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4038 PERMIT R- 4038 APPLICATION FOR �ITYOFCUPERTINO NUMBER INSPECTION DIVISION PERMIT EXPIRATION REROOF PERMIT (408) 252-4505 EXT. 228 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR ISO DAYS FROM LAST CALLED INSPECTION. BUILDING ADDRESS /fir �/� /�, / BUILDING USE 1 O 7 I In�{ Y \ I U l.� _ RESIDENTIAL COMMERCIAL OTHER OWNER'S/n// /^BI- -/yw �J,_ `�.`, v- NAME C CCrY, 1"1^PCYM -C FIREARDOUS�/' COVERING I S q'Q�;, Lr6 GaivS I✓D A/' t'O �., AREA V CLASS ADDRESS.(( S Ga.�`is��/ vi. l; Sn32_ lSLF� EXISTING ROOF COVERING PHONE '10`15 — ✓ /S`P —L - bL NUMBER OF EXISTING COVERINGS CONTRACTOR' C� rlf 1 � ' TO BE REMOVED TO BE RETAINED NAME /�C,�fn� 1I[/,S,fh�/'r-7�-C L TYPE OF ROOF COVERING CITY&Zii6 1 �u l.x�V�O/ �� EXISTING PHONE _ x1243 q BUILT-UP ROOF NUMBER l OctS^ '161 -�� / ASPHALT SHINGLES WOOD SHAKES IX LICENSED CONTRACTORS DECLARATION —ems I hereby.11mr,met I em licensed under prwision+of Chapter 9lcomm•n- WOAD SHINGLES int, with Section 70001 of Division 3 0l the Business std P,ii: raj Code, and my licmee i.Efu11$"end affect. C� Lluma CI p L. JJ Lic.Number ((// Dan. C, Contractor OTHER (SPECIFY) OWN RIBUILDER DECLARATION I h•r.by affirm mat I am exempt from the Contractor's Licenw Law for PROPOSED the following r. (Sac. 7031.6, Business and Professions Coda: Any city or county which requires a permit to c nstruct.alter, Improve, d•molish,or repair my structure,prior to its issuance,also requires the epplic.nt for such BUILT-UP ROOF permit to fila a signed statement that he is licensed pursuant to the provisions of the Contractors License Law ICnepter 9 (commencing with Section 7000) OI Division 3 of the Business and Professions Code?or that he is exempt mare ASPHALT SHINGLES from and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more that live hundred dollars(5500).1: WOOD SHAKES ❑ 1,as owner of the property, o my employees with wages as their sole COM paneetion,will do the work, and the structure is not intended or offered for sale (Sac. 7044, Business end Professions Coda: The Contractor'+License WOOD SHINGLES Law does not apply to an owner of property who builds or improves thereon. and who does such work himself or through In I$ own employees,Provided met �� •�� 71 f 1 such improvements are not intended or offered for sale. It, however, the OTHER (SPECIFY) building or improvement is said within one year of completion, the owner builder will have the burden of proving that he did not build on improve for j (! purpose of aria.^.. PROVIDE I.C.B.O. REPORT NO. ❑ I, as r of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractor's License Low does not apply to.0owner ofProperty PROVIDE MFGR. INSTALLATION SPECS. . Who build$ Or improves thereun,and who Contracts far such project,With e contractor($I Ii cemed Pursuant to[M1e Contractor'+License Law. ❑ 1 em exempt under Sec. ,B.&P.C.for his reason APPLICATION DATE VALUATION PERMIT FEE Owner Data PAI WORKERS'COMPENSATION DECLARATION {� Building 1 hereby affirm that I have.c•rtifi to of ant I...If insure,or.car ^ �y 3800'.of Workeri Compemmion Ipyu ren e,p pcer[Ifiatl copy me.aof Ise`. /fnp 4 / 2_S-a'l $elamic 3800'Lob S t"�(`✓eOFWcUbIi L.T �[yyl�,�Cyr_ fAA Ill-n nr/1 1 /.Ji v(J Policv No. •'J�. Yompeny +„Tjj i tietl c y is hereby lurnisnad. Fr1I��.e. �p Total Ca tlfisd Fogy i�i1e with he icy imp Y n division, C1 OF t' Applicant ( Y - CE��TE O E PTION FROM WORKERSE PTION FROM WORKERS' PERMI ' U. HORIZATION DATE COMP SATION I NSURANCE N.C. 0 (This$action neetl not be completed if the permit is for one hundred dial bre(5100)or he, i ca',tify tn•t in the performance Of the work for as rob this permit is issued, he not employ any Parson in any manner so as to bacons.subject Dthe Workers'Compensation Lem o1 California.n Data Applicant NOTICE should APPLICANT: o e making this Certificate of Exemption, you anCod become subject i [n•Workers'h Such provisions Provisions of the Labor Code, you must forthwith comply with such p.ovi,iom or this permit .hen be deemed.evoked. All roofsshall be Inspected prlortoany roofing material being 1certify that 1 nava read this application and+late that the above informs Installed If a roof is Installed without first obtaining an "On is correct. 1 agree to comply with .0 city and county ordinances and ina tion,I agr a to re ve all new mat ials for inspection. .[ate laws relating to building construction, and hereby authorix. rapres•m tetivee of this city to enter upon the above mentioned property for inspection _^ purposes. (We) agree to save, indemnify end keep harmless the City of Cupertino GJ against liabilities,judgment$,costs and expenses which may in any way accrue A 17a against said City in consequence of the granting of this permit. $I ATURE 03kPXICANT DATE 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 TILE CITY OF CUPERTINO BUILDING DEPARTMENT PRIOR TO ISSUANCE OF PERJvtJT AND INSPECTION PHASE. 1. Prior to permit issuance, you Huls( agree to comply Suit" U.H.C. standards and manufacturers spec's on reroofing. 2. New roof coverings shall riot be applied without first obtaining all iuspection and written approval from the building inspector. A final inspection and approval shall be obtained from the building inspector when the reroofiug is completed. 3. All types of roof shall be inspected prior to ally roof being installed. 4. In order to receive a final,you must complete steps 1, 2, and 3. l,) Preiuspection or tear off approval. 2.) Ill progress inspecliou approval. • 3.) Final inspection approval. a.) Operable smoke detector verilicalion b.) Spark arrestor installaliou 5. If plywood is installed, a plywood nail inspection is required. G. If ally roof is applied without first obtaining au iuspeclion, you will be required to remove all new material down to the sheathing and a building inspector will inspect all sheathing at that lime. WE UNDERSTAND T11E A13OVE POLICY ON REROOFING AND WILL COMPLY WITH THE POLICY 110MEOWNERS NAME: ADDRESS: REROOFING CONPANYNANE: APPLICANTS SIGNATURE: • CITY OF CUPERTINO BUILDING DEPARTMENT Reroof/winword