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R-3923 PERMIT R_ 3923 APPLICATION FOR CITY OF CUPERTINO NUMBER REROOF PERMIT INSPECTION DIVISION PERMIT EXPIRATION (408) 252-4505 EXT. 228 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR IN DAYS FROM LAST CALLED INSPECTION. �• BUILDING ADDRESS BUILDING USE RESIDENTIAL 6'`X' COMMERCIAL OTHER OWN 'S T' I. �LVO/� HAZARDOUS , , ROOF ERING NAM AREAFIRE \'�-y" )L CLASS iD/`,, EXISTING ROOF COVERIN RG ADDES NUMBER OF EXISTING COVERINGS PHONE CONTR_AOR'S NAMEDye X'A/ 460 � /� TO BE REMOVED TO BE RETAINED"_ /ser n1 TYPE OF ROOF COVERING ADDRESCIT&2if �l✓ �J" EXISTING 3 7 U77 BUILT-UPRO PHONE LICENSE ��/ ASPHAL INGLES NUMBER VSO WOOD SHAKE LICENSED CONTRACTORS DECLARATION I hereby coon 7000 I of liumae 3 of t provisions of Chapter 9(=.moans WOOD SH I G cog y li Section )0001 of Division 3 0,the 0winess ntl Prolenions Cotls, (( enc my hFonta I q .and n+e<t. f I " u=.Numbe` P Data C.m,.P.r OTHER (S Oat I Rol exempt R from the RATION I Denby affirm that I . exempt M1om tae Contractor's License Lew,or PRO O \`{`(j/QJ�x IS .1 oulotnty erg reawhich on.req (Sec. )Orli, Businessos1.and Professions i pr Code: Anis city county which re, pint . permit to c, sso re albs, improve, tlemolisuch / repels any structure, prior to en issuance,he i also requires pus theapplicanttolihe provisions B I P permit to,Ila a signed Li statease Law [be,be la licensed encingnt to the tion 7Ipn) D of the Contractor's License Lew (Chapter sso s (comm encing with Section)0001 S of Division 3 of the Business and P.obniom Code)o.that he i.exempt mare \A PHA SHINGLES !J N from and the basis for the alleged exemption. An, violation of Section 7031.5 by any applicant for a permitubject.Ina applicant to a civil penalty of not more that five hundred dollen($500 ).1: WOOD SHAKES ❑ I,e[owner o, the property, or my employee[with wage[as their sole \ compensation,will do the work, and the structure is not intended or offered for[ale (Sec. 7044, Bu[Iness and Professions Code: The Contractor's License WOOD SHINGLES Law do"not apply to an owner o1 property who builds or improve[thereon, and woo does such work himself or through his own employees,provided that such improvement[ era 007 intended o ona,ed ,or Sale. It, however, he OTHER ( ECIFY) ` .:din, o improvement b sold within one year of completion, me owner builder will nave me burden of proving that h•did no,build or improve for Purpose of Sale.). PROVIDE I.C.B.O. REPORT NO. ❑ I, n owner of the property, a exclusively contracting with licensed contractors to c nstmct the project iSc. 044, Business and Professions Coda: ThaContractor •sLicense Law does no,apply 1.anownerofProperty PROVIDE MFGR. INSTALLATION SPECS. who builds or improves thoeun,and who contracts for such projects with e contractor(sl licensed pursuant Io the Contractor's License Law. ❑ I em exempt pods. se=. ,B.aP.D.,o,this APPLICATIONson DATE VALUATION PERMIT FEE owDale p Owner WORKERS'COMPENSATION DECLARATION 10 ON W W Building 1 hereby affirm than"I nava a car,iii(c�etfefpo[fy�omens to�[)Ip)hin[wa,or a car. //��/ 10 $e� 'all a o,Workers- onion Insu�l IL/Lr �.ytMu_ Y PY thereof(Sec tl 3800,Leb. a4J/V �y Policy No. ompeny ! Lf Flea o o Corti iad copy hereby furni[aetl. Total $Certilietl copy i[filed with the city inspection division. �/ Applicant ♦� CERTIFICATE OF EXEMPTION FROM WORKERS' N.C. El MI+ UTHORIZATION DATE COMPENSATION INSURANCE This ).,sectionneed not be completed it the permit is for one hundred dol ///////�jjj / ten($100)or les[.) •/ZJ// I certify that in me performance OI ma work for whim this permit issued, I shell not employ any person in any manner so as to become wbjec, to the Workers'Compensation Laws of California. Date Applicmt TI NOCE TO APPLICANT: If, attar mining In.. Certiflcele of Exemption, you should become subject to the Workers' Compensation provision[Of the Labor Code,you must forthwith comply with such provision[or this permit [hall be deemed revoked. All roots shall be inspected prior to any roofing material being I Fortify ton I nava read his apprcnion and[1..7.the,In.above Informs Installed If a roof is installed without first obtaining an sat is np.n=t. I .gree to comply with all city and county ordinance[end Inspec ' n,Is rrl��pppppp��p{��to remove all new materielsfor�'ppspection. Rate IoW[ relating 1.0 building construction, and hereby authorize npmm /� � relives of this city to enter upon the above mentione i property for inspection purposes. IW, liabilities.agree to save, in ts,cos s end keexpe es whi h Iha Ina of Cupertino ...insl aidtyi judgments,costs of and expenses whin mem In any we accrue � RE OF APPLICANT DATE against said City in consequence of the grantingof 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 SUB1ECf: REROOFING POLICY FOR 771E CITY OF CUPERTINO BUILDING DEPAIYI-MENT PRIOR TO ISSUANCE OF PERMIT AND INSPECTION PHASE. 1. Prior to perruil issuance, you nmst agree to comply wilh U.D.C. standards and manufacturers spec's Oil reroofing. 2. New roof coverings shall not be applied without first obtaining all inspection and written approval from lire building inspector. A final inspection and approval shall be obtained frour the building inspector wile,,the reroofing is completed. 3. All types of roof shall be inspected prior to ally roof being installed. 4. In order to receive a rural,you rmsl complete steps 1,2,and 3. 1,) Preiuspeclion or tear off approval. 2.) In progress inspection approval. • 3.) Final inspection approval r a.) Operable smoke detector verification bJ Spark arrestor installation 5. if plywood Is installed,a plywood unit inspection is required. 6. If any roof is applied without first oblainiug an inspection, you will be required to remove all new material down to the sheathing and a building inspector will inspect all slrcathiug at that lime. WE UNDERSTAND THE ABOVE POLICY ON REROOFING AND WILL COMPLY WITH THE POLICY IIOMEOWNERS NAME: ADDRESS: o v REROOFING COMPANY NAME: — APPLICANTS SIGNATURE: • CITY OF CUPERTINO BUILDING DEPARTMENT Reroof/winword �'IF � L•� Cites of Cupertino SMOKE DETECTOR CERTIFICATE OF COMPLIANCE I understand and comply with Section 1210-a of the Uniform Building Code. j 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 puposes. if existing smoke detectors comply, no new detector shall be required. ed. I understand the above requirement and certify that we now have sm Ike detectors installed that do comply. ADDRESS: G/a�? PERMIT NUMBER: l �� HOMEOWNERS SIGNATURE: d-Y"," DA'Z'E: T M.� winword/smkdet FlV ilt I / •-c-=,;