99070019 �• 9� , 3 -�S ..- -�� -o , o �i q 000
PERMIT
- ,APPLICATION FOR CITY OF.CUPERTINO NUMBE�
INSPECTION DIVISIONPERMIT 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
i Q V O C � RESIDENTIAL COMMERCIAL OTHER
OWNER'S - HAZARDOUS FIRE AREA
n YES ❑ If yes—I ur d sfend that a Class A
NAME �/ � / roof assertldy is required.
NO ❑ Initial I.C.B.O.B
ADDREss S �'-- EXISTING ROOF COVERING
NUMBER OF EXISTING COVERINGS '
PHONE
CONTAAC TO BE REMOVED ` TO BE RETAINED ,
NAME
ADDRESS �j �I
CITY&ZIP
Q.,((p
EXISTING
PHONE 48 0> '}9 3 —63 73 .- BUILT-UP ROOF
LICENSE '/ '
NUMBER 7 Z7 00 - ASPHALT SHINGLES /��� --
UCENSED CONTRACTORS DECLARATION
1 hereby affirm Mat I am licensed under provlNoiu of Chapter B(commencing with Section WOOD SHAKES ❑
7000)of Division 3 of the Business and Professions Code,and my license t ensIn full force and
eHBCY' WOOD SHINGLES
Liberia Lk:.- `�� Lk:.Number 0 0 ❑
DatALL�-J Convector OTHER (SPECIFY) ❑
OWNER-BUILDER DECLARATION 1, PROPOSED
I hereby affirm that I am exempt from the CorralLicense law for the following reason.
(Sec.7031.5,Bualn,ss erg Prof wbns Code: Any city or county which requires a permit to
conatruct,after,Improve,demolish,or repair any structure,phor to Its issuance,also requires the BUILT-UP ROO
applicant for such pernut to lila a signed statement Mat he is konsed pursuant to the provisions
of the Contractors❑came law(Chapter 8(command�q wllh Section 7000)of Divi,bn 3 of the D
Business and Professoriat Code)or Mat he Is exempt�erelrom and the basis for the alleged ASPHALT SHIL S
exemption.My violation of Section 7031.5 by any appgcant for a pound si bless the applicant to
a cMl penalty of not more then five hundred dollars($501 WOOD SHAKE J U L 2 2X99
I,as owner of of dna property,or my employees "gas ges ea Meir sola o0mpn
, wton,will do
the work,and the structure Is not Intended or offered for sale(Sec.7044,Business and Profss-
Mons Cade:The Contractor's License law does not apply to an owner of property who bulk*or WOOD'SHING $
Improves thereon,and who does such work hlrnaea or through his own emboyess,provided that ❑
such Improvements are not Intended or offered for*ale.If,however,the talking or Impro romant
is sold within one year of completktri,Me owner-Wilder will have the burden of proving that he de OTHER(SPEC
not bulk or Improve for purpose of sale.).
❑1,as owner of the property,am exclusively contracewith licensed contractors to construct '
the prolect(Sec.7044,Business and Profession,Code:The Comractor,License law does not PROVIDE I.C.B.O.REPORT NO.
appy to an owner of property who Wilds or Improves thereon,end who convect for such protect
with a cantactods)licensed pursuant to the Contractors License law. PROVIDE MFGR.INSTALLATION SPECS.
❑1 em exempt under Sac. ,B 8 P.C-kr this reason
Omer Date APPLICATION DATE VALUATION PERMIT FEE
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declaration: - O
❑I have aro will maintain a Ceddkats of Consent to self-Insure for Workers Ccmpertatlon, ^' Building
as provided for by Section 37DD of the Labor Code,for the performance of the work for which this I.bi V0
permit Is Issued. !/ 9 Seismic
mI1r� have and Mil maintain Workers Compenaetion Insurance,as required by Section 3700 of
eTabor Cada,for the performance of the work for which this parmt is Issued.My Workers Total t
Compenw0�o-nr I,nsnn carrier and Policy number we: p ' c
Carder 4� � — Plot,No'5.71�Qp �/y . PERMIT AUTHORIZATION DATE
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE NCO
(This section need not be completed If the penult Is for one hundred dollars($100)or less.) -
I ceirty that In the performance of the work for which Mb Permit 1*Issued, shall not em fry
any person In any manner so as'to beoome subject to l e workers'Compensation Lawn of f5au- All rOOfR shall be inspected prior to any roofing material being
fount. installed. if a roof is installed without first-obtaining an
Date 7 T1 Applicant �• --A.^-��--= inspection,I agree to remove all new materials for Inspection.
NOTICE TO APPUCANT: II,after making Mt Cerliffilia of Exemption,you should become Applicant understands.end will comply with all non point
subject t the Worl wo'Companwtbn pprovision,of Me Labor Cada,you must forthwith comply
with each provisions or MIs permit shelp be deemed revoked. source regulations. -
I certify duet I have read this application and state that are above Information is correct.I agree
to comply with all city and county ordinances,and state laws relating to building construction,and All roof coverings to be class°C"or better.
hereby purip se representatives of INe city to enter upon the above-mentbnetl property la In. �IPAf??
hereby purpossr.
(We)agree to save,Indemnity and keep harmless the City of Cupertino axCuerKe
Imt,lkblllties,
lad mens,cost and expenses,which may In any way accrue against said City 4o con
of IRs granting of this permit. SIGNATURE QF 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
• CITY OF CUPERTINO - BUILDING DEPARTMENT
RE-ROOFING POLICY
1. Prior to permit issuance, you must agree to comply with U.B.C. standards and
manufacturers specs on re-roofing.
2. New roof coverings shall not be applied without first obtaining all inspections and written
approval from the building inspector. A final inspection and approval shall be obtained
from the building inspector when the re-roofing is completed.
;. All types of roofs shall be inspected prior to any roof being installed.
4. In order to receive a final, you must complete steps 1,2, and 3.
i. Pre-inspection or tear-off approval
2. In-progress inspection approval
3. Final inspection approval
a. Operable smoke detector verification
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 sheating and a buitding inspector will inspect all shearing at
that time.
IMPORTANT:
1. Flat roofs must have a `/4" per foot slope, or demonstrate that there is no ponding.
2. I.C.B.O. reports are required to be on the job site at the time of inspection. If you do not
have one, contact the building department.
WE UNDERSTAND THE ABOVE POLICY ON RE-ROOFING AND WILL COMPLY
WITH THE POLICY.
HOMEOWNER'S NAME: da� l �p w
ADDRESS: // a -
RE-ROOFING COMPNAY NAME: ay.01 we di e
APPLICANT'S SIGNATURE: ,� �Q_TcL_p _
• CITY OF CUPERTINO
BUILDING DEPARTMENT
Re-roo0winword