99110059 3s- 7 z al �o�s
PERMIT
APPLICATION FOR CITY OF CUPERTINO NUMBE
INSPECTION DIVISION
REROOF PERMIT - (408)777-3228 PERMIT EXP RES IF WOPIRI�(S NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
BUILDING ADDRESS
RESIDENTIAL COMMERCIAL v OTHER
OWNER'S HAZARDOUS FIRE AREA
YES ❑ d yes—I understand that a Class A
NAME /�J Tf/ 'c,11C �� `,[� g�� root assembly is required.
NO ❑ Initial I.C.B.O.N
ADDRESS EXISTING ROOF COVERING
PHONE NUMBER OF EXISTING COVERINGS -/
CONTRACTOR'
I, N� Dti TO BE REMOVED TO BE RETAINED
NAME
ADDRESS / O �£ A 7— TYPE OF ROOF COVERING
CITV EXISTING
PHONE I y��� ���—d � BUILT-UP ROOF
LICENSE t -
NUMBER p 9�j 70�J ASPHALT SHINGLEq-
not
LICENSED CONTRACTORS DECLARATION
1 hereby affirm that I an ikensed under provelons of Chapter 0(commencing with Section WOOD SHAKE7000)of Division 3 of the Business end Professions Code,ala my Ilce a le m full force andel - /, ESUcense Class e_'� 6 Lk.Number `' f'2z�_ Z �Date ContractsOWNER-BUILDER DEC P S
I hereby affimo that I am exempt from the contractors Uc low ng re n(Sec.7031.5,Business and Prolessums Code: Any cry or county which r ulr r
construct,sitar,Improve,tlertwlish,or repair arty slrudure,prior to it sun Fapplicant for such permit to file a signed statement that ha le 11certs re 1 e pr
of the Contractors Ucense Law(Chapter B(commencing with Sectl 000)Business entl Professions Code)or that he le axarrtpt Iherelrom I alleged Eexemption.Any valeti of Section 7031.5 by arty applicant bra perma"Nects asa dvil penamy of nl more then live hundred d llars❑I,as owner of the properly,or my employees with wagesthe work,and the structure is lout Intended or offered for seta I esans Code: The Contractors Ucense Law does not apply to w s or WOOD HINGLESlopro thereon,and who does such work himself or through plaryeee,provided that
such irrpr nonan is are nt Intended er crated for sale.If,however, a bulging or Improvement
is add within one year of completion,the owner-Ivilder will have t urden of proing that he did OTHER(SPECIFY) ❑build or improve for purpose of sale.).
❑1,as rnvrrer of the property,am exclusively contracting with licensed contractors to construct
the project(Sac.7044,Business and Profeoslarw Code:The Contractors Ucense Law does not PROVIDE I.C.B.O.REPORT NO.
apply to an owner of properly who builds or improves thereon,and o contracts for such proleclS
with a contractor(s)licensed pursuant to the Contractors Ucense Law. PROVIDE MFGR.INSTALLATION SPECS.
❑1 am exempt under Sec. ,B b P.C.for this reason
owner Data _
WORKER'S COMPENSATION DECLARATION APPLICATION DATE VALUATION PERMIT FEE
-
1 hereby affirm under penely of perjury ome of the folic irq declaration: nO
❑1 have entl wiN maintain a Certificate of Consent to seH-Insure for Worker's Compensation, + ` r{/
as protrded for by Section 3700 of the Labor Code,for the performance of the work for which this L((S O Cl .Building
pendt is taeaee. - _ Seismic 1,110
❑1 have and will melntaln Workers Compensation Insurance,as required by Section 3700 of
the Labor Code,for the performance of the work for which this permit is Issued.My Workers 'I
Campensatla nsureroe cnrrar erW Icy number are: Total ` 1�
Carrier Policy No (�,/a� n PERMIT AUTHORIZATION DATE
CERTIFICATE OF EXEMPTION FROM WOR .
