R-3846 PERMIT R- 3846
APPLICATION FOR CITY OF CUPERTINO NUMBER
Res
PERMIT . INSPECTION DIVISION PERMIT EXPIRATION
(408) 252-4505 EXT. 228 ED
WITHIT EXPIRES IF WORK IS N 180 DAYS OF PERM T ISSUANOT NCEOR
180 DAYS FROM LAST CALLED INSPECTION.
BUILDING ADDRESS BUILDING USE
I0g23— RESIDENTIAL COMMERCIAL OTHER
OWNER'SHAZ
Ni n �Oh� 1 t.�• ! \ FIREARDOUS. ROOF
NAME CLASS
AREA
- ` t \ EXISTING ROOF COVERING
ADDRESS/�(��r\$1 wF-7 B` ' -gDO't �T �`''�I
PHONE \`1 � S) �J`_v.31 / NUMBER OF EXISTING COVERINGS
CONTRACTOR'S ^ Q TO BE REMOVED TO BE RETAINED
NAME nc� No<-- C�Tr\ 1:Y_l c�� TYP OF ROOF COVERING
CITY a ZIP I g53 �1 •Ch gE�M� L�� EXISTING
PHONE \44o$D 9 -7 75 013 BUILT-UP ROOF
LICENSE11 G `O ASPHALT SHINGLES
NUMBER `I ✓ WOOD SHAKES K
LICENSED CONTRACTORS DECLARATION
I M1ereby affirm that I am licensed under provisions of Chapter 9(common"
Ch. with Section 7000) of Division 3 of the Business end Professions Coda, WOOD SHINGLES
and my licmu is II L11oru antl effect. C2. fO
LI.. o* Contrse Cls 'Lic.N umber
tor be- OTHER (SPECIFY)
OWN ER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for PROPOSED
the following reason. (Sec. 7031.5, Business and Professions coda: Any city
OI county which requires a permit to construct,biter, improve, demolish,or
repair any structure,prior to its issuance,also requires the applicant for such
BUILT-UP ROOF
permit 1. fila a signed statement that he is licensed pursuant to the provisions
of the Contractors Licema Law (Chapter 9 (Commencing with Section 70001
of Division 3 of the Business and Professions Code)or that he is exempt there" ASPHALT SHINGLES
from end the basis for In. alleged exemption. Any violation of Section
7031.5 by any applicant for a permit subjects the applicant to a civil penalty
of not mor.that five hundred dollar+( 500).): WOOD SHAKES
❑ 1,as owner of the property,or my employees with wages as their sola
compensation,will do the work, and the structure is not intended or offered
le
for sa (Sac 7044, Business and Professions Code: The Contractor s License WOOD SHINGLES
Law does not apply to an owner of Property who builds or improves meletin,
and who does such work himself or through his own employees,provided that
uch improvements ars not intended or offered for sale. If. however, the OTHER (SPECIFY) (26A
building or improvement is sold within one year of completion, the owner
builder will have the burden of proving that he did not build or improve for
purpose of'al.J. PROVIDE I.C.B.O. REPORT NO.
❑ I, a owner of the property, am exclusively convecting with licensed
contra to c nstruct the project (Sec. 7044, Business and Professions
Coda: The Contractor's License Law does no,apply to an Owner of property PROVIDE MFGR. INSTALLATION SPECS.
who
build+ or improve*theroun, and who contracts for such proje<s with
c e
Pmractor(s)licensed pursuant to the Contractor's License Law.
C3I am exempt under Sac. ,B.&P.C.for this
reason PPGTI • ATE VALUATION PERMIT F E
Owner Date
WORKERS'COMPENSATION DECLARATION Building
3800chereby affirm that I neva a certificate of consent to If.in+ure,or a coli ��� atl` ���� ./� hO� --'
."'o1 Workers'Compensation Inco renca,or <e.bN d copy masof(Sea RY!V4 /I{ / V $elSffllC
3800, No. C.1 S` .\_ �U__l
Policy Certified
'�. - �Company T0.'lC vKY\ du
8 Certified<ppy is hereby furnished. lY OF CUPEkPNO Total
Certified s lilad�p(th.(� ty 1inspection division.
