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R-3807 PERMIT APPLICATION FOR CITY OF CUPERTINO NUMB R Res 3807 REROOF PERMIT INSPECTION DIVISION PERMIT EXPIRATION (408) 252-4505 EXT. 228 YETHif 180 DAYS OF EXPIRES IF PERM IT NOT OR IN DAYS FROM LAST CALLED INSPECTION. BUILDING ADDRESS \\ [^ BUILDING USE 2Z�Q Y'K.v�p Q2 CX, RESIDENTIAL COMMERCIAL OTHER OWNER'S HAZARDOUS ROOF NAME �r [ CO i'16'M eQ�.I�'�er5 `(�G. FIRE COVERING D `- AREA CLASS ADDRESS- lar 1�1 w•°ST \A\I lar aT EXISTING ROOF COVERING � 103 L NUMBER OF EXISTING COVERINGS I PHONE J CONTRACTOR'S NAME '�ANI�or00''�'MaI TO BE REMOVED TO BE RETAINED TYPE OF ROOF COVERING ADRES CITY&ZlO I�5 3 S �e.�¢ � �*-. EXISTING PHONE (t4 C)8) 971 "7r00 BUILT-UP ROOF X LICENSE .f�� I� ASPHALT SHINGLES NUMBER '7 WOOD SHAKES LICENSED CONTRACTORS DECLARATION I ho«V affirm 7000)of licensed undo provisions of d Prole s ons Code, clop with section TDDDI of Division 3 of me Business and Professions Coda, WOOD SHINGLES and mY license I• f and effect. License Coesorca Lic.Number N��AtO oafs Cohfr«tor c t OTHER (SPECIFY) OWN RBUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for PROPOSED the following reason. (S« Code: Any 7031.5. Business and Professions CodAny city or count, which requires • permit to construct, alar, improve,demolith,or repair any structure, prior to its issuance,also requires the applicant for such BUILT-UP ROOF permit to file 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 Code)or that he is exempt there ASPHALT SHINGLES from and the basis for the alleged exemption. Any violation of Section 7031 by any applicant for a permi\ ubjects In.applicant to a civil penalty of not more that five hundred dollars($500 ).1: WOOD SHAKES ❑ 1,as owner of the property. of my employees with wages as their sole compensation,will do the work, and the structure is not Intended or offered for fate (Sep. 7144, Business and Professions Code: The Contractor's License WOOD SHINGLES Lew does not apply to an owner of property who builds or improves thereon, �,, 1 and who doesemant work himself int or ed oughro his own.male. If. provided that OTHER (SPECIFY) ,VkCP•-Pe��^� such who ere not intended or offered for sale. I1, however,othe building or improvement is sols, within one year of completion, me ownor builder will hrva me burden of proving that he did not build o. improve for purpose of sale.). PROVIDE I.C.B.O. REPORT NO. 39� 7- 0 1, f r of the property, em 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 Ilii INSTALLATION SPECS. who builds or improves thereon, and who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's Litems Law. ❑ 1 am exempt under S«. ,B.&P.C.for this reason APPLICATION DATE VALUATION PERMIT FEE Owner Off.— WORKERS' auWORKERS'COMPENSATION DECLARATION Building IIL4 1 nersby affirm that I have a cerg tifite o1 consent to fell insure,o B fill 'a pl Workers' Compensation Insurance,or certified copy thereof fS«. Seismic Fy 3800,Leo.C.1. �L`__1 _ r:�� 7t(0.uQ• J5C_ Polity ob CJ 214-� Company tJCT.J �J (y,I. V v eCihtifi.d copy if hereby fumished. (�rnSP sX /..a Total Certified copy it filed with the city inspection envision. WWWWY yJU Applicant CERTIFICATE OF EXEMPTION FROM WORKERS' N D 0 d M9 T AUTHORIZATION DATE COMPENSATION I N S URANCE __ (This•«[int need no[be completed if ins Permit is for one hundred dols / Ian 1(51001 or less.) ctify mm at in the performance of a work for which his permit is issued, I shall not employ any person in any manner so as to become subject To:he Workers'Compensation Laws of California. DApplicant er NOTICE TO APPLICANT: If, afnr making this Certificate of Exemption, you should become subject to the Workers'Compensation provisions of the Labor Code, you mutt forthwith comply with Such provisions or this permit mall be domes,rwoked. All roofs shall be inspected pdorto any roofing material being Icertify mat 1 have read this application ane sass that the.1i informs Installer If a roof IS installed Without first obtaining an tion if conact. I agree to comply with all city and county ordinances and Inspec 4 n,I agree to remove all ate materials for inspection. .tete laws rtlatinp to building construction, and hereby authorize represent nativist of this city to enter upon the above mentioned property fpr infpec[ion purposes. a ' .2 i+ q�^ (We)l abrse s, awe, indemnify and bop eatmleu the City of Cupertino GJ against liabilities,judgments,cons one expenses which may in any wry accrue sins[said Clev in consequence of me granting of this permit SIG ATURE OF APPLICANT DAT 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 FOR THE CITY OF CUPERTINO BUILDING DEPARTMENT PRIOR TO ISSUANCE OF PERMIT AND INSPECTION PHASE. 1. Prior to permit issuance, you must agree to comply with U.B.C. standards and manufacturers spec's on reroofing. 2. New roof coverings shall not be applied without first obtaining all 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. In order to receive a final,you must complete steps 1, 2,and 3. 1,) Preinspection or tear off approval. 2.) In progress inspection approval. 3.) Final inspection approval. a.) Operable smoke detector verification • b.) Spark arrestor installation 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 sheathing and a building inspector will inspect all sheathing at that time. WE UNDERSTAND THE ABOVE POLICY ON REROOFING AND WILL COMPLY WITH THE POLICY //�/► HOMEOWNERS NAME: M3 A6,eawYle.f- S ADDRESS: 1 T��or Jt . REROOFING COMPANY NAME: Reel' ' (" APPLICANT'S SIGNATURE: CITY OF CUPERTINO BUILDING DEPARTMENT • Reroof/winword y ikt— � CitN of Cupertino I SMOKE DETECTOR CERTIFICATE OF COMPLIANCE i.. I 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 used for sleeping purposes. If existing smoke detectors comply, no new detector shall be required. i • I understand the above requirement and certify that we now have sm Ike detectors installed that do comply. ADDRESS: 07 PERMIT NUMBER: r/ HOMEOWNERS SIGNATURE: f;. DATE: I: I'. winword/smkdet f. •