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R-5524Cl OFFICE COPY PERMIT R- 5524 APPLICATION FOR CITY OF CUPERTINO NUMB INSPECTION DIVISION PERMIT EXPIRATION REROOF PERMIT (408) 777 -3228 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. BUILDING ADDRESS T 10301 A-I rev F {J�r RESIDENTIAL COMMERCIAL OTHER OWNER'S /' HAZARDOUS FIRE AREA 'A 1^ ,� ,, n al or 0 401 YES E] 11 yes — I understand that a Class A NAME ' V t- 1v 1 roof assembly is required. NO Initial I.C.B.O. g / 1,4/, 1 �' w..�w 7b 94040 EXISTING ROOF COVERING ADDRESSd'^ 0' ��k —T--� • t t+r• Vf tl ^ 37'7 NUMBER OF EXISTING COVERINGS PHONE CONTRAC 'S�. Q t TO BE REMOVED TO BE RETAINED NAME TYPE OF ROOF COVERING ADDRESS "-760 CITY & ZIP 7 EXISTING 4 •� _7 ? —T (� PHONC0 - BUILT-UP ROOF ❑ LICENSE NUMBER 10`0177 ASPHALT SHINGLES ❑ 9 WOOD SHAKES G� LICENSE CONTRACTORS DECLARATION I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and l effect. 6 WOOD SHINGLES ZS ❑ License Clea Lie Nu /� _ ^ OTHER (SPECIFY) ❑ Data Contract OWNER-BUILDER D RATION PROPOSED I hereby affirm that I em exempt from the Centradoes License Law for the following reason. (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its Issuance, also requires the BUILT -UP ROOF ❑ applicant for such permit to file a signed statement that he is Ilcensed pursuant to the provisions of the Contractor's License Lew (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he Is exempt therefrom and the basis for the alleged ASPHALT SHINGLES exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($50() .): WOOD SHAKES W ❑ ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure Is not Intended or offered for sale (Sec. 7044, Business and Profes- sionsCode: The Contractors License Law does not apply to an owner of property who builds or WOOD SHINGLES ❑ improves thereon, and who does such work himself or through his own employees, provided that such Improvements are not Intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner-builder will have the burden of proving that he did OTHER (SPECIFY) ❑ not build or Improve for purpose of sale.). ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law does not PROVIDE I.C.B.O. REPORT NO. apply to an owner of property who builds or Improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Lew. PROVIDE MFGR. INSTALLATION SPECS. ❑ 1 am exempt under Sac. ,B & P. C. for this reason Owner Date q PLICATION DATE. VALUATION PERMIT FEE WORKER'S COMPENSATION DECLARATION '. I hereby affirm under penalty of perjury one n the following declaration: for ❑ have entl will maintain a Certificate of Consent to sell - insure for Workers Compensation, Building Lb eeprovided for by Section 3700 of the Labor Code, for the performance of the work for which this Q of permit Is Issued. F9 6 21 DI'(1T ­11 have and will maintain Worker's Compensation Insurance, as required by Section 3700 of RC{I D /$ /�y/7 $eISR11C the Labor Code, for the performance of the work for which this permit Is Issued. My Workers,,-(v ( I/I Total Campenaetlonclncupr nce c rrler antl P y number re: c.0 , (- l,lri _ /' PERMTAUTHORIZATION DATE Carrier StaF PoucyNd�734`f's��'° CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE N.C.D ^i' (This section need not be completed If the permit Is for one hundred dollar. ($100) or less.) G �� I certify that in the performance of the work for which this permit is Issued, I shall not employ any person In any mannor so as to become subject to the Workers' Compensation Laws of Cali- All roots Shall be inspected prior to any roofing material being forma. installed. If a roof is installed without first obtaining an Date Applicant inspection, l agree to remove all new materials for inspection. NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become Applicant understands and will comply with all non point P Y P subject to the Workers' Compensation provisions of the Labor Code, you must fohhwiN Comply with such provisions or this permit shall be deemed revoked. Source regulations. - I certify that I have read this application and state that the above Information Is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and All roof verings to cl "C" or better. hereby authorize representatives of this city to enter upon the above - mentioned property for In- spection purposes. yA l agree to save, indemnity and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may In any way accrue against mid City in consequence SI NATURE OF APPLICANT DA II of the granting of this permit. PRE - INSPECTION: PLYWOOD: Ild IN- PROGRESS: INSP. DATE INSP. DATE INSP. DATE TEAR OFF INSPECTION: BATTENS: FINAL: INSP. DATE INSP. DATE INSP. DATE NOTE: OSHA APPROVED ACCESSTO ROOF SHALL BE PROVIDED FOR INSPECTION OFFICE COPY 0 SUBJECT: REROOFING POLICY FOR THE CITY OF CUPEcTNO BUIIDNG DEPAR . IENT PRIOR TO ISSUANCE OF PEP NQ T AND NSPECION .. 1. P er [o pez it iss at ce, ypu must a,ee to compiv with U.B.C. st neares and ma ufac^ ea sec's an reroofing. 2. New roof coverings shall not be auolied without first obtaining all inspection and writ•.ea acproval from the building i==-.or. A final insce =ion and approval shall be obtained from &.e building i=ec,or when the reroofing is camoleted. 3. All types of roof shall be inre = :ed prior to any roof being ins�alled. 4. In order to re'_cive a final, You must complete steps 1, 2, and 3. 1,) P.c4rMecdon or tr_r off aoeroval. 2.) In progress inspection approval. 3.) Final inspec-doa approval. a.) Operacle smoke detector ve"u=ticn • b.) Spark are_stor installation 5.. If plywood is installed, a plywood nail inrecapa is required- Ii If stay roof is applied without first obtaining an ��pn, you will be required to remove all ne:v material down to the sheathing and a building itt �e or will lore all sheathing at that time. 1VE UNDERSTAND TEE ABO`1E POLICY ON REROOFNG P_ND WILL COMPLY WITH Tr' ^- POLICY • HOivEOWN+cRS NAME. ADDRESSS REROOFING COMPANY NAb1 APPLICANTS SIGNATURE: CITY OF CUPERTNO BUILDING DEPARTMENT Rercaflwintvard