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R-4088 PERMIT R_ '4088 APPLICATION FOR CITY OF CUPERTINO NUMBER INSPECTION DIVISION PERMIT EXPIRATION REROOF PERMIT (408) 252-4505 EXT. 228 WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. BUILDING ADDRESS BUILDING USE ESIDENTIAL COMMERCIAL OTHER OWNER'S A /A\ HAZARDOUS ROOF NAME f-Te�� Ld.�1LL� FIRE COVERING t Q 2`�,��7!// �� 1�.'�' �/^ �"T (�T AREA CLASS ADDRESS 1 9 3 l "�l�"1� � f EXISTING ROOF COVERING PHONE NUMBER OF EXISTING COVERINGS CONTRACTOR'S N1 kc Q ate, L-� J 2 TO BE REMOVED TO BE RETAINED NAME '' TT TYPE'OF ROOF COVERING ADDRESS C1ll CITY a ZIP ' (n( "'1 C�l__l�� st�3 EXISTING PHONE L�T TS a��S� BUILT-UP ROOF LICENSE O ASPH S NUMBER ODD SHAKES LICENSED CONTRACTORS DECLARATION 1 hereby affirm that 1 am licensed under provision[of Chapter 9(commerr OOD GLES ing with Section 7000) of Division 3 of the Business and Profe ions Code,end my license I.1 to I . . no affect. ^7!TQ D.Li.nw Clev Conxra mber tor_ • al USD _ OTHER (SPECIFY) Den Contractor l J WNER-BUILDER DECLARATION - I hereby affirm that I am....of from the Con[r•ctorl Lice.• Lew for PROPOSED the following reason. (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve. demolim,or repel any structure, prior to its issuance also require[the applicant for.uch BUILT-UP ROOF Permit to Iile a signed statement that he is licensed pursuant to the provisions of the Contractor's License Lew (Chapter 9 (commencing with Section 7000) from Division 3 of m.Business and Professions Code)or mss of is memos there if from and the bash for the alleged exemption. Any to of S...on of Divi 1 g by any she usi fora permit+lions t+ me applicant that hto a civil t thel e of not more that live hundred dollars($500).): ODD SHAKES ❑ 1,as owner of the property, or my employees with wages es their sole compensation will do me work, and the structure is not intended or onered LES for sale ISec. 7044, Business end Professions Code: The Contac •Licanw Law does not apply to en owner of Property who builds or improve$thereon, end who not such work himself or through his own employees,provided that such Improvements are no, intended or offered for sale. 11, however, the OTHER (SPECIFY) building P mprovam an, is within one year of completion, the ownan builder will havethe burden m proving that he did not baud or improve for Vunp....I.M..). PROVIDE I.C.B.O. REPORT NO. ❑ 1, as owner of the property, em exclusively contracting with licensed contractors to construct me project (Sec. 7044, Business and Profession% Cotla: The Contractor's License Low does not apply toanowner ofProperty PROVIDE MFGR. INSTALLATION SPECS. who builds or improves thereon,and who contracts for such projects with a contractor(.)licensed pursuant to the Contractor'[License Lew. ❑ am ..amp, under Sac. ,B.&P.C.for this .as$n PPL ICATI N•D TE VALUATION PERMIT FEE owner o•ta WORKERS'COMPENSATION DECLARATION Building hereby affirm that I have a carti,icne of consent to sell insure,P �p �$ tllicat•of Workers'Compensation Insurance,or a certified copy thereof(Sec. MAY 2/4 199 �^ Seismic 3800,Lae.C.). ear`� s7y —Lr� Po11cV No.r Company V �1 C titib copy is hereby furnished. n)�Y pf / _ Total 8 C.rf1 led copy is filed with the city inspection division. Ilk L"DDD Applicant CERTIFICATE OF EXEMPTION FROM WORKERS' N.C. ❑ PERMIT AUTHORIZATION DATE COMPENSATION INSURANCE (This.action neva not be completed it the permit is for one hundred dol tau IS10D)or that i 1 certify at n the performance of the work ,or hick fhi+ permit M1 iesuatl, smell C employ any Person in y manner f fes bacon•subject loth W r erY C sotion Lam of Cel n l., Dote Applicant NOTICE O AP L CANT: It, after making this Certificate of Exemption, you mould become subject to the Workers' Compensation provision[of tru Labor Coda, you must forthwith comply with Such provisions or this permit All roofs shell be Inspected prlorto any roofing material being .hell be deemed ravpked. I certify that I nay.read this.pplmati.n and$tem that the above ihforma. installed If a roof is Installed without first obtaining an tion is correct. 1 ogree to comply with all city and county ordinances and Inspection,I agree to remove all new materials for insp ction. rtes lam relating to building construction, and hereby authorize represen pure f s. this city n refer upon me.hoer mentioned property for impaction \ f � purposes. r�� (Wel agree 1.s. un, indemnify and .,a harmless the City of Cupertino against liabilities, COns0 U. cortf end gra nu[which dry in my way accrue against said City in conwweno of the glinting of,m+o.rmit. SIGNATURE 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 _ _ _ SUBJECT: REROOFING POLICY POR THE CITY OF CUPERTINO BUILDING DEPARTMENT PRIOR TO ISSUANCE OF PERMIT AND INSPECTION PHASE. 1. Prior to permit issuance, you rust agree to cauply with U.B.C. standards and manufacturers spec's Oil reroofing. 2. New roof coverings shall Mol be applied without first obtaining all inspection and written approval from the building inspector. A final inspection and approval shall be obtained from lire building inspector when lire reroofing is completed. 3. All types of roof shall be inspected prior to any roof being installed. d. In order to receive a final,you Must complete steps 1, 2, and 3. 1,) Preinspcction or tear off approval 2.) In progress inspection approval. • 3.) Final inspection approval. a.) Operable smoke detector verification b.) Spark arrestor inslallalioM 5. If plywood is installed, a plywood nail inspection is required. G. If any roof is applied without first obtaining air inspection, you will be required to remove all new material down to the sheathing and a building inspector will inspect all sheathing at tial lime. WE UNDERSTAND THE ABOVE POLICY ON REROOFING AND WILL COMPLY WITH T11E POLICY HOMEOWNERS NAME: Poi- DW( ,s y- , T /� ADDRESS: 19 9 -7 C7, 1w� �l,�J �l�l V • 0jP REROOFING COMPANY NAME: APPLICANTS SIGNATURE: CITY OF CUPERTINO BUILDING DEPARTMENT RercoUwiuword Cit-4 of CNperti"O SMOKE DETECTOR CERTIFICATE Or COMPLIANCE 1 understand and comply with Section 1210-a of the Uniform Building Code. Section 1210-a requires when. repairs to a single family dwelling exceed $1,000, a smoke detector will be installed, mounted on the ceiling or wall in each sleeping room and at a • point centrally located in the corridor or area giving access to room use3'for sleeping purposes. If existing smoke detectors comply, no new detector shall be required. 1 understand the above requirement and certify that we now have sm Ike detectors installed that do comply. ADDRESS: 9 9 3 7 L( 6, G. PERMIT NUMBER: — HOMEOWNERS SIGNATURE: DATE: i • winword/smkdet