions Cotle: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 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) ❑ 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 Contractors License Lew. PROVIDE MFGR.INSTALIA SPECS. ❑1 em exempt under Sec. ,B a P.C.for this reason 1 Owner Date APPLICATION DATE ­VALUAfIC& PERMIT FEE WORKER'S COMPENSATION DECLARATION - I hereby affirm under penalty of perjury one of the following declaration: -11 have and will maintain a Certificate of Consent to self-insure for Workers Compensatlon, Building IIY- as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. Seismic vwo ❑I have and will maintain Worker's Compensation Insurance,as required by Section 3700 of _the tabor Code.for the performance of the work for which this permit is Issued.My Worker's Total 1141 r Compensation lion Insurance cerrU end Pa,icy number are: t]L�bL_ /P /�GL/t Policy Na .� 5'� ,� .3- PERMIT AUTHORIZATION DATE Ca CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE ?(SiSection need not be completed if the permit Is for o rad 100)or less.) I certify that In the performance of the work for which rm s d.I shell not employ any person in any manner so as to become subject or pensnion Laws of Cali- All roofs shall be inspected prior to any roofing material being fornia. installed. If a roof is installed without first obtaining an Data Applican inspection,I agree to remove all new materials for inspection. e NOTIc ro A LICANIT: If,offer makin thi Ce thesis of Exemption,you should become A licant understands and will corrmll FvithPall non oint subject to the Workers'Compensation provisio a Labor Code,you must forthwith comply PP P Y P with such provisions or this permit shafte deemed revoked, source regulaticnS I certify that l have read this application and state that the above information is correct.I agree ��g 1995 to comply with all city and county ordinances and state laws relating to building construction,and All roof CD CI G" t hereby authorize representatives of this city to enter upon the above-mentioned property for in- spection purposes. (We)agree to save,Indemnity and keep harmless the City of Cupertino against liabilities, oil}' judgments,costs and expenses which may In any way accrue against said City In consequence A E OF APPLICANT DAT of the granting of this permit. 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 SUBIEC'I': I1EROOFING POLICY FOR 'I'IIL• CI"lY OF CUPERTINO BULLDING 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 manuf ciurers specs on reroofing. ' 2. New roof coverings slhall not be applied without first obtaining all inspection and written approval from the building inspector. A final inspection and approval shall be obtained rrom the building Inspector wherl lire reroofing is completed. 3. All types of roorshall be i»epccted prior to any roof being installed. d. ht order to receive a rrnal,you Must complete steps 1, 2, and 3. 1,) Preinspeetioih or tear off approval. 2.) lm progress inspcciion approval. • 3.) Final inspection approval. a.) Operable sahoke detector vcrirrcntioa b) Spark arrestor installation 5, if plywood is installed, a plywood nail inspection is required. G. If any roof is applied w•itihout first obtaining all inspection, you will be required to remove all 11cw material down to lire shclhing amd a building imspeotar will imspe^_1 all sileathilhg at Uhal little. WE UNDERSTAND 171E AIJOVE POLICY ON IIEROOFING AND WILL COMPLY WITH THE POLICY HOMEOWNERS NAbIE: -B�zYin/ ADDRESS: RCO EROOFING MPANY NA NIE: da APPLICANTS SIGNATURE: CITY OF CUPERTINO • BUILDING DEPARTMENT Recaaf/h:iinrard Citli of Ciejxrtino SMOKE DETECTOR CERTIFICATE OF CONLPLIANCE I understand and comply will' Section 1210-a of the Uniform Building Code. Section 1210-a requires when repairs to a single family dwelling exceed SI,000, a smoke • detector will be installed, mounted oil the ceiling or wall in each sleeping roam and at a point centrally located in the corridor or area giving access to roam 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. P �e ADDRESS: o e/62 PERNUT NUMBER: HOMEOWNERS SIGNATURE: DATE: i .. • winword/su'kdet ID I J