R-6249 PERMIT R_ 62 9
APPLICATION FOR CITY OF CUPERTINO NUMBER
•- .INSPECTION DIVISION
REROOF PERMIT (408)777-3228 PERMIT EXPIRES'IF WORK'IB NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
•
BUILDINGADDRESS
1 RESIDENTIALCOMMERCIAL OTHER
OwNER'S n n - .HAZARDOUS FIRE AREA
NAME D .1.v7�' 'y ,/ _ •,�� YES ❑ Nies undarste required.
NO
Class
root assembly is required.
- NO ❑ Initial LC.B.O.x
ADDRESS // //�G^�L EXISTING ROOF COVERING
PHONE b 6, (� b / 3 NUMBER OF EXISTING COVERINGS I
CONTRACTOR'S r
NAME TO BE REMOVED ` TO BE RETAINED
ADDRESS 2 C/ 3f TYPE OF ROOF COVERING
CITY&ZIP
PHONE ✓ Z''BUILT-UP ROOF l
LICENSE
NUMBER �Q9 ASPHALTSHING S JUN 115 1999 D
LICENSED CONTRACTORS DECLARATION
I hereby anlrm that'I am licensed under provisions of Chapter 8(connmen ing with Section WOOD SHAKES ❑
7000)of DMefon 3 of the Business and Prolemona Code,and my license he In lull lone and
ani' WOOD SHINGLE By
License Class Lk.Number
e Contractor i OTHER(SPECIFY) ElDat
OWNER-BUILDER DECLARATION PROPOSED
hereby affirm Met I am exempt from the Contractors License Lew for me 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 abucWre,prior to its Issuance,also requires the BUILT-UP ROOF
of the C t for such permit to Iib a sigma r 9 bo ant Ihei he Is licensed pureuenf to visa provisionsof the
al the Conor such Permit
t Lew(Cheerer a(cammercl with Sensed 7000)of Division 3 of the
• Bmlmss and Profe,elons Code)or that he Is exempt erelrom and the beats for the alleged ASPHALT SHINGLES ❑
exemption.Any violation of Section 70.71.5 by any applkant lar a pemtit subjects the applicant to
a chil penalty of not more then five hundred dollars($500),):
E)1.as,owner of the property,or my employees with wages as their sole campenselon,will do WOOD SHAKES ❑
the work,and the structure Is ret Intended or offered for Bele(Sec.7044,Business end Protons.
along Code:The Contractors License Law does ret apply to an owner of property who builds or WOOD SHINGLES ❑
Improve,thereon,entl who does such Kingpin or through his own employees,provided that
such Improvements are not Intended or offered for sale.If,however,the building or Improvement
is,old wllNn one year of completion,rhe ovmer-bullder will he"the Wmen of proving that he did OTHER(SPECIFY) ❑
not build or Improve for purpose of sale J.
❑I,as owner of the property,am exclusively contracting with licensed contractor,to conetnct
the project(Sec.7044,Busine,a entl Proleaefone Code:The Contractors License Law don not PROVIDE I.C.B.O.REPORT NO.,
appty to an owner of property who W Ilds or Improves,thereon,and who contracts,for such protects
atm a contractors)licensed pursuant to the Contractors Ucense Lew. PROVIDE MFGR. INSTALLATION SPECS.
❑1 em exempt under Sec. ,B 8 P.C.for this lesson
Owner Date
WORKER'S COMPENSATION DECLARATION IT APPLICATION DATE VALUATION PERMFEE
I hereby affirm under penalty of perjury om of Offer following dederatkn:
❑1 have and will maintain a CeNlncate of Caneent to self-Insure for Workers Compensation. 7
vitl
as proed for by Section 3700 of the Labor Code,for the performance of the work for abklr Use D/4 Building
per Is Issued. 1slgq �
,YYO Seismic
n
xhave arW will maintain Workers Compensation Insurance,m required by Section 3700 of D D
the bur Code,for me performance of JAII,work for which If permit Is Issued.My Workers .r•
Compensatl mance ler and Po numbs re: Total
Center Policy Not 0� �� PERMIT AUTHORIZATION DATE
CERTIFlCATE OF E% PTION FROM WORKERS'
COMPFllSATI INSURANCE N.C.O
(TNe section mad nal be completed If ma permk is for ono hundred dollen($100)or IM.) `C
I cerdly Chet In the performance of the work for wi rub permit to sued,I shelf not artp by
any person in any manner so as to become subject to me Workers Comobonsatfon Lawn of Cally All roofs shall be inspected prior to any roofing material being
fonka. installed. If a roof is installed without first obtaining an
Date shy Applicant nth inspection,I agree to remove all new materials for inspection.
NOTIc TO APPLICANT:p If,after mpeklnp thls�of Exemption,yoExemypWon,yo Applicant understands and will comply with all non point
Subject to the Workers Compensation provisions of the Labor Code,
MM such provalons or this permit iffe a deemed revolted. Source regulations.
I certiy that I have read this application and state Chet me above Information Is correct.I agree
to comply with all city and county,ordinances and state Jews rail to Wilding conshuction,end All roof cos, be clan or better.
hereby aulfrorixe representativee of this dry to enter upon the above-mentlamtl property for In.
,pection purposes. / �5
(We)agree to save,Indemnity and keep harmless the City of Cupertino against liabilities, b
judgments,mete and sponges which may In any way accrue against sem City In consequence 'SIGN URE APPLICANT ATE
Ali
Of O e 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 ACCESSTO ROOF SHALL BE PROVIDED FOR INSPECTION '
OFFICE COPY
CITY OF CUPERTINO - BUILDING DEPARTMENT
16 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..
3. 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 J.
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 building inspector will inspect all sheating 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:
ADDRESS:
RE-ROOFING COMPNAY NAME:
APPLICANT'S SIGNATURE:
CITY OF CUPERTINO
• BUILDING DEPARTMENT
Re-mot%winword