COMP If the per INSURANCE !C V — O
(Tale sedan need voter completedthe
If the for wt Is for one hundred dollars(8100) t leeso
I person
that a thenifer s as to b the work for which INS permit b lowed, shel not employ
any pereom Ipary manna co ea to become suged to Una W«kers'Compensation Laws of Cell- All r00}S Shall be Inspected prior to any r ting material being
locale. installed. If a roof is installed without first obtaining an
Date Applicant inspection,I agree to remove all new materials for inspection.
NOTICE TO APPUCANT: IL after making this Certificate of Exemption,you should become Applicant understands and will
subject to the Workers'Compensation prWsions of fire Labor Cade,you must forthwith comply PP comply P y with all non POln}
with such provisions or this permit shell be doomed revoked. source regulations.
I certify that I have read this application and state that the above Inkxmaticn Is correct I agree `��f
to comply with all city and county ordinances and state laws retailing to building construction,and All Vrovrings a las A for L
hereby authorize representatives of this city to enter upon the abwe�mentioned property for In. {�'
spedlon purposes. / �/�
(We)agree to save.Indemnify and keep hnarMees the City of Cupertino against liabilities, //` d—T
judgments,costs end expenses which may in any way accrue ageinst add City In consequence SI O P A DATE
of the granting of this permit.
PRE-INSPECTION: - PLYWOOD: I - OG SS:
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
RE-ROOF/TEAR-OFF POLICY
(408) 777-3228
1. You must schedule an inspection for the tear-off the day before the date you wish the
inspection to be made. The procedure is to call the Building Department between the
hours of 1:00 and 4:30 p.m. for the next day inspection.
2. When the roof is torn off, the nails removed or driven in, and all of they dry rotted
wood has been replaced, THEN YOU CALL THE CITY BUILDING DEPARTMENT.
An inspector will be notified that the roof is ready, and he will respond to do the
inspection as soon as his schedule will allow. There are special hours for this service,
between 8:00 a.m. and 11:00 a.m., and between 1:00 p.m. and 3:00 p.m.
IF YOU CALL FOR THE TEAR-OFF.INSPECTION AND THE JOB IS NOT READY,
THERE WILL BE A RE-INSPECTION FEE OF $69.00 CHARGED, WHICH MUST
BE PAID BEFORE ANOTHER INSPECTION IS MADE.
• re-ro Ywinword
• 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.
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 3.
t. 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 shearing and a building inspector will inspect all sheating at
that time.
IMPORTANT:
1. Flat roofs must have a ''/:' per foot slope, or demonstrate that there is no pbnding.
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. ,L
HOMEOWNER'S NAME:
ADDRESS: p
RE-ROOFING COMPNAY NAME: /r C E_
APPLICANT'S SIGNATURE:
• CITY OF CUPERTINO
BUILDING DEPARTMENT
Rc-roof/winword
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INVO".CE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CUPERTINO
• BUILDING PERMIT INVOICE OPERATOR: karenb
Sec: Twp: Rng: Sub: Blk: Lot:35720022.00
INVOICE DATE.... .. : 11/10/1999,
REFERENCE ID # ... : 99110059
SITE ADDRESS ..... : 10290 BUBB RD
SUBDIVISION ...... .
CITY . . . .......... : CUPERTINO
IMPACT AREA ...... .
OWNER . . ........ . . : HOVER ELIZABETH H AND WADE H E
ADDRESS ....... . . . :
CITY/STATE/ZIP . . . : LOS GATOS CA, CA 95032-6916
CONTRACTOR ....... . LIC #
COMPANY . . ........ :
ADDRESS . ......... :
CITY/STATE/ZIP ... .
TELEPHONE ........ :
FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE
--------------- --- --------- ------------ -----------
BPERMFEE P 722.00 0.00 722.00
BSEISMICRE P 8.70 0.00 8.70
--------- ------------ -----------
730.70 0.00 730.70
V ID DESCRIPTIONVOICE ID DESCRIPTION
.. ............................ ........ ............................
FRAME 307 INSULATION
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
603 ROOF BATTENS 609 ROOF IN-PROGRESS