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R-3986 (2) PERMIT R- 3986 APPLICATION FOR CITY OF CUPERTINO NUMBER Res VECTION DIVISION PERMIT EXPIRATION REROOF PERMIT (408) 252-4505 EXT. 228 WITHIN 180 DAYS OF P RMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. BUILDING ADDRESS BUILDING USE OWNER'S \ LAS RESIDENTIAL COMMERCIAL OTHER HAZAROOF NAME J oFf � l4OO fI FIRE AREARDOUS COLASS VERING ... . ADDRESS 34173 IGl ✓IQM0y1'1` I)A ' EXISTING ROOF COVERING mOrH� S C.a 4TGS o PHONE — s NUMBER OF EXISTING COV RINGS CONTRACTORS n NAME R/4��R [200 Et NG TO BE REMOVED TO BE RETAINED ��// ^^ �� TYPE OF ROOF COVERING RESS CIOTDY&ZIP ?4/617 r-OWL14-11! - dA'st rillPA EXISTING CA 9So5'r PHONE km ¢" �`�' ?S3 BUILT-UP ROOF LICENSE ASPHALT SHINGLES l �" NUMBER /7WOOD SHAKES LICENSED CONTRACTORS DECLARATION I hereby affirm that I em licensed under provisions of Chapter 9(common curb with Section 7000) of Division 3 of the Business and Profession+code, WOOD SHINGLES and my Ilcwea n fW ge and attest. // and Y license n Lia Number oat. K Contractor OTHER (SPECIFY) OWNER UILDER DECLARATION 1 n...by affirm that l em .xsmD, nom the Contract or's License L.w f PROPOSED the following reason. (Sw. 7031.5, Business and ProfiesCotla: An [y Or <OuntY which requires a permit to construct, alter, r0 iah,Or repair any structure,prior to its issuance also requires Dplicwt for such BUILT-UP ROOF Permit to fila a signed statement that he Is lic.nawl ant to the provisions of the Contractor's Liceme Low (Chapter 9 1 mend n9 with Secfi on 7000) n 41 ' of Division 3 of the BI., h wll Protm,ion otlel or tatet he is empt tater{"�V� ASPHALT SHINGLES from ane the bnia for th• ellaeetl ax Psion. AnY violatio f SwtioF/� J 7031.5 by env aDDlicanl for permit jests the applicant[o a penalty of not m as that five hundred dolor $500).1: WOOD SHAKES ❑ I, ea owner 01 tate Drope. or my employees wHM1 a m pema,ion,will do ma wor , and me structure is not i e o e WOOD SHINGLES for Bele (Sac. 7044, Business fid P.ofafsiom Code: TM1a Co lOr' eme Lew does not apply to a o of D.opoty who build prove.t and who don rvCh work M1i sell or[M1rougM1 his own a f,p aided Inn such improvement. ere n0 intended or offs ad f . a. iryPyvaver, t OTHER (SPECIFY) building or improvement i wld wi In In one COmpleh ate ow r builder will neve the burden f Droving that of builtl in nto, P.m...Of"o.l. PROVIDE LC.B.O. REPORT NO. ❑ I, as owner of tate prop tY. am uclus ontrwfing with li a sae contractors to construct the Dr 'wt IS 7044, slno+ and Pro e Coda' TnaComnctor'sLicenseLwdoesnotappl oanownerof ropserry PROVIDE MFGR. INSTALLATION SPECS. Who build, or improves thereon, a who contracts for such Floje .With e A ontractor(s)licensed pursuant to th Contractor's License Law. H c ❑ 1 em exempt under Sac. ,8. .C.for this owfo. o. `y CAT( N ATE VALUATION PERM( FEE WORKERS'COMPENSATI DECLARATI J/ I*rj BuildingJIG rr I hereby affirm that I neve a cern liceta content t seltlnsu sure or a car ^ ,iflca[.of Workers' Compensation Intu h., lad copy thereof(Sec. f1 119,Q $elamlC 3800,Lee.C.). L`M1. s ` �- Policy No. Company V 1�`��,J�✓ 8 Certified copy is h...by f.,nlsh.e. 7Yj �- Total Certified copy is filed with the city'Inspection division. '♦� Applicant CERTIFICATE OF EXEMPTION FROM WORKERS' N D ❑ PERMIT AUTHORIZ N DATE COMPENSATION INSURANCE (This,wtiOn need nor be completed if the permit I.for One hu nered dol Ig lard(51001 0.lea..) �� certify thea in the performance of the work for which this permit is use, I shell employ any Pardo eaY mann) es to become subject totna nxtlon Law u// r.(�/L.►� Dau Applicant ✓�� NOTE O APPLICANT: If, after making this Certificate of Exemption, you should become Subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit All roofsshall be Inspected prlortoany roofing material being .Fell be deemed revoked. I certify me, I hay.read this application and+rate that he above inform. instelle If a roof IS Installed without first obtaining an ,tun i. correct. f agree to comply with en city and county ormna tc.,and in, 1 on,I agree to remove all new materials for inspection. ata,. laws relating to building construction, and hereby wthoris. r.P,".n ,lives of this city to enter upon the above-mentioned property for inspection purpmea. QC IWtl agree I. uv indemnifycots dna keep edwhi h the City of Gupar _ ( J against sliabilities,idti cons a consequence cosh and expensedwhich they in any way wcm. ,win.,said crtv in comagpwca of me g.emmg of this permit. S GNATURE 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 SUBJECI': REROOFING POLICY FOR TlIE CITY OF CUPERTINO BUILDING DEPARTMENT PRIOR 7'0 ISSUANCE OF PERMIT AND INSPECTION P11ASE. 1. Prior to permit issuance, you must agree to cowply with U.D.C. standards and manufacturers spec's on reroofing. 2. New roof coverings shall not be applied wilhout first oblaimiflg all inspection and written approval Rom Ilio 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 flms(courplele steps 1,2,and 3. 1,) preinspeclion or tear off approval. 2.) In progress inspection approval. • 3.) Final inspection approval. a.) Operable smoke detector verificaliom b.) Spark arrestor iustallatiou 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 flew material down to the sheathing and a building inspector will inspect all sheathing at that lime. WE UNDERSTAND THE ABOVE POLICY ON REROOFING AND WILL COMPLY WITH TM- POLICY oil ,l/ 1140 o fl-,i- ADDRESS: NAME: q,�1rSb ADDRESS: 3Y7 3 91 n c M*N 7 l) A- .�o r S C'O REROOFING COMPANY NAME: i APPLICANTS SIGNATURE: • CITY OF CUPERTINO BUILDING DEPARTMENT Reroof/winword I City of cupe/'t111O SMOKE DETECTOR CERTIFICATE 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 stn Ike detectors installed that do comply. ADDRESS: PERMIT NUMBER: HOMEOWNERS SIGNATURE: DATE: I winword/smkdet