Applicant ��WLP'J KOdOvA
CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT AUTHORIZATION DATE
COMPENSATION INSURANCE N.C. ❑
(This action need not be completed if the permit is for one nun diad dol" �\
fan 151001 or less.l
certify that m me performance of the work for which this permit is
issued,
1 +M1a not employ any person in any manna(+O as 10 become+ubject
to the WorkeralCompensation Low.Of Califpinia.
Date Applicant
NOTICE TO APPLICANT: I1, after making this Csnifiun of Exemption,
you should become subject to the Workers' Compensation provisions of the
Labor cod., youevoked.mustforthwith comply corm Such provisions pr this Permit All roofs shall be inspected priortoany roofing material being
shall badNmW r
1 certify that 1 have sad his application and slate that the above informs" installed If a roof Is installed without first obtaining an
tion is correct. I agree to comply with all city and county ordinances and inspe lagreetoremove ll W materials for inspection.
stats laws relating to building construction, and hereby auth oris repression
tatives) gra ci.r a en nr upon yadkabove p ntionedharmless
Phe Cit for Cupertino ����/4•¢/
purooses.
(We) a.rro 1.s. uve, indemnify and keep es which
the City at Cupertino- --- --
eg.iut said liabilities.i consequence
costs and expenses which may in any waV accrue
' a.amn+sie City in ronroggsnr.of the premiss.of this Permit. SIG TURE OF APPLICANT DAT
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
SUBJECT: REROOFING POLICY FOR THE CITY OF CUPERTINO BUILDING DEPARTMENT
PRIOR TO ISSUANCE OF PERMIT AND INSPECTION PHASE.
1. Prior to permit issuance, you must agree to comply with U.B.C. standards and manufacturers spec's
on 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 the 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 must complete steps 1, 2,and 3.
1,) Preinspection or tear off approval.
2.) In progress inspection approval.
3.) Final inspection approval.
a.) 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 an inspection, you will be required to 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 COMPLY WITH THE
POLICY /'�
HOMEOWNERS NAME: 1 v0¢{ 1�V� I r� � �� l . A -
ADDRESS: I D () py N O( ((�moo i AA-
REROOFING COMPANY NAME:
APPLICANT'S SIGNATURE: s
CITY OF CUPERTINO
BUILDING DEPARTMENT
•
Reroofhvimvord
MAT 26 '95 01: 15PM CORNISH k- CAREY P4'Y MRY.26. 199EP•2h'16PM 10
FROM CONTEMPO REALTY PHONE NO. : 4097731650
'nrR-21-1995 14:17 T;;YLGR Roo=t NG 402 9711390 P.01
„
of C"wertitl
P.O.Ooz Sao
70.1fi0'irn rr,••••e��oe Cuperilnn,CA 95013.0500
Cogrci lino,CA 9,
Telg.liomic:Owl;2.4203 .
t,�a: ;anal)SrINS)
CQMl'LIA-N�
and C00114wit:+ Scclio't 121G•,. o�lhe III
Building Code. •
w' Cu reo� n to s ;k '�nlily dwe!lillo exceed $1,000, a smoke
a rco0l'�CS � •
Jciccto; �:il! be A twiiec!, :ocw'ted ()It e
y or wall itl each sleeping COQlil aliat a
}pial C�•;'YO!iy IOC,tCri ,il I.IC C91'rIIIC• G' ' p.Vlitj.' aCC09S 10 '001"I used for sleeping
I:oW detector 5I1aII bC required.
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APR-21-1995 14.17 TAYLOR ROOFING 408 9711380 P.01
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i
• Citi OF CU�)C1'11110 •
Ea Uox 5110
Copcillnc,CA 95015.0500
10.10f1 Ini�r.A,0,uC i
Cupci tlno,CA 950I4•]255
TBr.I,LOnc;(AQUI 257-A505 .
fAX:1A0111 252.0751 i
COMMUNITY oFVELOPMENr I
�
C mILIANCG I
$ CUC1'G ']OIL' CL'll'llt'IC/�IL l
1 understand altd coniply wit11 Scclion 1210-a of the Uniform Iluilding Code.
i
Section 1210-a requires wllc" rePdlon the CC I Sror11wa l it' cachlliI% esleep)ingiroom and smoke
dcteclor Will be installed,
sed Nr
or nrcri
&g "cess
•
point
celgrPHY
slm, y d orr&0f comply, 6o new deleel loshalllberequired-
purposes.
equired sleeping Iu
I undcrslalid the !love rcquircnlenl and certify that we now have smoke detectors .
iuslaRed that do comply.
