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99070028• • 9 PERMIT APPLICATION FOR CITY of CUPERTINO NUMBE INSPECTION DIVISION PERMIT EXPIRATI N REROOF: PERMIT (408) 777-3228 PERMIT EXPIRES IF WORK IS NOT STARTED ' WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. BUILDING ADDRESS - - ` I RESIDENTI COMMERCIAL CTHER OWNER'S HAZARDOUS FIRE AREA ` VES ❑ If yes- I understand that a Class A AMEW �Vw.i 7- - �'1/-1 �_�' Ni� roof assembly is reduired. . NO ❑ Initial I.C.B.O. $ ' % Urn✓tiSi to EXISTING ROOF COVERING ADDRESS . jy Fal/. S %c_ToS G4— $ ��©� NUMBER OF EXISTING COVERINGS / PHON O - D CONTRAACTOR'S NAME 9b�r S PeK SO r+� TO BE REMOVED/ TO BE RETAINED ADDRESS' Sz-5.04 TYPE OF ROOF COVERING CrrYazIP6ys /Thrni &t iV EXISTING PHONI(yQ&) 02 - .¢ BUILT-UP ROOF ❑ (—�jO. NUMBER 7?a ASPHALT SHINGLES ❑ - LICENSED CONTRACTORS DECLARATION I hereby affirm that I em Iloensad under provisions of Chapter a (commencing with Section WOOD SHAKES 7000) of Dlvison 3 of the Business end Professions Code, and my license Is In full force and effect. C'_2C, 1/J2�O � WOOD SHINGLES License Cleve ✓ W. Number % Date Con Vector ^' OTHER (SPECIFY) - ay ❑ �. OWNER-BUILDERDECLARATON I hereby affirm that I em exempt from the Contractors Ue Lew cersfor the following reason. PROPOSED C (Sec. 7031.5, Business and Probsdons Code: Any city or county which requires e permit to construct, eller, Improve, demolish• or repair any structure, prior to Ile Issuance, also requires the BUILT-UP ROOF El. applicant for such permit to file a signed statement that he Is licensed pursuant to the prW,Ions of the Contractor'. Ucanse Lew (Chapter a (commencing with Section 7(K0) of DMson 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged ASPHALT SHINGLES exemption. Any violation of Seol 7031.5 by any applicant for a permit subjects the applicant to . a clvg penalty d not more than live hundred dollen (5500).): WOOD SHAKES El 1, as owner of the property, or my employees with wages as their able compensation, will do ❑ the work, and the struci Is not Intended or offered for sale (Sec. 7044, Business and Profen ekns Code: The Convectors ucense Lew does not apply to an owner of property who builds or WOOD SHINGLES ❑ Improves thereon, and wfo does such won, himself or through his own employees, provided that such Improvements are not Intended or offered ler sale. If, however, the Witting or Improvement Is sold within one year of completion, the bw ,Ibulldar will funs the burden of prodrig Nat he did OTHER (SPECIFY) ❑ not build or Improve ler purpose of saiii ❑ I, as owner of the property, am exdusNsiy contractf g with licensed contractors to construct the project Sao. 70,14, Bushes and Professions Code: The Contrectwb Llcenee Lew Was 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 contractors) be firmed Pursuant to the Contractors Lbenw Lew. ' PROVIDE MFGR. INSTALLATION SPECS. ❑ 1 am exempt under Sec. ,B a P. C. for thio reason Owner Date APPLICATION DATE VALUATION PERMIT FEE WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of Me "lowing dedaratlon: ❑ I have and will melntsln a CertBbete of Consent to sdbinaure ler Workers Compensation, Building as prWifu d for by Section 37W of the Labor Code, for the performance of the work ler which this peIl-Is Issued. gl have MII Workers Compensation Insurance, by Section 3700 dL Y' Seismic and maintain ee required of Ne labor Coda, ler the performance of the work for which this permit is leeued. My Workers O Con"nes, N I�purencs ranter end Polley number ere:, �p QS'fl' V Z'A4- Total I Carder Policy Nb. {�/(�+��3 PERMIT AUTHORIZATION DATE CERTIFICATE OF EXEMPTION FROM WORKERS' - COMPENSATION INSURANCE N.C.[] (This section need not be completed 8 the permit le for one hundred dollars ($1W) or lees.) I certify that In the performance of the work for which Nis permit Is laeued, I shall not employ any person In any manner so as to become subject to the Worked Compeneation Laws of Cali- All roofs shall be inspected prior to any roofing material being fourth. installed. If a roof is installed without first obtaining an Date Applicant inspection, I agree to remove all new materials for inspection. NOTICE TO APPLICANT: It, after making this Certlficete of Exemption, you should beconu Applicant understands and will comply with all non dint pP P y P subject to the Workers' Compensation prmislons of the Labor Code, you must forthwith comply with such provlelons or the permit shall be deemed revoked. Source regulations I certify that I have reed this eppllceHon and state that the above Information Is correct. I agree to comply with all city and county ordinances and state laws relating to building consvudlon, and Or better. All roof COV I��� hereby hereby authorize representatives of MIs dry to enter upon the above mentlonetl properly ler In. r ^ spoodon purposes. sC; ��3^ 9 (We) agree to save, Indemnity, and keep harmless the Gty of Cupertino against Ilablitles, Judgments. costs and expenses which may, In any way accrue epinst eek Gty, In consequence of the grant) of ads permit. IGN RE 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: Rug: Sub: Elk: Lot:36944005.00 INVOICE DATE......: 07/23/1999 REFERENCE ID # ...: 99070028 SITE ADDRESS .....: 20302 PACIFICA DR SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ....... OWNER ............: NAKA YAMA KENICHI AND SANAE ADDRESS ..........: CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-3001 0 CONTRACTOR .......: LIC Y COMPANY ..........: ADDRESS ..........: CITY/STATE/ZIP .... , TELEPHONE ........: FEE DESCRIPTION CHR TOTAL FEE PAID -TO -DATE BALANCE DUE _______________ BPERMFEE --- P --------- 107.00 ------------ 0.00 --_--_-.-_- 107.00 BSEISMICRE P 0.50 0.00 0.50 --------- 10].50 ------------ 0.00 ----------- 107.50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION . ............................ FRAME -3-0-7- ................... 30] IN 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 603 ROOF IN -PROGRESS 604 FINAL REROOF 0 0 • 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. i. Pre -inspection or tear -off approval 2. In -progress inspection approval I. 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 Ye" 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: RE -ROOFING COMPNAY NAME: APPLICANT'S SIGNATURE .CITY OF CUPERTINO BUILDING DEPARTMENT Re-roo Vwinword C M - -S