R-6663 y PERMIT R_ 6663
APPLICATION FOR CITY OF CUPERTINO NUMBER
• INSPECTION DIVISION PERMIT EXPIRATION
REROOF PERMIT (408)777-3228 PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN IN DAYS OF PERMIT ISSUANCE OR
19)DAYS FROM LAST CALLED INSPECTION,
BUILDING ADDRESS a \\\
QC�� (��. �J RESIDENTIAL' - COMMERCIAL OTHER
OWNER'S - - HAZARDOUS FIRE AREA
YES ❑ If yea-I mldersfand that a Class A
NAME I�.0�V%U roof assembly Is required.
/—
�
1 7 NO ❑ Inma I.C.B.O.
ADDRESS ,-a' ( )nl'ueCS1 �V P`�).}�eS 6A�C� EXISTING ROOF COVERING
PHONE
NUMBER OF EXISTING COVERINGS
CONTRACTOR'S
NAME ` '�L�� ��._S ��b� TO BE REMOVED TO BE RETAINED
ADDRESS /t (�� I�,S�;NS— — - TYPE OF ROOF COVERING
CITY a zIP b p- U ZEXISTING -
PHON `-C6$ / 0 —G 3 3 0 BUILT-UP ROOF ❑
LICENSE
NUMBER C ASPHALT SHINGLES ❑
DCENSED CONTRACTORS DECLARATION
I hereby affirm met I am licensed under provisions of Chapter 9(commencing with Section WOOD SHAKES
7000)of Division 3 of the Business and ProfessCorte,
ions and my license b In full force and -
effect. p-
3q y5, O WOOD SHINGLES ❑
llcensie Cleve ( Lk.Number � I � -
Dale-- ? 9 Q ( Contractor fo'-r Seaae,An RFfo• OTHER(SPECIFY)
OWNER-BUILDER DECLARATION PROPOSED I hereby affirm that I em exempt Iron the Contredoes License Lew for the following reason.(Sec.7031.5,Budrwse entl Prolmine Code: Any city or county whlch repulree a permit toconstruct,alter,improve,denwllsh,or repair any stmcture,pror to its lesuance,also requires the BUILT-UP ROOFapplicant for such permit to file a signed statement that he le fkensetl pursuant to the provisions of the Contractors License Law(Chapter9(commendrg withSectkn7000)ofDivlelon3ofthe Business end Professions Code)or met he Is exempt therefrom end the belle for the alleged ASPHALT SHINGLE
exenptlon.Arty violation of Section 7031.5 by any applicant for a Permit subjects the applicant to
a civil penally of not more than five hundred dollarsEO
D1,as owner of the property,or my employees with wages as their We compensafion,will do WOOD SHAKES
the work,and the atrv�Nre Is not Intended or offered for sale(Sec.70x4,Business ark Profos-
slons Code:The Contractors License law does not apply to an owner of property who bulldo or WOOD SHINGLES ❑
Improves thereon,and who does such work himself or through his own employees,provked met .
such Improvements ere not Intended o offered for sale.II,however,the building or Improvement
le¢eltl within ane year of completion,the owner-builder will have the burden of proving that he dM OTHER(SPECIFY) ❑
not build or Improve for purpose of sale.).
❑I,as owner of the property,em exclusively contracting with licensed contractors to construct
the project(Sec.70",Buelness and Professions Code:The Cantrectore license Iaw does not PROVIDE I.C.B.O.REPORT NO.
apply to an owner of property who builds or Improves thereon,and who contracts for such projects
with a convactor(s)licensed punsuenl to the Contraclors Ucense Lew.
❑I em exempt under Sec. _ ,B a P.C.for this reason PROVIDE MFGR.INSTALLATION SPECS.
owner Date - APPLICATION DATE VALUATION PERMIT FEE
WORKER'S COMPENSATION DECLARATION
I hereby aalrm under penalty of perjury one of the following declaration:
❑1 hove and will malmaln a Certificate of Consent to seg-insure for Workers Corxaensalfon• Building I
as;provided for by Section 3700 of me Labor Code,for me performance of me wok for which lhh, /) 9 �j /I Ol
permit Is
Am heve and will mountain WonMare Gxnpenealbn lnsuran e,as rpulred by Section 370001 //_ffiAIX D O `— Seismic
Dor Code,for the pedornrence of the woh for ehkh 9tis permit Is Issued.My Worker's L
Compenmikn Insurance carrkr e d Pc nu ar ere: �r 0-S-9600
� q. Total 1L
Cartier I`Qh0t/� �oj PaleyNo.WWW9600 ( PER HORIZATI N DATE
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE N.C.Q o
(This section need rot be competed it the Permit Is fon one hundred dollars($1 OO)a leas.)
1 certdy that In the performance of the work for which this Permit Is issued,I ahall nor employ
any person In any manner so as to become subject to the Workers'Compensation Laws of Can. All roof.^,shaijiffe inspected prior to any roofing material being
fornia.a installed. a roof is installed without first obtaining an
Data Applicant inspect) n,I agree to remove all new materials for inspection.
augNOTICE ToAPPLICANT: If, ming this m rt ficcat eocExemption,yon,ahon'a become Applicant understands and will comply with all non point
pe p you must forth comply
whh such provisions«this permh ahelObe deemed revoked. - source.regulations.
I certify met I have read this application and state that vire above Information Is correct.I agree
to comply with all city and county ordinances and state laws relating to buikirg construction,and All roo v 'ngs to be ass"C"or better.
hereby eutiorize representatives of thin city to enter upon the above-mentioned property for in- 9 9 9
(We)agree to save,Indemnity and keep harmless the City of Cupertino a fret liablilties,
judgments costa and expenses which may In any way accrue against said Gry n coneequarwe SIGNATURE OF APPLICANT DATE
. .• of me 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
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.
1. 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 cheating 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: ��, � �� �y µ UJ- S�cv1 t°12�
ADDRESS: 7�_ 7 N J«S ��/ Py 165 C�ATO S '•es �
RE-ROOFING COMPNAY NAME: IFC> f S24 So K S
APPLICANT'S SIGNATURE:
•
CITY OF CUPERTINO
BUILDING DEPARTMENT
Re-root/winword