R 2248 , 1
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IPERMIT R_ 2248
APPLICATION FOR CITY OF CUPERTINO NUMBER
REROOF PERMIT NSPECTION DIV ISION PERMITIF WOR ISN
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN DAMS OF PERMIT ISSUANCE OR
SBO DAYS
FROM LAST CALLED INSPECTION.
�\• BUILDING ADDRESS BUILDING USE
22431 Carnousti Ct . RESIDENTIAL X COMMERCIAL OTHER
OWNER'S
HAZARDOUSROOF
NAME James & Mary Tallis FIRE COVERING
AREA CLASS
ADDRESS 22431 Carnousti Cf EXISTING ROOF COVERING
NUMBER OF'EXISTING COVERINGS 1
PHONE 253-0127
CONTRACTOR'S X TO BE RETAINED
TO BE REMOVED
NAME Securii:y ROU'FiHQ Inc . TYPE OF ROOF COVERING
ADDR&SSI, P . 0. Box 2450 , Menlo Park 94026CITY EXISTING
PHONE- 947-8811 BUILT-UP ROOF
LICENSE ASPHALT SHINGLES
NUMBER 306844 WOOD SHAKES Y'ZJ X
L I LENSED CONTRACTORS DECLARATION
I hereby affirm that I am licensed under provinom of Chapter g([ammem WOOD SHINGLES
ting with Section ]000) of Division 3 of the Business and Professions Code,
untl my license 1 In I ce end effect.
[ers.C•� ,+ - °` LIc.Numb,E�� OTHER (SPECIFY)
Oats 4e— — Convector I 1 �1
OWNER B exempt f DECLARATION Inc
hereby lowin affirm that I em sump( item the Conversion License Lew for PROPOSED
or ountyl following reason. (Sec. permit,to construct,
Professions improve,
Ce, d Any city
or county which t requires,prior a permit fa ,also alter, Improve, demoll+uch
repair any.nonage,prior to of issuance,he
eI also requires the t to them for auto BUILT-UP ROOF
permit to file statement (commencing
pursuanttotheprovisions
of the OOnt3 of t s Luc Ines Lew (ChProfessions
s (comm on clap with Section the,.
01 m000)
and
r of me Business the
and Ped a Coded or that he ti exempt mesa' ASPHALT SHINGLES
I • from end the applicant
for me filmed exemption.th Any ant to
of Section
7031.5 by any,tfive ant fora permit subjects the applicant to a civil penalty
of not mpg.that r of the ol. dollars($500).):my e.): WOOD SHAKES heavy
❑ I,of owner or Ind property.or he employees with wend•as Nair sole
for sale I non,will do the work,and me structure is not intended 's License WOOD SHINGLES
for Selo (Sec. apply
Business and f property Code: The Convector',License
Lew does not apply t0 on awed•of property who builds employees,
r ees, oval thereon,
and who does such work himself or through roffered M1it own employees, how.providedr met
mcM1 Improvements era not old wittl o yfor fele. if, however. m° OTHER (SPECIFY)
buil dine o eve t e bur is sold ovinia or
year of completion, tbp ownerr
oullder will have the burden of proving that M1a did not build or Improve for
parEl 1 of Gown PROVIDE I.C.B.O. REPORT NO.
❑ I, a st the he property.roje t (Sec.
70 4, Busincontress an wl(M1 licensed
wpmt: The m construct Ice project (S°[. t app Business nen end Prpropipm
ade: The or improves thereon.
and don,who cot eapro to an such
owner of with
a PROVIDE MFGR. INSTALLATION SPECS.
who builds)l improves Manan, entl who contracts fore La p•olec[.witM1 e
contractor(s)tar(0 licensed pursuant m the Contractor's License Lew.
❑ l em exempt under Sec. ,Bea P.D.for this FASTENER
reason
Owner Dna
WORKERS'COMPENSATION DECLARATION
l of
anirIn that I have a certificate of consent fo If Insure,or a can TYPE n a i 1 s
(III[ste of Workers Compensation Insurance,or a calif lied copy thereof fSec.