X833 kOLO o k *-,r— .
Al)llILLSS_ - � T I
1'LILMIT 1 I0W3 It.
dIOM�OW,NGRS SIGNKI'URl:: I '
- 11:11 :'i�- - •
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RPR-21-1995 14:17 TAYLOR ROOFING 408 9711380 P.01
i
i
at'q of C"pe.111110
r.o.oo.Sou
Cuperllno,CA 75015.0500
C,ulrci I Ino,CA 95014-3255
400 25-4505
Tcirldrunc:( 1 I
rAX:14011)25-0757
COMMUNITY OEVEEOrMENT
I
I
SMQKI L)ITI-E 'I TIDIOM1( AI6 P C M 'LlANCG
IDIOM-
ill, Section 1210.7 of the Unifonu Iluilding Code"
I understand and comply w
i .
Srclion IZIO a requires when rcp»irs11 the shell 14f orlllwa I�inleach sleeping lraom and olca
defector will be installed, mounted o
point centrally located in the corridor or arca giving access to room used for sleeping
purposes, if cxisliug smoked detectors comply, no new deteolor shall be required.
• I understand the above rcquircmcnl and certify that we now have smoke' defectors
installed Ilial do comPQ-
Aulalslss:
U8y1 oR�f�4s+4� i
PEKMIT NUNI.UL•R:
IIOM OWNGItS SICNATUIW: --
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UAE:
wo I OIIVsnikdcl
Tnrn� n n --
RPR-21-1995 14: 17 TAYLOR ROOFING 4ee 97113eo P.Ol j
• citq of Cupertir10
r.o.not 500
Culcillno,CA 95015OSOn
l0,1n11 Iair.Arcuur. '
C.uyn l lno,CA 95011.7755
Tclr,IdOnc;(100)757.-4505
(AX:(1011)2570757
COMMUNITY pEVGEOrMENr i
li
I
SjMOICh ULI'L '1 -OIL' CLIl'I'II�ICA'fG 1'
M 'LIANCG i
Scclion 1210-a of the Uniform 1luilding Code.
1 undcrsland and corllply with
xr
Scclion 1210 a requiresi"Alco u�le7dlon the cc ingf orllw.1, inleacllesyp nglro," 01Sd smoke
detector will be installed,
poll7� lpsesllrlf cxisoting simolded dele �ecloos Comply, no new deleclorr shAllbelrequ ed.sleeping
pulp
- crsland the above rcquirclnent and ccrlify that we now have smolde Detectors
I und •
iustollcd [hat do comply.
ADDRESS:. g/ 1
PERMITNUM.BEll:-- �tb
1'IOMIsOWNC_71LSSIGNA'l.'URL:
DATE: .
winword/sInkdcl -
RPR-21-1995 14: 17 TAYLOR ROOFING _ 408 9711380 P.01
Cita of CV41K.1 tit10
r.o.no.500
Cupc10no,CA 95015.0500
10,100 I m l r.Avenur. '
��Orcitlno,CA 75014.3255
ktirphrnla;(4001 252-4505
Wt(40111251-0753 -
COMMUNITY U@VrtOrMUlr
i
SM ICI: ULIAN
C'I•L T 11 CLRVi'II IC!`'t> UI' Cn Cr
I tllldcl'staltd and comply with Scclion 1210-a or tile Uniforlu 13uilding Code.
Section 1210-a rcgtlires whc° reldlon lire aclliluglor11wyalillvillleachesleep nglroom a' s
nd atCn
detector will be installed, mounteo
12or 3oses111Jf ex located
d illlced deteclo0s coulply, no n w detectors shall lbe required.sleeputg
p
I the above rcquircnlclll and certify that we now have smoke detectors
understand •
iuslallcd that do comply.
D S ,
Al)UILLSS;' o /O
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1'IOMrOWNI_.IIS SIGNAI'URL:
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