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R-4116 (2) ' PERMIT APPLICATION FOR CITY OF CUPERTINO NUMBER R- 4116 INSPECTION DIVISION PERMIT EXPIRATION REROOF PERMIT (408) 252-4505 EXT. 228 WITHIN 180 DAYS OF PERM T ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. BUILDING ADDRESS - Y BUILDING USE NWhe4aii^IU2 RESIDENTIAL_LY_ COMMERCIAL OTHER OWNER'S HAZARD OOF NAME 1'1 E- � lQ. dQY)1lfr IIFIRE OUS C �AOVVSES ING ADDRESS S / WVI ' eri1l EXISTING ROOF COVERING PHONE NUMBER OF EXISTING C VERINGS CONTRACTOR'S �f,,��1 NAME V es fo/a sate- gao( 'i 74 TO BE REMOVED TO BE RETAINED ,f' pp�� w�t�tI�� I�'� TYPE F ROOF COVERING ADDRESS CITY&ZIP ��Q1� — LJ N.F-(M PA/? /rl 146N �y0Y3 EXISTING PHONE � 5'/ 20— 615 BUILT-UP ROOF LICENSE ASPHALT SHINGLES NUMBER WOOD SHAKES LICENSED CONTRACTORS DECLARATION I ftenby ct ion that I of licensed under Om visions of dChapterProfs 9 on.Coca resp wtrn Section l000l of Division 3 of me eD.m...end Prof«aorta cod., WOOD SHINGLES end my Ilunse if in full 1 rte and Number Nf«c Lic.Pas f Lice Data Contractor OTHER (SPECIFY) WNE RBUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Lew for PROPOSED the lotlowing reason. (S«. 7031.5, Business and Professions Code: Any city county which requires a permit to construct, after,improv, d.molish,or rep. .nv.,t,.ctur.,Prior 10 It issuance.also requires the applicant for such BUILT-UP ROOF permit to file a signed statement that he If licensed pursuant to In.provisions of the Contractor'. License Law (Chapter 8 (commencing with Section 7000) of Division 3 of the Business and Professions Coda)or that he is exempt mere ASPHALT SHINGLES from and In. basis for [ase:11.1 111 e.emD\ion. Any vioi.tio. of Section 7031.6 by any applicant fora permit subjects the applicant to a civil penalty ofnot morethat five hundred dollars($500).1: WOOD SHAKES ❑ 1,as owner of the property, or my employees with wages a their sole compensation,will do the work, and the structure if not intended or offered for sale (Sec. 7044. Business and Profession$Code: The Contractor's License WOOD SHINGLES Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees,provided that such improvement ere not intended or offered for sale. It, however, the OTHER (SPECIFY) building or improvement i sold within one year of completion, the o builder will have the burden of proving that he did not build or improve for purpose.1 sea.). PROVIDE I.C.B.O. REPORT NO. D I, as owner of the property, a exclusively contracting with licensed contractors to construct the Project (Sec. 7044, Business and Profession, Codmi .: The Cor«tgs License Law does not apply to an owner of property PROVIDE MFGR. INSTALLATION SPECS. who builds or improves menun, and who contracts for such projects with s contractor(N licensed pursuant to the Contractor's License Law, E) 1 am exempt under S«. ,B.&P.C.for this reason APPLICATION DATE VALUATION PERMIT FEE owner Data- WORKERS' ^— y WORKERS'COMPENSATION DECLARATION or {2 ®.� IfJtlJv Building I M1ereb affirm that I neva a certificate OI consent to self-insure,o tificab of Workeri Compensation Insurance.or a certified copy thereof(Sea //2);,o F,o as Seismic 3800-L.b.CJ L ftp /1,-�� lr �-- PolicyNo.NWL91�954�QomDany -S[ aCertified copy is hereby fppppufip'ii1/shte'd }PIC'' /� 1996 Total C.rtif.d coq 'A�fJje MPTf1';J ROOM Iv,uon. Applicant f All� i1 '1+ OT C R IFIL ATE OF COMPENSATION INS FROM W RKE RS' N.C. D ❑ PERMIT AUTHORIZATION DATE COMPENS millet INSURANCE IThie action head not be completed if the permit is for one hundred sob Ian IS1001 or lanai I :This that in the performance of the work for which this permit Is issued, I shell not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California. Deb Applicant NOTICE TO APPLICANT: 11, alter .eking this Certificate of E..R ion, you mould become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with Such provisions or this permit All roofsshallbeInspected prlortoanyroofing material being &hall be deemed revoked. I cartifV that I have read mif.pphcation end st.te Ina\tha.b.va Informs Installed If a roof is installed without first obtaining an non is pq,nacJ. I agnea 10 comply with .0 pity and county ordinances and Inspection,I agree to remove all new materials for inspection state laws relating to building construction, and hereby authorize repre&emtat - �1//�1M, JI1/(/�1 / Purpoe.se..01 this city to enter upon the above mentioned property for inspection /1^1+---� �1.1 purposes. 111(II II]' (We)liabilities,abroe uve, indemnify end keep esharmlesswhich the City of Cupertino WWI qagainst Cti cons a tee,costs and expanses which may In.nY waY«true awin&[uid cb in consequence of the granting of this permit. MINATURE OF APPLICANT DATE 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 SUB1ECf: REROOFING POLICY FOR THE CITY OF CUPERTINO BUILDING DEPARTMENT PRIOR TO ISSUANCE OF PERMIT AND INSPECTION PHASE. 1. Prior to permit issuance, you ulust agree to comply with U.B.C. standards and manufacturers spec's ou reroofing. 2. New roof coverings shall not be applied lvitlwut 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 Illus(complete steps 1, 2,and 3. 1,) Preiuspection or tear off approval. 2.) In progress inspection approval. 3.) Final inspection approval. • nJ Operable smoke detectorvcrificalioll bJ Spark arrestor installation 5. If plywood is installed, n plywood nail inspcctiou is required. G. Ir ally roof is applied without first obtaining an inspection, you will be required to remove nll new material down to the shattlting and a building inspector will inspect all sheathing at that lime. WE UNDERSTAND THE ABOVE POLICY ON REROOFING AND WILL COMPLY WITH TI1E- POLICY HOMEOWNERS NAME: Gh ( [a a ha ' J 1 ADDRESS: 19 tq 9S-LI REROOFING COMPANY NAME: APPLICANTS SIGNATURE: CHY OF CUPERTINO • BUILDING DEPARTMENT Reroof/winword - - i Citvj of cmVerli"O S,IIOKE DETECTOR CERTII'ICATE OF COMPLIANCE 1 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 detector will be installed, mounted on the ceiling or wall in each sleeping room and at a • 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: PERMIT NUMBER: HOMEOWNERS SIGNATURE: DATE: I I winword/smkdet