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R-5571 (2) PERMIT APPLICATION FOR CITY OF CUPERTINO NUMBER R� 5571 INSPECTION DIVISION PERMIT EXPIRATION REROOF PERMIT (40$)777-322$ PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN DANS PERMIT ISSUANCE OR WI DANSSFROM LAST CALLED INSPECTION. BUILDING ADDRESS pL (O 3 S A L' I RESIDENTIAL COMMERCIAL OTHER OWNER'S HAZARDOUS FIRE AREA / YES E] If yes—I understand that a Class A NAME// �-n ��4 u, L�C!�()/C. �/� roof assembly Is required. / NO [/}/ Initial I.C.B.O.k ADDRESS V /W- ct1-P 4a EXISTING ROOF COVERING PHONE NUMBER OF EXISTING COVERINGS CONTRACTOR'S /�, TO BE REMOVED--y-C-3—TO BE RETAINED NAME /T l� I ADDRESS // / TYPE OF ROOF COVERING � CITY&ZlP ✓kbZ �� I �r • � C `�¢ EXISTING PHONE PHONE T 4 S'p p�a 3 73 BUILT-UP ROOFLICENSE ❑ NUMBER ASPHALT SHINGLES ❑ LICENSED CONTRACTORS DECLARATION hereby inion that am licensed under provisions of Chapter 9(commencing with Section WOOD SHAKES ]000)of Division 3 of the Business and Professions Code,and my license Is In full tome and effect' n WOOD SHINGLES ❑ License Class 3 7 Uc.Number S> !7 QOM 0-oaF. OTHER(SPECIFY) ❑ Date rr�� Contractor / OWNER-BUILDER DEC's Lice O'"�awfor PROPOSED 5' 1 hereby affirm in that am exempt from the Contractor's or county w for the low ng reason. (Sec.1031.5.Business and Professions Code: Any city or county which requires a permit to construcapplicnt.orsuImprove.demoto file signed air statement eny mentrthat heure,prior to its issuance,alsorequiresprovisthe BUILT-UP ROOF ❑ applicant for such permit a lila a signed r 9(commencing nci g Is licensed 7000)of to the provisions of the Contractors License Lew(Chapter g(commencing with Section 7000)of Division 3 0l 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($500).): WOOD SHAKES ❑ ❑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 Proles. sions Code:The Contractor's License Lew does not apply to an owner of property who builds or WOOD SHINGLES El thereon,and who does such work himself or through his own employees,provided that ouch 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,em 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 Law. PROVIDE MFGR.INSTALLATION SPECS. ❑I em exempt under Sec. ,B&P.C.for this reason OwnerData WORKER'S COMPENSATION DECLARATION APPLICATION DATE VALUATION PERMIT FEE I hereby affirm under penalty of perjury one of the following declaration: ' ❑I have and will maintain a Certificate of Consent to sell-insure for Worker's Compensation. � , Buildinilm as provided for by Section 3700 of the Labor Code,for the performance of the work for which this p� permit is Issued. Y- Seismic have and will maintainWorker's Compensation Insurance,as required by Section 3700 of Z" the Labor Code,for the erfdormanof the work for which ihl9 permit IS Issued.My Worker's ® �` Total ' thepCompensellon Insurance terrier and Policy number are: Carrier Policy No. PERM M.ORIZATION DATE CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE N.C.I] (This section need not be completed it the permit is for one hundred dollars($100)or less.) I certify that In the performance of the work for which this permit is issued I shall not employ any person In any manner so as to become subject to the Workers Compensation Laws of Call. All roofs shall be inspected prior to any roofing material being torula. . installed. If a roof is installed without first obtaining an Date'7 Applicant �u0 e ., inspection,I agree to remove all new materials for inspection. NOTI E APPLICANT: If,altar making this Certificate of Exemption,you should become- Applicant understands and will comply with all non point subject to the Workers'Compensation provisions of the Labor Code,you must forthwith comply pP P Y P with such provisions or this permit shalflbe deemed revoked. source regulations. I certify that I have read this application and slate that the above information Is correct I agree to comply with all city and county ordinances and stale laws relating to building construction.and All roof coverings to be class' V rbetter. hereby authorize representatives of this city to enter upon the above-mentioned property for in. V sp(We) purposes. z 7 (We)agreesand save,Indemnity and keep harmless wa the Clry of Cupertino y Inagainstcon liabilities,nce judgments,costa end expenses which may In any way accrue against said Clry In consequence NATURE OF APPLICANT D E of the granting of this permit. 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 INSPECTIC)" OFFICE COPY - ® 10300 Torre Avenue Cupertino,CA 95014 Circ of llpertilllo B_uildin_Divsion (408)777-3228 (408) 777-3333 (lax) March 20, 1998 Homeowner 10385 Melissa Ct. Cupertino, CA 95014 SUBJECT: REROOF PERMIT Dear Homeowner: We have been going through our files in the Building Department, and contacting those people with re-roof permits remaining "open". Our records show that either you or your roofing company have not: (1) called to schedule a final inspection, or(2) missed getting the sign-off after calling us for a final. • Sometimes an inspector will return to a job and sign off the permit in the field, but neglect to inform staff for input into the computer. If this is the situation and your permit card shows the final sign-off, would you please contact us so we may complete our computer records? If the permit is not signed off, please call to schedule an inspection for final closure of the permit. Because of the large volume of paperwork within the building department, we cannot separately monitor the progress of each permit. We ask that you give this notification your immediate attention. If we do not hear from you within fifteen (15) working days, we will expire the permit and remove the records from our computer. Thank you for your assistance. Sincerely, CITY OF CUPERTINO Christy Akatiff, Administrative Clerk • P:mrcu nn Peax:en Parer