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R-3843 PERMIT Res 3 8 4 3 APPLICATION FOR CITY OF CUPERTINO NUMBER INSPECTION DIVISION O PERMIT REROOF PERMIT EXPIRgT10N (408) 252-4505 EXT. 220 WITHINEBODAYSOFPERMTISSUANCEOR 180 DAYS FROM LAST CALLED INSPECTION. BUILDING ADDRESS BUILDING USE WSO ) - Ip rA fV}�fr�hOI RESIDENTIAL COMMERCIAL OTHER OWNERS 1 vrt� �O'I N'I— t I Of? HAZARDOUS ROOF NAME �( FIRE N (n COVERING AREA CLASS ADDRESS 1090 YUOr" ,00,.nt EXISTING ROOF COVERING 1� �� 1 1 PHONE C `IiJ C, 1 NUMBER OF EXISTING COVERINGS ` CONTRACTOR'S 1 .0 � QOOT Lr,(A TO BE REMOVED I TO BE RETAINED NAME 1-6w 1 ADDRESS11�/��{ C ((,, C c 1 TYPE OF ROOF COVERING CITY&Z16 UJfk5, 7f'" t I ' `l EXISTING PHONE (Lice) q-71-7M BUILT-UP ROOF LICENSEv15 \ G ASPHALT SHINGLES NUMBER 1 ,) WOOD SHAKES X LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9(cammm ing with Section 70001 of Division 3 of the Business and Profusions Code, WOOD SHINGLES and my license i I tome and affect L(A C.hh' miser �L-� Dete��k-A � Li..N tdr OTHER (SPECIFY) OWNER-BUILDER DECLARATIO I hoeby affirm that I am exemor Nom the Contractor's License Lew PROPOSED the following o=h. (Sec. 7031.5, Bus and Professions Code: Any city or County which requires a permit to construct,alter, improve, d.molish,or rapelr any anu<[ure,prior to its issuance also requires the applicant for such BUILT-UP ROOF Pomh to Nis a signed statement that he is licensed pursuant to the provisions of the Contractor s License Lan (Ch epier 9 (cammencing with Section 7000) of Division 3 of the Business and Professions Code)or that he is exempt there ASPHALT SHINGLES from and in basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjectsthe applicant to a civil penalty of not man that five hundred dollars(S500).r: WOOD SHAKES ❑ 1,as owner of the property, or my employees with wages as their sale compensation,will do Na work, and the structure is not intended or offered for sale (Sec. 70,44, Business and Professions Code: The Contractor's License WOOD SHINGLES Law does not apply to an owner of property who Duilds or improves[hneon, / � 11 And who noes such work nemseN or ed oro nes own , Sale. aIf, provided that OTHER (SPECIFY) ca [5AA<•P uch improvements improvement are his old within o. offered for ons N, however,o the building or improvement ee sola proving one year of of build [see owner builder will have [sea burden of proving[hat see did not build ar improve for purpose of ssl..1. PROVIDE I.C.B.O. REPORT NO. ❑ 1, s owner of the property, am exclusively contracting with licensed contractors to c nstruct the project (Sec. 7044, Business and Professions Code: The Contractor'. License Law does not apply to an owner of Property PROVIDE III INSTALLATION SPECS. who builds or improves tnereun, and who contracts for such Projacte with a con tractor(s)licensed pursuant to the Contractor's License Law. ❑ I .m exempt Pm.. s.p. ,B.ay.c.for this noon APPLICATION DATE VALUATION PERMIT FEE Owner Date WORKERS'COMPENSATION DECLARATION 4 Building �" I ,L eby affirm that have i n Insurance, , consent to l It insther o a c.C. (�p I©©Q 3800se of Workers'Compensation Ineu <a,ore<0 11 i.d cy o�Y thereof(Sac. 3800,Lab 11ww 'W„ 1y�\ r- ,, ® SBISff11C Policy No.�jl4,�y�YompenyiL�bl 61F�ag1- �/OUrWi, Certified cop,is hereby I.— had. C U Total LII Certifi d copy tileA�nn tl�j ty inspection division. APR _ Applicant In APR n CICATE OF EXEMP ON FROM WORKERS' N.C. C ❑ ^ l P R AUTHORIZATION DATE COMPENSATION INS URANCE V f III (This action need not be Completed if Ina permit is for one hundred d01 V I- r` , ` I� 1.,.