99070030 3 9 D1 0 3U
PERMIT
APPLICATION FOR CITY OF CUPERTINO NUMBS
INSPECTION DIVISION PERMIT EXPIRATION
REROOF PERMIT (408)777-3228 PERMIT EXPIRES IF WORK IS NOT STARTED'
WITHIN 1K DAYS OF PERMIT ISSUANCE 09
1W DAYS FROM LAST CALLED INSPECTION.
BUILDING ADDRESS
(1C k¢ R. RESIDENTIAL COMMERCIAL OTHER
OWNER'S - . . HAZARDOUS FlRE AREA
I GYES 0 ff yes-I understand that a Class A
NAME t-�AA�C.�'u ��. < er l// e �' rod assembly,Is required.. .
NO ❑ - Initial I.C.B.O.N
ADDRESS72 7 L/^ V q-U• .6s 6•o--4tT Ga EXISTING ROOF COVERING
PHONE OFd J ' 0 c:5 NUMBER OF EXISTING COVERINGS
CONTRACTOR'S C
NAME:ZZ4 U eCr SO 1^fS Ci� TO BE REMOVED TO BE RETAINED
ADDRESS .YS— - TYPE OF ROOF COVERING
CITY&ZIP ( O('vt/1 65,5• GA- 9S_17 :2
EXI
STING
PHONE(*8� 2 BUILT-UP ROOF ❑
LICENSE
NUMBER ASPHALT SHINGLES ❑
LICENSE CONTRACTORS DECLARATION
I hereby Shim met I am licensed under provoilons of Chapter 9(commencing with Seaton WOOD SHAKES — '�
]1100)of Division 3 of the Business end Professions Code,and my license Is In lull force and
effect
WOOD SHINGLES /
Ucenae Cleeev�� I Dc.Number Y� l
OTHER(SPECIFY) /❑
Date OWNER-BUILDER
�O
ONNER B e Contractors
DECLARATION PROPOSED
I hereby affirm that I an exempt from the Contractors Ucenee Lew for the requires
a Permit
to
(Sec.7031.5, ,Impr se end Pmeeaone Cade: Any dry or county which x,.els a uirmk to
corecant or ,su Improve,to file demolish,Signed
statement
any aructtre,prior to se lcvwx:a,also requires ma BUILT-UP ROOF ❑
of mar
Contractors
such permit to Nle a Chaps statement met he a licensed pursuant to the prwa the
of the Contractors License Lew(Chapter B Is ex a pt t with Bacton]000)of for the 3 al the
• e
exemption.
and Pm lotion f Code)or the.he Is exempt therefrom am ma hecto for the alleged ASPHALT SHINGLES
exemption.Arty act onofhealon]031.6 byany applicant).for a permit euojeas the applicant to
e dv0 penalty d not more Nen INS hurgretl tldlers($500).):
C]1.as owner of the property,or my employees with wages as their sole compensel wig do WOOD SHAKES ❑
the work,and the structure IB not Intended or offered for able(Sec.7044,Business and Proles
Sons Coda:The Contractors License Lew does not apply to an owner of property who builds or WOOD SHINGLES -❑ '
Improves thereon,and who does such work himaea or through his own employees,provktad that
such Improvements are rot Intended or offered for see.It,howa+eq the Wilding or Improvement
e sold within one year of compleubn,the owner leer will have the burden of proving that he did OTHERSPECIFY
not build or Improve for purpose of eels.). OTHER(SPECIFY) ❑
❑1,as owner of the property,em exclusively contracting with Ikenaed contractors to construct
the protect(Sec.]ono,Bualneaa and Profenaiml,Cade:The Contractors License law,does not PROVIDE I.C.B.O.REPORT NO.
apply to an owner of property who Wilds or Improves thereon,and who contracts for such projects
with a contractoge)licensed pursuant to me contractors Ucenae Law. PROVIDE MFGR. INSTALLATION SPECS.'
❑1 em exempt under Sec. ,B&P.C.for me reason
Owner. oats -
WORKER'S COMPENSATION DECLARATION APPLICATION DATE VALUATION PERMIT FEE
I hereby affirm under perWty of perjury erre of the following dederetkm:
❑1 have end will maintain a Certlgcate of Co Bent to eelf-Ineurs for Worli Compenseher. Building
as provided for by Section 3]00 of me Labor Code,for trre performance of the wok for whish this � �� g
pennil a"and �QO Seismic
hI have entl will melnteln Workare compensation Insurance,the required by 9ecdon 3700 of
IWLebor Code,for the performance of the work for which INS permit Is Issued.My Workers
CompereIa/tbln/Inlf�urenca carrier end Pdlay number are: Total
CenierV�([9/`y0y TSS Pdky,No, G�� oq pERMITAUTHORIZATION DATE
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE N.C.p
(This seclbn need not be completed If the permit Is for one hundred ddem(5100)a lase.)
I ceNfy met In the performance d the work for which les permit Is Issued,I Shell rot employ
arty,person N any manner ao the to become subject to the Werkers'Comperwailon Lowe of Cell- All roofs shall be inspected prior to any roofing material being"
home. installed. If a roof is installed without first obtaining an
Dee ApplImnt inspection,I agree to remove all new materials for inspection.
SubjecctNICE m Me APPLICANT: 11,after Workers'Campereetlon ru ib m Courteous,the Labor Code,you you alrowd become Applicant understands and will comply with all non Point
with a provisions or this pemdt shallIbe deemed revoked. must forthwith campy source regulations.
I candy met I have read thio applkellon and State that the above Information Is coned I agree
to campy with all city and county ordinances entl state levee relefing to building constructm.and All rO Co gs Class.0°ort]^tter.
hereby authorize represent of this city to enter upon me aloin-mentloned propsrry for In- y/`/J �^
spectlon purposes.
(We)agree to Save,maternally and keep harmless the City of Cupertlrw against liabilities,
In97
dents,costa entl expenses which may In arty way accrue against sold City In consequence
of tha granting of min permit. - S G URE OF APPLICANT 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
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CUPERTINO
• BUILDING PERMIT INVOICE OPERATOR: karenb
Sec: Twp: Rng: Sub: Blk: Lot:36944006.00
INVOICE DATE......: 07/23/1999
REFERENCE ID # ...: 99070030
SITE ADDRESS .....: 20298 PACIFICA DR
SUBDIVISION .......
CITY .... .........: CUPERTINO
IMPACT AREA .......
OWNER . ........... : HIGASHIUCHI ALTO TRUSTEE
ADDRESS .......... :
CITY/STATE/ZIP ...: LOS ALTOS CA, CA 94022
CONTRACTOR ....... : LIC #
COMPANY ..........:
ADDRESS ..........:
CITY/STATE/ZIP ....
TELEPHONE ........:
FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE
--------------- --- --------- ------------ -----------
BPERMFEE P 107.00 0.00 107.00
BSEISMICRE P 0.50 0.00 0.50
--------- ------------ -----------
107.50 0.00 107.50
VO ID -_-__-- DESCRIPTION_-------- VOICE ID ---- DESCRIPTION
.. ........ ........ ... ...............
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.
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 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: d Z C Qg lY�t C tl
RE-ROOFING COMPNAY NAME: �Ov� JP��So+ SCo
APPLICANT'S SIGNATURE:
V
• CITY OF CUPERTINO
BUILDING DEPARTMENT
Re-roof/winword