99070031 � n �( QC7
7 PERMIT R_
APPLICATION FOR CITY OF CUPERTINO. NUMBER
INSPECTION DIVISION
PERMIT EXPIRATION
REROOF PERMIT (406)777-3228 PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
• 180 DAYS FROM LAST CALLED INSPECTION.
BUILDING ADDRESS
�+ILLDING ADDRES/ �CSS
//" /� /�
�•[ CJf{F'( L RESIDENTIA COMMERCIAL OTHER
OWNER'S HAZARDOUS FIRE AREA
///) t I YES ❑. II yes—1 understand that a Class A
NAME/ �/K�"`y/Ly/'y (X}�vr .�G/�/C'P_ rrwfa mby is required.
f NO ❑ Initial I.C.B.O.tl
ADDRESS Z27 Uk"✓«erfk 40, EXISTING ROOF COVERING
PHON t0 7 "Q NUMBER OF EXISTING COVERINGS /
CO TOR'
-
NAME //Ofi/ Lill So.w_T. TO BE REMOVED TO BE RETAINED
�/L!'�L�_ .
ADDRESS TYPE OF ROOF COVERING
clTvazip 6 ys /�o�hincsT• �S SCf�• 9J'//7
EXISTING
PHONE 62 72-0330 BUILT-UP ROOF ❑
LICENSE.
NUMBER - Q ASPHALT SHINGLES ❑
LICENSED CONTRACTORS DECLARATION
I hereby shirts that I erri licensed under provisions of Chapter B(commenting with Sedlm WOOD SHAKES
]000)of Dlvaim 3 of the Business and Professions Code,and my license is in full force end
Lk,anea ClaSe �3/ L1c.Number 7 p WOOD SHINGLES
ken �
Dale cen,mdor OTHER (SPECIFY)
OWNER-BUILDER DECLARATION PROPOSED *xr!v
I hereby affirm that I em exempt from the Contrectoes License law for the bIkr ng reason.
(Sec.7031.5,Business and Professions Code: Any city or county smith requires e permit to
construct.after,improve,demoe.h,a repair any stru,ture,prior to Its issuance,W"requires the BUILT-UP ROOF ❑
eppt cent for suets Permit to file a signed eetement that he Is licensed pursuant to the proviSims
of the Contractor's Lkerree Law(Chapter v(commendwith Section]000)of Divium 3 of the
Businase end Professions Code)or that he Is exempt therefrom and the basis for the Staged ASPHALT SHINGLES
exemption.Any violation of Section 1031.5 by any applicant for a permit subleds the applicant to
e civil penalty of rot come then five hundred dollars
C]1,as owner of the property,or my employees with wages as mer sae conrpeMatlon,will do WOOD SHAKES ❑
the work,end the Structure b not Intended or offered for sale(Sec.1044,Business and Profits.
skis Code:The Contractor's License Lew does mt apply to an owner of property who bullde'or WOOD SHINGLES
Improwe meZ,and who does such work himself or through his own employees,provided that ❑
such Improvements are not Intended or offered for see.ll,however,me Nlkitp or Improvement
is sok wimin one year of completkm,me owner-tullder will hese the burden of proving met he did OTHER(SPECIFY) E)not bulk le.).
or Improve for purpose of sal
❑I,as ow,nor of me property,am exclusively contracting with licensed contredota to construct
Me project(Sec.1044,Business and Professions Code:The Contractor's License Lew does not PROVIDE I.C.B.O.REPORT NO.
