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R-2718E OFFICE COPY PERMIT APPLICATION FOR CITY OF CUPERTINO �NUMBERR._, 2718 INSPECTION DIVISION PERMIT EXPIRATION REROOF PERMIT (408) 252-4505 EXT. 228 Y THIN 180 DAYS OF PERMIT ISSUAN ETOR 180 DAYS FROM LAST CALLED INSPECTION. BUILDING ADDRESS BUILDING USE 1�R �iovernber �r i Ljo v RESIDENTIAL COMMERCIAL OTHER OWNER'S L HAZARDOUS ROOF NAME BirUC�--� �L`\�S�el (� - FIREAR COVERING AREA CLASS �, 10Q 1 MoV hPr Dr' EXISTING ROOF COVERING ADDRESS 1.1,�Svz.. �' NUMBER OF EXISTING COVERINGS PHONE © - I CONTRA TOR'S j / _e�O ^ - TO BE REMOVED TO BE RETAINED TYPE OF ROOF COVERING G, NAME Il�icr� 6l�>,',C1.11l I61 ADDRESSCITY ���,,1,n 1I! & ZIP ��LJ L1g Oak- �1� �n 'I�fC.I \w Qr, Iv EXISTING BUILT-UP ROOF PHONE -4 LICENSV`o r`� ASPHALT SHINGLES 1371 NUM B EK -r`` ✓ -T WOOD SH FS�� LICENSED CONTRACTORS DECLARATION I witty affirm 7000 I licensee under provisions of Chapter 9 (commons N A L. ® @ N of ting with ens . . )fI4 of Divisionnf3 of me 6utina..ne� 1prole'tio}Is Code• and my li ns i force and effech s_ll WOOD SH G'L � p License CI n L.c.Number P V E Data— Z Contractor OTHER (S C)�"' r OWNE R -a.. -orf DECLARATION I neraby Net I exempt bons the License Lew for DATE PROPOSED real . d ProofContractor's ,he lollowinq reason. (Sec. 7031.5, Business and PrCle00ions Code : Any city Or Fou ri which requires a permit to construct, alter, improve, dem Olbn,or ._.d' repair am structure. prior to its issuance also requires the applicant for such BUILT-UP ROOF permit to Ills a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Carl or that he ;s exempt mere ASPHALT SHINGLES from and the basis Ins the alleged exemption: Any violation of Section 7031.5 by any, applicant for a permit subjects the applicant to a civil penalty ' of not mora that five hundred dollars (§500).): WOOD SHAKES 0 1, of Owner OI the property, ormy employees with wages as their sole compensation, wiu eo the work, and the structure a not intended or offered for tele (Sec. 7044, Business and Professions Code: The Contractor's License WOOD SHINGLES LeW doe. no[ apply to an owner of property who bulled or improves thereon, and who rose such work himself Or through his own employees, provided the, not such Improvements . intended or offered for sale. If. however, the OTHER (SPECIFY) building p improvement sole within one year of completion, the on builder will have the burden of proving that he did not build or improve for purpose of sets.). PROVIDE LC. B.O. REPORT NO. 0 I, as owner of the property, a exclusively contracting with licensee contractors to construct the project (Sec. 7044, Business and Professions ' Code: The Contractor s License Law does not apply to an owner of property PROVIDE MFGR. INSTALLATION SPECS. Who build. or mproves thereon, and who contracts for such projects with e t.n[,actor(s) IF ended pursuant to [M1e Contractor's License Law, O I am exempt under Sec. ,S.&P.C. for this APPLICATION DATE VALUATION PERMIT FEE reason - Own., Dam WORKERS' COMPENSATION DECLARATION yy n y P 79 hereby affirm That I have a certificate plconsent to self insure, or a car YY tihc ate OI Werkeri Compensation Ins Or e llf;e poor thereof (S c 3800. Labe '1G C�r6 L C �unc� SEISMIC ComfenY • . Policy Certified p Cer,ilied copycopy if hereby furnished, a A�q Cerul HIe m tr '. division. MAR — 4 �\ ©c.,� 1`L—J y{ f �q ec 10 AT n - L Applicant .1/ CER FICATE OF E MPTION FROM WORKERS' PERM( 11Ab ATIbWLh I 114 DATE COMPENSATION INSURANCE (This section need not be completed it the permit it to, One M1u ntlree d01 mrs (§100) Or that o certify [het In the performance of the work for to this permit rs as issued, 1 freer not employ any person in any manner so as to become subject to ma Workeri Compensation Laws of California. Oats NT:Apptem NOTICE APPLICANT: etre, making mit Certificate to OI Exemption, you .M1 Cold become subject to Workeri Compensation of +ire should o nso r this must forthwith comply with such p.oyl:Tont or this permit Labor code, youhe All types of root shall be inspected prior to any roof being installed. To .hall be deemed revoked, receive a final I am aware there will be three approved inspections: I certify that I have read this application and state that the above informs pre, in ro ides, end final. It root is a lied without first obtainin an P g PP g tion .s correct agr1. comply with ell city and county ordinances d .,a,. laws rs [o liee te!,Ging construction, and hereby authorize reprosen inq inspection, I agree I will remove all new material for inspection. tativaf of this city to enter upon the above-mentioned property for inspection psi"... . (We) agree to save. Indemnify and keep harmless +M1e City of Cupertino against R; 1!ties, ludpmen[f, cof4 end expenses which they ;n any way accrue again. said City in consequence o1 +Fe granting Of 700!7 permit //YJIIi� /�(_{�Jrj/_�,E/•"`Q IGN TURE OF APPLF ANT c DATE PRE -INSPECTION IN -PROCESS INSPECTION FINAL INSPECTION REQUIRED INSPECTIONSh INSPECTOR DATE INSPECTOR Di INSPECTOR DATE NOTE: OSHA APPROVED ACCESS TO ROOF SHALL BE PROVIDED FOR INSPECTION OFFICE COPY rll 0 'is 10300 Torre Avenue eupeilino; ealllornla 95014 Telephone: (401) 252-4505 C1tll Of CN11Gi'101O P.O. no. 500 Cuper11110, C01110mia 95015 DEPARTMENT Of PLANNING AND DEVELOPMENT SUBJECT: REROOFING POLICY FOR CITY OF CUPEIZIM WILDING DEPAi3TIMU PRIOR To ISSUANCE OF PM4IT AND INSPECTION PHASE. 1. Prior to permit issuance, you must agree to comply with U.S.C. standards and manufacturers spec's on reroofing. 2. New roof coverings shall not be applied without first obtaining an inspection and written approval from the building inspector. A final inspection and approval shall be obtained from the building inspector when the reroofing is completed. 3. All types of roof shall be inspected prior to any roof being installed. 4. IIT order to receive a final, you must ccaTlete steps 1, 2, and 3. 1. Preinspection approval 2. inprogress inspection approval 3. Final inspection approval a. Operable smoke detector verification b. Spark arrestor installation 5. If . any roof is applied without- first obtaining an Inspection, you will remove all new material down to the sheathing and a building inspector will inspect all sheathing at that time. WE UNDERSTAND ME ADOVE POLICY ON REROOFING. AND WILL CCRIPLY WI111 THE POLICY IIOP'IEOh'NER.S NAME: ADDRESS: REROOFING COMPANY NAME: APPLICANT'S SIGNATURE CITY OF CUPERTINO BUILDING DEPARIMIWP �Ruc� lIC14 g ig 14 3