($tOOI jIJIMhat i ia1�INy •/`r (` I <otihe tnet in theemploy performance person of the work for which this permit is towed, I creel not employ any Lenon in any manner so as to become wbjeet to the Workers'Compensation Lews of California.n NDate—OT Applicant you ShoICE TO APPLICANT. o hear making this Compensation Certificate of Exemption, you should become Subject i the Worker' Compensation nso r this of the Lebon Code, you must forthwith comply with such provisions or this permit Mall be deemed reeokad. All roofsshall be inspected prior to any roofing material being I Certify tires I h.v.read his.ppli..Ii..and st.[.tr.t m..bov.lnmrm.. Installed If a roof is installed without first obtaining an tion is correct. I agree to comply With ell city end C...1, ordinances and inspection,I ag Be to remove all new materials for inspection. sten laws relating to building construction, and hereby authorize represent tatives Of this City to enter upon the above mentioned property for inspection purposes. (We) ague to saw, indemnify and keep harmless the City of Cupertino /against liabilities.liabilities,judgments,coots and expenses which may in any way accrue _V(] against Said City in consequence of the granting of this permit. SIGNATURE OF APPLICANT if 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 I RPR-21-1995 14:17 TAYLOR ROOFING 408 9711380 P.01 j • • Citrq of CUi�ert1110 P.O.oo. ao Cul,cillnp,CA 95015.0500 10.1(10 Inur.^venue Gipcillno,C1 0'151-3455 05 TClrphunC: ( l fA%:130111251-tl75J i COMMUNITY 0@"@IOrMWI I SM ICC UC"1'L' '10it �j'f�� �"I"1 1 C M 'LlANCG I will) Section 1210-a of the Unifonu Iluilding Code L undlcrsland and complyan . DS Section 1210-:1 requireslwll ountclairs 4ohe cicil l Scorlilw�dv>>leachesleepinglroom and aka detector will be installed, li sed for �loca,edmal<edl deolectdo0s coomply. giving point centrallyo new detectors shall)berrequkcd.sleeping • purlloscs. Ifc 6 •I l understand the above r,dreuleM and certify that we now have smoke detectors installed Al do comply" ADDRESS: pr,lI IIT NUMBER: C C -ItS SIGNA'I'URL: I"lONtrOWN_I ' LE f , winword/sAdcl i RPR-21-1995 14:17 TAYLOR, ROOFING 408 9711380 P.01 H • Cjtq 0'f Cti{j)CI't1110 • r.o.0vk 5110 Cupertlnv,CA 95015.0500 10.10(1 In�ir.Me-MO CupciiLty, CA 75011.1251 1tirithunc;(4011) 252-410$ � WA 14 0111 25 2 02 5 7 COMMUN1(y llCvrlorMfNr I $M�13 UE'1'L '] RCL=It l ll�i(`A•fC )�L�'LIANCG i I understand and comPly will, Section 1210-a of the Uniform 13uilding Code- Section 1210 -ilelulsta`Ieswh ll Iep'd11ou oll e cieil l gfo llwyal�iellenc11 sleePutgltoom and ot`n (1e1eC10 pailit cc !fc located diced (I oll-id0s or ni y, 6o new delectoroshall be requrooll' sed ned.sleCPl g • pu 1 0 •; I understand the about requircn,enl ant, certify Thal we now have smoke, defectors I iuslalled lhal do comply. • /��U; �Q2iHo�lc SQL ADDRESS: QQ GG PERMIT NUM.UER: IIOMf-,OWNFItS SIGNA'I'UIIE: _ 23— DATE: I • I � 1 winword/snll(dcl t i TI1T111 rl f]1 RPP.-21-1995 14: 17 TAYLOR ROOFING }, 408 9711580 P.01 Cita of C'�i�erti��o r.0.00t 500 Cupctllnn,CA 95015.0500 10.100 rnur.Avl'1IOC Cupc,dnv,CA 7501,10255 7clrpLvnc; (4001253,4501 (A%: 140111252U75J ; COMMUNITv OcvuorMLw a SM�I's L)E r011 CER�r1l 1CAJ P ' M 'LlANCG I undcrslalld and comply wills Section 1210-a of the Uniform fluilding Code. exceed X1000a smoke Section 1210-11 requires %Y11cn repairs to a single family dwelling , , n detector will be instnlli I {the lcorr11orted Wt 11or accalgivoing accessItol 0on1SIC(T11used rot s1ooln 111eeping point ecntl'ally located ill purposes. If c:eisliug smoked dalectors comply, no now detector shall be require . • I uudelMand the above rcquircnlcnl and certify that we now have smoke defectors • installed that do comply. 