apply to an owner of property who Nude or Improves thereon,and who wntrects for such projects
with a contmcmr(s)licensed pursuant to me Contractor'.Ucense Law. PROVIDE MFGBINSTALLATION SPEC$
❑1 em exempt under Sec. . .,B&P.C.for this reason I
owner Date - APPLICATION DATE VALUATION PERMIT FEE
WORKER'S COMPENSATION DECIAfiATION
I hereby affirm under penalty of perjury one of me following dedemtion:
❑1 have and will mentaln a Certificate of Consent to sell-Insure for Worker's Compamatlon, Building
as provided for by Section 3100 of the Lobnc
Lobar Code,for the performae of the work for which this L/ 00 g
Permit Is Issued. / Od ''Seismic
❑i have and will themes Worker's Compensation Inaumn finis
p required Is l by S.My 3100 s
the Labor Code,for the pedonnend of the work for which tMs permit le Issued.My Worker's
Compensation Insurance censer end Policy number ere: Total
Carrier PdicyNo. PERMIT\AUTHORIZATION DATE
CERTIFICATE OF EXEMPTION FROM WORKERS' 1
COMPENSATION INSURANCE N.CQ rl '
This Section need not be completed It me permit is for one hundred dollars($100)or lees.)
I ceNfy met in me padormanae of the work l which this permit Is Issued,I Shall not emW Cryany person in any manner so as to become subject to me Workers'Compeneebon Lowe of Cat All roofs shall be��nspected prior to any roofing material being
installed. If a roof is installed without first obtaining an
Date Applicant inspection,I agreeto remove all new materials for inspection.
NOTICE TO APPLICANT: If,after making this CenHkate of Exempilon,you should become Applicant understands and will comply with all non point
Subject to the Workers'Compensation prova ons of the Labor Coda,you must forthwith comply
with Such provisions or th4 pemnQ Shen be deemed revoked. Source regulations.\
I certily trait 1 have reed m1s,aWileatkm end state that the above Information is cared.I agree
to comply,with all dry and county ocdlnac and see laws relating to Wilding and All Mcov s obe class"C"or better.
hereby authorize representatives 0r'mis dry to enter upon the above-mentioned property for In.
� `� c� 2
spection purposes.
(We)spree to save,indemnity end keep harmless yway lite City of Cupertino evelnet IIebIlHles,
0 marts,waif and expenses which they In arty way accrue against ealtl Clty In consequence
• oltevrentlngofMIS permn. - SIG�N/V 1REOFAPPLICANT 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 OP CUPERTINO _
• 2 of 2 BUILDING PERMIT RECEIPT OPERATOR: nancyc
COPY N 1
Sec: Twp: Rng: Sub: Blk: LOC:36944007
DATE ISSUED.......: 07/23/1999
RECEIPT k.........: 9612
REFERENCE ID # ...: 99070031
SITE ADDRESS .....: 20296 PACIFICA DR.
SUBDIVISION .......
CITY ............. : CUPERTINO
IMPACT AREA ...... .
OWNER .. .......... : COMMUNITY MANAGE. SERV.
ADDRESS .......... : 727 UNIVERSITY ADDRESS
CITY/STATE/ZIP ... : LOS GATOS, CA 95031
RECEIVED FROM .... : TIM
CONTRACTOR .......: LIC N
COMPANY .......... :
ADDRESS .......... :
CITY/STATE/ZIP ....
TELEPHONE ........ :
FEE ID UNIT QUANTITY AMOTN7T PD-TO-DT THIS REC NEW BAL
---------- _ __________ __________ __ -_
BPERMFEE VALUATION 5,000.00 107.00 0.00 107.00 0.00
BSEISMICRE VALUATION 4,500.00 0.50 0.00 0.50 0.00
__________ __________ __________ __________
0PERMIT 107.50 0.00 107.50 0.00
OF PAYMENT AMOUNT NUMBER
___________ ____________ __________________
CHECK 215.00 1475
••
TOTAL RECEIPT 215.00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
........ ............................ ........ ............................
305 FRAME 307 INSULATION
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
603 ROOF IN-PROGRESS 604 FINAL REROOF
•
1
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.
J. 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 sheating and a building 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. n
HOMEOWNER'S NAME: nn
ADDRESS: d Z to I� qC l cCcy- DP_
RE-ROOFING COMPNAY NAME:
APPLICANT'S SIGNATURE:
CITY OF CUPERTINO
BUILDING DEPARTMENT
Re-rooUwinword