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99070017 �I00l PERMff APPLICATION FOR CITY OF CUPERTINO NUMBE INSPECTION DIVISION PERMIT EXPIRATION REROOF PERMIT (408)777-3228 PERMIT EXPIRES IF WORK IS NOT STARTED . - WITHIN 180 DAYS OF PERMIT ISSUANCE O Wri DAYS FROM LAST CALLED INSPECTION.. BUILDING ADDRESS � /- 1zSl -CCS RES_IDENTIAL__?_�, _COMMERCIAL OTHER OWNER'SE] HAZARDOUS FIRE AREA ( YES B yea-I understand that a Class A NAME I roof assem l is required. NO Initial I.C.B.O.N ADDRESS EXISTING ROOF COVERING PHONE 3 — NUM ER OF EXISTING COVERINGS CONTRACT R••'S,, . NAME (N� 7 �( TO BE REMWED �� TO BE RETAINED ADDRESS / / TYPE OF ROOF COVERING CITY&ZIP o �/J EXISTING PHONE BUILT-UP ROOF ❑ LICENSE p NUMBER - ASPHALT SHINGLES3 SED R�C�TO/RSDECARTION - - I hereby affirm that I am Iiceneed under provlslone of Chapter g(commencing with Section WOOD SHAKES ❑ - 7000)of Division 3 of the Busine"and Profenelons Code,end!my license is In full force and effect. (/�' WOOD SHINGLES ❑ Ucensa Claes `('�3 Llc.Number-=-�� . Data n coon W W ll Zjk r� El (SPECIFY) OWNER-BUILDER DECLARATION PROPOSED 1 hereby affirm that I am exempt from the Contractors License Lew for the lolloving reason. (Sec.7031.5.Business and Proleeslons Code: Any dry or county which requires a permit to - construcLeiter,Improve,demolish.or repair any Mal prior to Is Issuance,also requiresNe BUILT-UP ROOF ❑ appacent for such permit d file a Signed Statement Net he b licensed pursuant to the provisfons OI the Contractor's License Law(Chapter a(commeatln wird Section 7000)of OMsfon 3 d the BuStum and Prolesalom Coda)or that he Is exempt therefm roand Me'be.Ms for Ne alleged ASPHALT SHINGLES exemption.Any violiall of Section 7031.5 by any applicant for a permit subjects the applicant to e cIvI penalty of rot more Nan five hummed tlollen($500).): C]1,as owner of the property,or my employees WIN wages as their Sole compensation,willW WOOD SHAKES ❑ the work,and the structure Is not Intended or offered for Bele(Sec.7044,Buslnees and Proles. ' Mom Cade:The Contractors License Law does not sppty to an owner of property who bulks or WOOD SHINGLES Improves thereon,and who clones Such work himself or through his own employees,provided that ❑ such Improvements are not Intended or offered for sale.If,however,the bulking or Improvement Is sold within one year of completion,the owner-bulltler will have the burden of proving Net he did 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 protect(Sea.7044,Business entl Professions Cade:The Contractors License Lew class not PROVIDE I.C.B.O.REPORT NO. apphy to an owner of property who bulla or lmprovee hemon,end who contracts for such pneects - with a contmctor(s)Ilcensetl pursuant to the Contranore License Law. PROVIDE Ml INSTALLATION SPECS. ❑1 em exempt under Sec. ,B&P.C.for this reason Owner Dare _ApPLICATI N DA VALUATION PERMIT FEE ' WORKER'S COMPENSATION DECLARATION �� II 1 hereby affirm under penalty of perjury one of Ne following dederatkm: f r LO❑1 have aM will maintain a Cemncate of Consent to self-Insure for Wodmrs Compemetion, '77 Building as provded far by Section 3700 o1 the Labor Cade,for the performance of the work for whichrl,e II 2 1999 �/ permit Is Issued. f J L 2 TJ have and will maintain Workers Compensation Insureal as repuirea by Section 37011 of. S61SrI11C Me Coale,for the performance of Ne work for which Nb permit is hsued.My W ie - CompaneatknI"�u comer end Polley mbar ere: Tota Carrier -lac -P =2 relay Nof or ORIZATION DATE - CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE N (This section need rot Ee competed H the permit b for ore hundred dollars($100)00)or IeeeJ .. I certHy that k the pftrlorma of the work for which Nle permit b Wueq 1 e shelf t em any person In eery manner So as to became subject to the Workers'Co mpeneation Law All roofs shall be inspected prior to any roofing material being fornix. 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 Ce-hficate of Exemption,you should bamrne Applicant understands and will comply with all non int Subject to the Workers'Compensation provisions of the Labor Code,you must forthwith comply pP P Y point with such provisions or this permit shatlibe deemed revoked. source regulations. I cartily that I have read l application ark Mate Net the above Information is correct.I agree to comply with at city era county ordinarxroe and state few relating to bulking construction,anti All root coverings to be class"C"or better. hereby autlloh ui represantethros of thin city to enter upon the ebovol-mentioned property kr In- `yy�� hereby purposee. `/ / (We)agree to save.Indemnity and keep hermiees.the CIN of Cupert e apalnst Ilabllilles, .w t /� judgments,coolie and expanses which may In arty way accrue against said City In consequence SIGNATLIR F APPLICANT DATA of the granting of Nle 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 INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE CITY OF CUPERTINO . BUILDING PERMIT INVOICE OPERATOR: karenb Sec: Twp: Rng: Sub: Blk: Lot.36611109.00 INVOICE DATE......: 07/22/1999 REFERENCE ID # ...: 99070017 SITE ADDRESS .....: 1258 S STELLING RD SUBDIVISION ......: CITY .............: CUPERTINO IMPACT AREA ......: OWNER ............: BING LIN ADDRESS ..........: CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-5204 CONTRACTOR .......: LIC # COMPANY ..........: ADDRESS ..........: CITY/STATE/ZIP ...: , TELEPHONE ........: F DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE RMFEE P 107.00 0.00 107.00 BSEISMICRE P 0.50 0.00 0.50 --------- ------------ ----------- 107.50 0.00 107.50 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 • 'e)� ITY 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 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 ''/6" 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 CONIPNAY NAME: APPLICANT'S SIGNATURE: CITY OF CUPERTINO BUILDING DEPARTMENT �\ Re-raoVwinword 1 J V � I �� Z2 . fb b /// L_ ��/ f' �-- 1 \ , f. :'v, :w �� h:_ ,� :� i . �. f