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990700290 M APPLICATION FOR REROOF PERMIT BUILDING ADDRESS -i?l C/! C a CITY OF CUPERTINO INSPECTION DIVISION (408) 777-3228 NAME1�`^-7Vas! ^ P �^W/ . c1�t/O� C \� I C42 ADDRESS/�2 ��tf ✓ ill` V AU, .,s 64ro_s NAME ��ir 5? 5-12 x -✓S i` -i 6 - ADDRESS CITY B ZIP `[/ �� 4(%G!'I�'1/M TEAR OFF INSPECTION: �2�•� N l� PHONE I [ Q TL c- / % tp — 033 V . LICENSE NUMBER 7,-,?- 7V /, o � I hereby affirm that I am Ilcenaedunder provislone of Chapter 8 (commencing with Section 7000) of DMeIDn 3 of the Business and Promaskm Code, and my license Is In full force and effect. IF License Ges s3_-uc. Number 2'.` Date Contractor OWNER -BUILDER DECLARATION I hereby affirm that I em exempt from the Contractor's License Lew for the lollowlng reason. (Sec. 7031.5, Business end Professions Code: Any city or county which requires a permit to constnct, eller, improve, demolish, or rapelr any structure, pdorto Its Issuance, also requires the applicant for such permit to file a signed statement that he is iceri pursuant to the provisions of the Contractor's Licerree Law (Chapter g (commencing with Section 7000) of Divlabn 3 of the Business and Profesakxu Code) or that he is exempt Marefrom and the basis for Ne alleged exemption. Any violation N Section 7031.5 by any applicant for a permit Subjects the applicant to a doll penalty of not more Nan five hundred dollars ❑ I, as owner of the property, or my employees with wages as Meir We coropensodon, will do the work, and the structure is not InterMed or offered for seta (Sec. 7044, Buslne ut and Profes- alone Code: The Contractor', License Law does not apply to an owner DI property who bullde Or Improves thereon, and who does such work hlmaee or through hie own employees, provlded that such Improvements are not Intended or offered for sale. If, however, the bulWlng or Improvement Is solo within one year of completlon, the owner -builder will have Me burden of proving that he did not bulk! or Improve for purpose of able.). 01, as owner of the property, em"cluelvey corntractln w8h licensed connectors to caretruct the project (Sec. 7044, Business and Profesabro Code: The Contractors Ucense Law does rot apply to an owner of property who bulloS or Improves thereon, and who contracts for such projecia with a contractor(s) licensed pursuant to the Contractor's Ucense Lew. ❑ I em exempt under Sec. B & P. C. ler this reason Owner Data WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the Witt, Ing decleretlon: ❑ I have and will malnl,ln a Certificate of Consent to selhlnsure for Worker's Compensation, as Provided for by Section 3700 of the Labor Code, for the performance of Lha work for which this Permit is Issued. hi have and will maintain WorI Cortpensnbn Insurance, as required by Section 3700 of the Lebon Code, for the Performance of Me work for which this permit Is Issued. My Worker's CompenseNon Insurance carder and Policy number are: Camerl/ft/(61101/9- IA)'s- Parry No.WCS015_lyW CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE N.CU This section need not be completed H Me permit Is ler one hundred dollar$ ($1 (10) or lase.) I partly Met In the performance of Me work for which this parmyt Is III I shall not employ any person In any manner a0 as to become subject to the Worker,' Companeation Lowe of Cells fomle. Data Appllcant NOTICE TO APPUCANT: If, after melding this Certificate of Exemption, you should become Subject to Me workers' Compensation pruvLetons of the Labor Code, you must forthwith comply with such provisions or Me penult Mee be damned revoked. I certify, Met I have mad Mls application and state that the some Information to correct. I agree to comply with all city and county ordlrences and state laws reletlrq to bullding wnavuctbn, and hereby authorize repreasniadvas of MIs city to enter upon the above-mentioned property ler In- epechon purposes. ' (We) agree to save, Indemnity snd keep harmless the City of Cupertino epalnst Ilebli les, Judgments, costa and expenses which may In any way accrue against said City In cormequence PERMIT R_ "4 NUMBER PERMIT EXPIRATI N PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR COMMERCIAL' OTHER YES ❑ II yes - I understand that a Clew A roof assembly Is required. NO ❑ Initial I.C.B.O. k NUMBER OF EXISTING COVERINGS TO BE REMOVED ! TO BE RETAINED TYPE OF ROOF COV __NG EXISTING BUILT-UP ROOF ASPHALT SHINGLES /G`. WOOD SHAKES %C WOOD SHINGLES ❑ OTHER (SPECIFY) ❑ BUILT-UP ROOF or me 9renmg or m,a Person. • PRE -INSPECTION: INSP. DATE _ _ PLYWOOD: INSP. ❑ TEAR OFF INSPECTION: BATTENS: PERMIT R_ "4 NUMBER PERMIT EXPIRATI N PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR COMMERCIAL' OTHER YES ❑ II yes - I understand that a Clew A roof assembly Is required. NO ❑ Initial I.C.B.O. k NUMBER OF EXISTING COVERINGS TO BE REMOVED ! TO BE RETAINED TYPE OF ROOF COV __NG EXISTING BUILT-UP ROOF ASPHALT SHINGLES /G`. WOOD SHAKES %C WOOD SHINGLES ❑ OTHER (SPECIFY) ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER (SPECIFY) ❑ PROVIDE I.C.B.O. REPORT NO PROVIDE MFGR. INSTALLATION SPECS, APPLICATION DATEI VALUATION I PERMIT FEE I p o Building ysao Seismic Total I PERMIT AUTHORIZATION I DATE I All roofs shall be inspected prior to any rooting material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Applicant understands and will comply with all non point source regulations. All roof 014rin to be class "C" or better. SIGNATURE OF APPLICANT DATE INSP. DATE FINAL: NOTE: OSHA APPROVED ACCESS TO ROOF SHALL BE PROVIDED FOR INSPECTION CITY OF CUPERTINO I• 1 of 2 BUILDING PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Loo:36944009 DATE ISSUED.......: 07/23/1999 RECEIPT q.........: 9612 REFERENCE ID k ...: 99070029 SITE ADDRESS .....: 20294 PACIFICA DRIVE SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ....... OWNER ............: COMMUNITY MANAGE. SERV. ADDRESS ..........: 727 UNIVERSITY AVE. CITY/STATE/ZIP ...: LOS GATOS, CA 95031 RECEIVED FROM ....: TIM VOICE ID DESCRIPTION CONTRACTOR .......: LIC # ........ 307 ................... INSULATION COMPANY ..........: ROOF TEAR OFF 602 ROOF PLYWOOD NAIL ADDRESS ..........: ROOF IN -PROGRESS 604 FINAL REROOF CITY/STATE/ZIP .... , TELEPHONE ........: FEE ID UNIT QUANTITY AMOUNT PD -TO -OT -----"'------------------------- BPERM£EE VALUATION 5,000.00 ---------- 107.00 ---------- 0.00 BSEISMICRE VALUATION 4,500.00 0.50 0.00 ---------- ---------- T• PERMIT 107.50 0.00 OPERATOR: nancyc COPY # : 1 . THIS REC NEW BAL --------- ---------- 107.00 0.00 0.50 0.00 --------- ---------- 107.50 0.00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION ........ 305 ............................ FRAME ........ 307 ................... INSULATION 6D1 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 603 ROOF IN -PROGRESS 604 FINAL REROOF 0 0 • CITY OF CUPERTINO - BUILDING DEPARTMENT RE -ROOFING POLICY 1. Prior to permit issuance, you must agree to comply with U.B.C. standards and manufacturers specs on re -roofing. New roof coverings shall not be applied without first obtaining all inspections and written approval from the building inspector. A final inspection and approval shall be obtained from the building inspector when the re -roofing is completed. All types of roofs shall be inspected prior to any roof being installed. 4. In order to receive a final, you must complete steps 1,2, and 3. t. Pre -inspection or tear -off approval 2. In -progress inspection approval 3. Final inspection approval a. Operable smoke detector verification 5. If plywood is installed, a plywood nail inspection is required. If any roof is applied without first obtaining an inspection, you will be required to remove all new material down to the sheating and a building inspector will inspect all sheating at that time. IMPORTANT: 1. Flat roofs must have a Yd' per foot slope, or demonstrate that there is no ponding. 2. I.C.B.O. reports are required to be on the job site at the time of inspection. If you do not have one, contact the building department. WE UNDERSTAND THE ABOVE POLICY ON RE -ROOFING AND WILL COMPLY WITH THE POLICY. HOMEOWNER'S NAME: ADDRESS: RE -ROOFING COMPNAY NAME: APPLICANT'S SIGNATURE: •CITY OF CUPERTINO BUILDING DEPARTMENT Re-roogwinword S.et S4 K s (Z F c-