R-6497 PERMIT
APPLICATION FOR CITY OF CUPERTINO
NUMBER R-
INSPECTION DIVISION PERMIT EXPIRATION
REROOF PERMIT (408)777-3128 PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 1130 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION,
BUILDING ADDRESS
796 V/ /y/c Glc 11 ti� Iz'�I 9fo/�/
RESIDENTIAL COMMERCIAL OTHER
OWNER'S - HAZARDOUS FIRE AREA
YES ❑ tl undersand that a Class A.
NAME roof else=is required. _
NO ❑ Initial I.C.B.O.A
ADDRESS EXISTING ROOF COVERING.
PHONE NUMBER OF EXISTING COVERINGS Z_
CONTRACTOR'S �• REMOVED _z_ �.
TO BE REMED i0 BE RETAINED
NAME
ADDRESS, ri/ TYPE OF ROOF.COVERING
CITY B ZIP .-flyS• -j �A S -
EXISTING
PHONE(�) a9L-71' yy/ BUILT-UP ROOF
LICENSE q 9,,yNUMBER % Z— ASPHALT SHINUAP:R27Ej99
UCENSED CONTRACTORS DECLARATK)N -I hereby affirm that I em licensed under provisions of Chapter B(commendrp with Section WOOD SHAKE7000)of Division 3 of the Business end Prolesslore Code.entl my hoarse Is In lull force end effect. G P C) 7 L WOOD SHINGLLlcense Chas Lk.Number /���Date y' z7' 99 Contractor �� ( O OTHER(SPECT
OWNER BUILDER DECIARATION PROPOSED
I hereby affirm That I em exempt from the Contrectofs License Lew for the blloreinp reason.
(Sec.7031.5,Business entl Profeselora Coda: Any city or county which requires'a par=t to
construct,alter,Improve,demolish,or repair any smocture,prior to its issuance,also requires the BUILT-UP ROOF
applicant for such permit to Iib a signed statement that he Is Ilcaasetl pursuant to Ne provisions
of the Contractors Lienee Lew(Chapter S(commencing with Section 7000)of DNWon 3 of the
Business and Professions Code)or Chet he Is exempt therefrom and the basis for the alleged ASPHALT SHINGLES ❑
exemption.Arry yloletlon of Section 7031.5 by any applbent for a permit subjects ma applicant to - (/
e dull penalty of not more than caro hundred doftyeas a with
wag.): WOOD SHAKES YI
❑I,,.owner of the properly,or to ded oyaee with wages(SNalrBole compe"and,wolf a.
Cre work,ark iha structure Is not Intended or offered for Salo(Sec.]044,Buelnese entl Prole,-
slons Code: The Contmctore Uceose Law does not applyto an owner of properly who builds or WOOD SHINGLES ❑
improves thereon,and who does such work himself or through his own employees,provdad that
such Improvements are not Intended or offered for seta.If,howayer,the bulling or Improvement -
issoldMminoneyearofcompbtlon,the owner-bulderwill have the burden clproving that hedId OTHER(SPECIFY) ❑
not Wlld or Improve for purpose of seta.).
❑I,as owner of the property,em exclusively contracting with licensed contractors to construct
the project(Sec.7044,Business and Professlons Code:The Contractors License Lew does not PROVIDE I.C.B.O.REPORT NO.
apply to an owner of property who builds or Improvas thereon,and who contracts br such projects
with a cuntmctons)licensed pursuant to the oontractofs Uanse Lew. PROVIDE M GR.INSTALLATION SPECS.
❑1 em exempt under Sec. a 6 P.C.for this reeean
6a'- IKI e V N —36121
co=ot Data.
WORKERS COMPENSATION DECUBATION APPLICATION DATE VALUATION PERMIT FEE
I hereby affirm under penalty of perjury one of the lollowirg declaration:
❑1 have and will maintain a CerBllcsa of Conant to""unsure for Worou"Compensation, Building
as provltled for by Section 3700of the Labor Cotle,for the pedormence of the work for wNch Nle /N/2,.q9 �/x
permit Is Issued.
❑1 have end will maintain Workers Compensetlon Insurance,as required by Section 37W 0l 000-
)01/
Seismic
the Labor Code,for the performance of the work for which this penult Is Issued.My Wornere
Compensation Insurance carder end Polley number a7 Total
Carrier GSM b 1 rM+NS /drlfi.h/policy No.6 6 HOZ Z 7 9—� PERMIT AUTHORIZATION DATE
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE N.C.0
(Tha section need not be completed If the permit Is for one hundred colors($100)or less.)