3800,Lab.CA.C C—9 1 Comae
Policy N°. LVJ n5tate Como . Ins . Fund
® Certified cup,I.h...by furnished. n LENGTH 6D
Car need cppV ii Illdd rh t .[itv In�pecaon dimes
Applicant-1/4+—.�1� r h/r�y FEE SUMMARY
CERTIFICATE OF E%E MPTION FROM WORKERS'
COMPENSATION INSURANCE
(This,action need not be completed it the permit f+for one hundred not
lar+191001 or Pa..) VALUATION $6 . 22Z . 00
I certify that In the performance of the work for wbich this pprmlt f+
ism ed, 1 shell not employ any person in any manner+o as to become subject
to the Worker'Compensation Laws of California.
Dat. Applicant 90 . 63
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, PERMIT FEE
you should become subject to the Workers Compensation provisions of the
Labor Code,You mus, forthwith comply with such provisions or this permit DATE OF APPLICATION
shall be doomed revoked.
certify that I neve reed this comply
with al and state that the above Ines and
tion p laws
ran. I agree m ng cofy with all ally end county aur ordinances entl
nets laws relating fp building construction, and hereby authorize repre+am tl'
tsnves of this city to enter upon the above monloned property for Inspection
pulp..... WV
W.) agroe to says, Indemnify and keep traumas, the City of Cupertino - PERMIT VALIDATION
against liabilities,judgmentat,coats end expenses which may in any way accrue
against Id W In cons. ncis 1 Iqq granting of his permit. fy. 01 ale
• N. r. 411A ry 4- 16-91 61� f
j—JA.tUhI6 6f Applicant/Contractor Deli
PRE-INSPECTION IN PROCESS INSPECTION FINAL INSPECTION
REQUIRED
INSPECTIONS INSPECTOR DATE_ INSPECTOR DATE INSPECTOR DATE
NOTE: OSHA APPROVED ACCESS TO ROOF SHALL BE PROVIDED FOR INSPECTION
me I re- CDpv _
y
Cit>H of CNpert1110
10300 Torre Avenue P.O. Box 500
Cupertino, California 95014 Cupertino,California 95015
Telephone: (400) 252-4505
DEPARTMENT OE PLANNING AND DEVELOPMENT
SUBJECT: REROOFING POLICY FOR CITY OF CUPERTINO BUILDING DEPARTMENT PRIOR
TO ISSUANCE OF PERMIT AND INSPECTION PHASE.
1. Prior to permit issuance, you must agree to c mply with U.B.C.
standards and manufacturers spec's on reroofing.
2. New roof coverings shall not be applied without first obtaining an
inspection and written approval from the building inspector. A final
inspection and approval shall be obtained fraR the building inspector
when the reroofing is conpleted.
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, aril 3.
• 1. Preinspection approval
2. Inprogress inspection approval
3. Final inspection approval
a. Operable smoke detector verification
b. Spark arrestor installation
5. If any roof is applied without first obtaining an inspection, you will
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 SLY WITH THE
POLICY
HIDIERS NAME: James & Mary Tallis
ADDRESS: 22431 Carnousti Ct .
REROOFING OOMPANY NAME: Security Roofing . Inc .
APPLICANT'S SIGNATURE M f DanR .ry
CITY OF CUPERTINO
BUILDING DEPARTMENT
Y
Citti of Cupertino
10300 Torre Avenue P.O. Box 500
Cupertino, California 95014 Cupertino,California 95015
Telephone: (400) 252-4505
DEPARTMENT OF PLANNING AND DEVELOPMENT
SUBJECT: SMOKE DETECTOR CERTIFICATE OF OOMP?lIANCE
I Understand and agree to Comply with Section 1210 of the Uniform Building
Code.
Section 1210 requires when repairs to a single family dwelling exceeds
$1,000 a smoke detector will be installed mounted on the ceiling or wall
at a point centrally located in the corridor or area giving access to
rooms used for sleeping purposes. If existing smoke detector complies no
new detector shall be required.
I understand the above requirement and certify that we now have smoke
detectors installed that do comply.
ADDRESS: 22431 Carnousti Ct .
PERMIT NUMBER: R-2248
HOMEOWNERS SIGNATURE:
DATE: 1;7 /R 7
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