R-4059ft
OFFICE COPY
PERMIT R- 4059
APPLICATION FOR CITY OF CUPERTINO NUMBER
REROOF PERMIT INSPECTION DIVISION PERMIT EXPIRATION
MIT
EXPIRES IF WORK
(408) 252-4505 EXT. 228 NOT STARTED
WITHIN 180 DAYS OF ERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION,
BUILDING ADDRESS
BUILDING USE
/U j/�i��
/� • Y/�/
RESIDENTIAL COMMERCIAL OTHER
OWNER'S
�(,��(citbz'of /'
HAZARDOUS ROOF
�-
NAME /`if /!/Z�0 /a
FIRE COVERING
AREA CLASS
EXISTING ROOF COVERING
ADDRESS, 0
.2
�S��fI�/�C�'�(2/`
��rs`K
NUMBER OF EXISTING COVERINGS
PHONE J V'
CONTRACTOR'S
r,y�
:��(
TOBEREMOVED� TO BE RETAINED
TYPE OF ROOF COVERING
NAME
{P%�/G/"
ADDRESS -7
CITY & ZIO S / ( �Q�1
EXISTING
/ 7
5
BUILT-UP ROOF
PHONE (,5/eX%�-'dZ�yG
LICENSE
ASPHALT SHINGLES
NUMBER
WOOD SHAKES
L I LENSED CONTRACTORS DECLARATION
I hereby affirm that I em licensed under provisions o1 Chapter 9 (comment
dng with Section 7000) of Division s of he er.mes. and Profession. coag,
WOOD SHINGLES
and my license ie in lull or • and affect,
tense cla..�-V co..... fir r SGr e. sa- e./
�i f!f
OTHER (SPEC Y)
DECLARATION
Oat
I Mrwing naso that I m exemDERpt
f
exempt from she Contractor's License Lew for
PROPOSED ^ ///��Y
inn ISec. . Coed Any city
the ollocounty
and Plter, i
\ \ / `
/
re. permit, o const a
county wnicn uiresprior a permit to construct, improve,
which pr
�
,. prior ro it.en issuance, uires tforsn.or
10. also requires applicant for such
applicant
arm
BUILT-UP ROOF
to elle 4
to 1. a si n
aiynee that he a licensed pup ua the provisions
of se
�`
of the Contractor?*'
the t License Lew (Chapter
Law (eomm entsuant it
with Section )000)
a
of Business aha Profession. r the, i tarn
or met
Division 0 or the Bfor
ASPHALT SHINGLES
fr th geexmtion. of ion of S
from end the anis for the euermi exemption. Any violation of Section
TOOLS am applicant for • permit subjects the applicant to a civil pma[y
of not mfr. met
. doss... 1:
WOOD SHAKES
r of the pro o r my in
❑ I, ati owner OI the property, emplur eis with wends as Mair aria
he
tompamstion, will do [ha work, andthe structure is not intended or offered
a
for sale ISec. 7044, Business and Professions Code: The Contractor's License
WOOD SHINGLES
Law dose not apply to an owner of property who builds or improves thereon,
andwho don such work himself or through his own employees, Provided that
such improvements are not intended or offered for sole. If, however, the
OTHER (SPECIFY)
bu ldin0 or improvement i sola within one year of completion, the Owner.
bui der will have me burden o1 burden that he did not build or improve r
pulp... .1 sea.).
PROVIDE I.C.B.O. REPORT N0.
❑ 1, as o1 the property, am ..elusively contracting with licensed
contractors to c mtruct the project (Sec. 7044, Business and Prrfess'mns
coda: The Cc rector's License Law does not apply to an ower of property
PROVIDE MFGR. INSTALLATION SPECS.
who builds or improves mareun, dna who contracts for such projects with .
contractor(s) Il tamed oursuent to the Contractor's License Law.
C31 em exempt under Sac. ,B.&P.C. for this
reason
APPLICATION DATE
VALUATION
PERMIT FEE
owner Det.
WORKERS' COMPENSATION DECLARATION
1 herebyaffirm I nava insure, or car
ay�
Building
that a certificate OI confess a
eifi "of Work.,.'C.mpe n ln,uaor a certified copythereof (S.c.
�
3900Lab. CJ.
-40
Seismic
Polic,y Na. Company
(/W/N4u
4
Certified copy I. hereby furnished.
B is filed m
Total .
Certified copy with e city inspection division. ./l�
Applicant {HI
so—
UF' JdIT AUTHORIZATION DATE
CERTIFICATE OF EXEMPTION FROM WORKERS' N.C.
C ❑
COMPENSATION INSURANCE
(This section need not be completed if the is for one hundred dol
permit
Ina 1$I
N /y
�4p
iDDIr.
certify ot n the performance of the work for which this permit
that
issued, 1 .hell of employ any parson Y en s9 as to b.com...bj.c,
to the W kers', o ensetion Laws g}¢)li�..
Data Applicant _i�U
NOTICE TO APPLICANT: If, ft ki this Certificate of Exemption,
You should become subject t0 the Workers' Compensation provisions Of the
Labor code, you must forthwith comply with such provisions or this permit
All roofs shall be Inspected prlorto any roofing material being
mall be deemed revoked.
installed If a roof is installed without first obtaining an
1 certify that I have ..ad anis application and abn that In. above infirm._
.
tion is correct. I agree to comply with all pity and county ordinances and
inspection, I agree to remove all new materials for inspection
Geta laws relating to building construction, and hereby authorize .frau.
'olives of this city to enter upon the above mentioned property for inspection
Purposes.
(We) agree to sw$, indemnify and keep harmless the City Of Cupertino
Y✓ yC
against liabilities, judgment$, mats and expenses which may in any way accrue
in
SI AT RE 0 AP ICANT DATE
against said City consequence o1 the granting of this 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 ACCESS TO ROOF SHALL BE PROVIDED FOR INSPECTION
OFFICE COPY
0
SUBJECI': REROOFING POLICY FOR TILE CITY OF CUPERTINO BUILDING DEPARTMENT
PRIOR TO ISSUANCE OF PERrv11T AND INSPECTION PHASE.
1._ Prior to penuit issuance, you mrus( agree to coutply will' U.H.C. standards and niamufacturefs spcc's
oil 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 lite 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 'trust complete steps 1, 2, and 3.
l,) Preinspection or tear off approval.
2.) In progress inspcclion approval.
• 3.) Filial inspection approval.
n.) Operable smoke detector verification
b.) Spark arrestor installation
5. If plywood is installed, a plywood nail inspection is required.
G. If any roof is applied without first obtaining nil inspection, you will be required to remove all new
material down to the sheathing and a building inspector will inspect all sheathing at that little.
WE UNDERSTAND TI' ABOVE POLICY ON REROOFING AND WILL COMPLY WITH THE
POLICY
IIOMEOWNERS NANM:
ADDRESS:
REROOFING COMPANY NANtE:
APPLICANTS SIGNATURE:
CI7Y OF CUPERTINO
• BUILDING DEPARTMENT
Reroof/winword
WV
0
Citil of CUPCI-lino
SMOKE DETECTOR CERTIFICATE OF COMPLIANCE
I understand and comply with Section 1210-a of the Uniforni 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.
1 understand the above requirement and certify that we now have smoke detectors
installed that do comply.
ADDRESS:
PERMIT NUMBER:
HOMEOWNERS SIGNATURE:
DATE:
• winword/smkdet
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