I certify that on the performance of the work for which this permit Is Issued,I shell not employ
any person in any mentor coo tae to become wNed to the Workers'Compereatlon Lawn of Cali- All roofs shall be inspected prior to any roofing material be ng
Wnla. installed. If a roof is installed without first obtaining an
Data Applicant inspection,I agree to remove all new materials for inspection.
NOTICE TO APPUCANT: II,after mako-g this Cerdfloaa of Emirption,you should become Applicant understands and will comply with all non point
subject to the Workers'Comper sailor lora provosof the labor Code,you Mat forthwith comply
with such proAslora or this permit shallibe deemed revoked. source regulations.
I canny Chet 1 have read tub appllcadon and state that the above Information Is correcL I agree_
to comply with all dry and county ordinances and Mate laws routing to building coratmctbn,and _ All roof Coverings t0 be CI C"or better.
hereby authorize representathres of this city to enter upon the abov nnentloned property for In- !, G
sp'We, aureate. - y" z 7—
(Wen agree is ave,Indemnexpenses
w an kay I harmless the City a Dape flnod Ci y n con IequelaM,
of the gran cats and expenses which may In any way accrue against aeltl Clry In conaequerra
01 the granting of this permit. I RE OF PLICANT DATE
PRE-INSPECTION: PLYWOOD: N-PROGRESS:
INSP. DATE INSP. DATE INSP. DATE
TEAR OFF INSPECTION: BATTENS: FINAL:
r
INSP. DATE INSP. DATE INSP. DATE
NOTE: OSHA APPROVED ACCESS TO ROOF SHALL BE PROVIDED FOR INSPECTION
OFFICE COPY
..� cev_.._!� pAT " �' SU$JECr•'r.- /CC."'' � /�C /en 'SHEET
; • . `L
.CHKD: BY •QATB' - .1 G "�" R`c4� JOB NO..LL. L:[
__, . . . •. .;;{`Ter /I7!? G A:d - - -- .___._._�__.
KENNETH NELSON'
Reg Mared.CM Eng)neer
References s' (1)r l $d.;;UBCr 940 Saratoga Ave.
(408)W.?= Sul a 215
Desigrf Load AssumptionaY'(psSanJose Califomla85129
f)
LL
Roof •2
QOf EaS/D y
Ceiling;.,
e 2
Slopes WS., ,
� �2 .
lst 'Floor �� �SiED 9%q*W �1
2nd Floor. ,� OFCA�tF�Q�
Ext. Walls r pp
Int. Walls __ F�\I�Iln�lll'.nLn -
PBrty MAY 17 •1999
• Wind':' .,...� L G..INSPECTION DEPARTMENT
Seismic. "Va M-0"
CIP(,OF CUPERTINO '
Timber Conbtructi'oA •Desd" . Criteria
Use Grade: f ! E x 106 f.'(repatltive use)
Struct. Tight
Frnming' (4 x 4) ' •� .• � 02'• X7'5' .. 1.7a• ••
Struct.'.Joists, .` ?l 1000• 1.7. . 115b '
Planks & •Rafters• ti dt.D
.42 x`775 .:V.(a 1--%kc0RuANGV �:,!TH THE CITY Of, '-
CUPERTINO CQ0Evq AND ORDINANCES .
Light Framing .&. Std.
Studs
-Grads 5SO 1.¢ MATE
Beams &•Stringers Densa Sel. SIGNE[ __-,
Struct. .. This se , , ' agcihcations MUST
1900 1.7 be ksp, ; limos and it fs un,
Beams &"ieringers.. Sbl: Strupt. ; 1600 1.6 lawfu! t r:.' : :,; r s:uryha nr alterations
Beums & Stringers. 'Densa Cl:: •1550 1,7 on.`amr' "t%it.,:. ! ;.,a pe,mission from
he ht 1 � :;° ( ;P Copartino.
O1 1350-' 1.6 the starpp i,', �Irkiz Ad Specifications
• , i TALL 1y0 r Go e a t He'Mit or to be. an
Post & 'Cimbers 'Dense CL fb 1406 • .T.7 pproval oi,ihe t :a L? c:; ;.try provisons
It anv C,ti 0 dapnce orT. F�K* taw,
Di• Fb 1200 1.6'
KENNETH NELSON /P C/,/�,//Qn
Ha0lalared Civil Engineer JCB
• SHEET NO. 2 OT
'-CAECOCATED BY— DATE
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. --` - CALCVLATED BY �f• �" DATE
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