0 y/ art ADDRESS: 8�3 I'LILM.IT NUM.UL•R: � D � �f I � I IIOMf?OWNt'ILS SIGN�'1'UIIL: � un•rL: - i winword/sml<det i IkI • Sl1B' IOIt'f ' O 0ISSUAIGf N 1OI' f_'tt FOR' 1111' C,Il C oUN I�IIIASElIJO BUILDING DEPAII"1'MGNI' I. I'lior to permit issllmlce. you most aglcc to comply with U.D.C. slaadards and nmuufaclmcls spa's on rcroofng. lspcClion ell �11 2. Flourl[lie building illspoctoro.l be A fllml illlspceliou and nppr000lhshnddlbe oblaincdll'lonlllllc 6uilJilg illspcclol \\'llcll [tic reboring is completed. . ], All IYIICS of rOOf S11:111 be inspected III lOr to any loot being installed. 4. In odder to receive ;l 1111;11, )'Oil I,,[Is[ colnplcic slcps 1, 2, and J. I,) 11rciospecliou or tear orf opplovol. 2.) In progress inspection approval. S.) I incl inspcclion ;lpplovol. Opel,lblc sulokc dClcclor vclifadion • b ) Spall allcslor iuri;dlalion 5. If plywood is installed, a plywood i ;lil iuspcclion is lquiled. G. If auy roof is eppdicd without first obtaining :ul inspection, Y0111eel be requited to remove all ncly Imitclkll down to the sllcallling and ;1 building inspeclor will inspect '111 shcolhing al lhol lime. WI, UNDERSTAND '1111: ABOVE POLICY ItBltOOFING AND WILL COMPLY WI'fll "171E POLICY I\ I % 4DAL IIOMI;OWNLItSNAMI'?: Opbo ADDRESS: ltj;ltOOPING COMPANY NAME: r APPLICANT'S SIGNATURE: CI'T'Y 01' CUTER(INO BUILDING DEPARTMENT Itcroofhvilmold i RPR-21-1995 14:17 TAYLOR ROOFING 408 9711380 P.01 Citi of CUi>QYti110 r.o.Box 500 CupcHlnn,CA 95015.0500 101(1(1 IFv,c Avcnur pgmnlno,CA 75011•.3255 iclrplumr;(10Ui 252rd5n5 rA%:(1011(25bU751 (:UMMUNI(Y DCV@torMEN! .i a♦ SMQICI,3 UB1'L�yR CL'•1L�11l�1CA'1•GP )M 'LiAI ME I understand nod comply with Section 1210•a of the Uniform Building Code. Section 1211a requires when repairs to a single family dwclling exceed $1,000, a smat a oke all in do 1c'ltoclg 1111yclAuk"oc�ted lu the comoumc(rid ord on tloe �Cc�giving 1ccess�to'room11useld for soorn leeping giving Io purposes• !f cxistiug smol(cd detectors conlplY, no 1'ow detector shall 6c required. • l d the above requirement and celtiry that we now have smoke detectors understan •I installed that do comply- 3) �- C) - ADDRESS: 8`43 1'L.ItM1T NUM.tiL-It: � j EbS uF5 7uboui�l IIOMI OWNCiRS SIGNA'1'UIIL: / I i j 4VIn14Dl'(IJSllll((I el I i ��RPR-21�-1995 14: 17, TWLOR 'ROOFING. 406, 9?11380 P.01 r •. C'11ij O� CwpQf,fMO. r.o.Box 5130 • - - Cupertlno,CA 95015.0500 40.1(10 rnnc AvOiuc' Cupe Inu,CA 75011.7255 - .rAX:(40111251-075) - COMMUNITY UEVEIorMENT ' J> SMOG DG't'L 'I Il CL"11 1 I''A CL 1 PLlANCB 1 indcrstalld and comply with Seclion 1210-a of the Uniform iiading Code- llO xceed Scclion 1210-11 requireslwii otinledlon is �he cicil isllgIr lor11wall`i nyr leachesleepiiglroom and Smoke tda dclecloi will be installed, poi 7oses1tllf exisoli at sluloldill ed deleclle doos comply, no new delecloosh�lilbo rednired sleeping 1 I •. I undorstand the abovc rcquirolllrM and ccrtify that we now have smoke detectors • inslallcd Ilial do congily- ADDRLSS: IILIIMITNUM.U,L•R: _ — 1lOMI;O S SIGNACURG: W " -�- DA'1'L: winword/snllaid . 1 TrTP P_P1 _ - i APR-21-1995 14:17 TAYLOR ROOFING 408 9711380 P.01 Citt{ of CWI)QHif10 r.o.no=suo Cupn Une,CA 9501S•0500 10,1M1 Imm Avenue �upct lino,CA 59014)155 kirltllvnc; (400) 152,4505 rAX:(40111252-0753 COMMUNITY ocmorMENI i • s WAN UG1'L• '1 OI It 1Il ICA'I G 1' M U/ 1ACG I undcrslond and cmnPly wllb Section 1211a or Me Uniform Ewilding Code. Section 1210-a requires 1 vii ountedllon to ie cicil l>Sror11wa I inleach sleepingPS lroom and at olca . I (IclecloI. will be installed, room used Nr r or area givy, access L? ilor�L cumroHy located at slu,ol(od de�ecl(ws comply, no new detectors shall be required- ked • haves 1 I L m1moland the above TMOrenlent and certiry that we now511101(c deleclors • IIISI alICC1 (Init (lo COI11Ply. ADDRESS: I'L'tLMITNUM.UL•R: K 0 11OMJ OWNI3-RS S1GNA1'UIIL: DA'I'1s: — + 1 i i 1 I winword/smkdcl . . I