R-3708 (2) Q�
PERMIT R- 3708
APPLICATION FOR CITY OF CUPERTINO NUMBER
REROOF PERMIT INSPECTION DIVISION PERMIT EXPIRATION
(408) 252-4505 EXT. 228 PERMIT EXPIRES IF WORK IS NOT STARTED
10WITHIN
1 FROM LDAYS AST PERMIT ISI INSPECOR
TION
ON,
BUILDING( 00 ADDRESS 7/�1 o�y0r�
- BUILDING USE
_ 110 Q OkA 0a'� RESIDENTIAL COMMERCIAL OTHER
OWNER'S
HAZARDOUS ROOF
NAMEN71ykPO� MOAFIRE A/Q
COVERING
(� Q AREA CLASS
ADDRESS 10990 990 Nor4 (OII�.,II ��n�, EXISTING ROOF COVERING
PHONE (11,115) 0\5A -63 ,11 NUMBER OF EXISTING COVERINGS
CONTRACTOR'S
NAME�O!- Roof�no, TO BE REMOVETYPE OF ROOF COVERING D I TO BE ED
ADDRESS -3 1A53 Sb, �rti5+� sS �iSlid
EXISTING
�kD -71 -7,r BUILT-UP ROOF
PHONE
LICENSE 5l oto ASPHALT SHINGLES
NUMBER cX y�
WOOD SHAKES
LICENSED CONTRACTORS DECLARATION
1 hereby affirm 7000) em licensee 3 of t provisions of Chapter B on.Codes
cine with Section 70001 force
Dred If 3 of me Butinn+ena Plot enlom Coee, WOOD SHINGLES
and my license In force end ellect. 1 L I'�Olo
Llceme0l- LIc.Number r'1 OTHER (SPECIFY)
Oars Comrx7or
owl R BUILDER DECLARATION
I n...by affirm mat I am exempt from the Contractor's License Law for PROPOSED
he following reason. Ise,. 7031.6. Business and Professions Coda: Any city
or county which requires a permit to construct.alser, improve. aemohsh,or
repair any structure,prior to its issuance,also reouires the applicant for such BUILT-UP ROOF
Permit to file a signed statement that he is licensed pursuant to the provisions
of the Contractors License Lew (Chapter 0 (commencing with Section 7000)
' of Division 3 of the Business and Professions Code)or that he is exempt there. ASPHALT SHINGLES
from and the basis for the alleged exemption. Any vicalron of Section
7031.6 by env applicant for a permit subjects the applicant to a civil penalty
01 not more that rive hundred dollars($6001.): WOOD SHAKES
D I,as owner of the property,Or my employees with wages as their sole
compensation,will do the work,and he structure is not intended or offeree WOOD SHINGLES
for sale (Sac. 7044, Business end Professions Code: The Contractor's License
Law does not apply to an Owner of property who builes Or impr Ove$thereon, C
and who does such work Is
or through his own employee.,provided met OTHER (SPECIFY) ��1 Shakg
such improvements are not intended or
offered for sale. I1, however, the
building o improvement is sold within one year of com Vlatio n, the owner
builder will have me burden of proving that he did not build or improve for
Purpose of let..). PROVIDE I.C.B.O. REPORT NO.
C, 1, as owner of the property, am exclusively contracting with licensed
contractorsto construct the project (Sec. 7044, Business and Professions
Code: The Contractors License Law does not apply to an owner of property PROVIDE MFGR. INSTALLATION SPECS.
who builds or improves theraun, and who contracts for such projects with a
contractors)licensed pursuant to the Contractors License Law.
reason I am °"empt unser se,. ,9.aP.C,for this PPLIC PON DATE VALUATION PERMIT FEE
Owner case
WORKERS'COMPENSAT ION DECLARATION p, Building
1 t ereby el firm Ina, I neve a certificate of consent to sell insu ra,or a car ^ /?
6fiute of
Workers' compensation Insurance,o[$ap a .1. 'U cypv In of fsec. (r A
3800,Lab Com_)., _-,- p� S • 1 l� Y.v�.l !h` 1JO(� fO� SBISmIC
Polity No.
4.-pan Ci 1� A V irk/
oxer d to—pY s ne eb carni n it Vrry/,N Total
Certi('yd cop/ b est 7y'mspecnon dlmpon.
AOplicent Vlln
C RTIFICATE OF EXEMP ON FROM WORKERS' N.C. ❑ PERMIT AUTHORIZATION DATE
COMPENSAT IONFINSURANCE
(This section need not be completed if the permit is for one hundred tlob exist
Ian($100)or Ins.)
1 certify that in the performance of me work for which this permit is
mad, 1 shall not employ any person in any manner to as to become subject
to the Workeri Compenesr
tkm Laws of C0lifonm
Data
Applicant
NOTICE TO APPLICANT: It, alter making his Certlf cste o1 Exemption,
you should become subject to the Workers' Compensation provisions of the
Labor Code, you must forthwith comply with such provisions or this permit All roofs shall be inspected prlortoany roofing material being
shell be deemed revoked.
I certify that I have read this application and atete het the above inform. Installed . If a roof IS Installed without first obtaining an
tion is correct. 1 agree to comply with all city and county ordinances and Inspection, agree to remove all new materialsfor inspection.
ante of relating to building the
oven, end hereby authoNn npresem
nti. l of this tiny to ental upon ns ab lion. and
hetl property for inspection
n
pp.poes.. 3-3►—qJ
(W0) spree to save, indemnity and bap harmless the City of Cupertino
against liabilities,judgments,costs and expenses which may in any way accrue
against said City in consecuence of the granting of this permit. SIGNATURE OF APPLICAGNT 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
0FFICE COPY
RPR-21-1995 14: 17 TAYLOR, ROOFING 408 9711380 P.01
Uji Of CWpCt'0110
r.0.13o+500
Colmipno,CA 55015.0500
10,100 IN,r.Avci,,,0 '
C,greillno,CA 05011-.1255
Icicp6niu:110tl1 251-4505 ,
rnx:(4001 2;1 0757
COMMUNHY D[VrL0rME1`4r ,
1
nail
DL'1'L '1 R L6R'i'It iCA'I'C CP C MPLIN�CC
1 understand and comply with Section 1210.0 of the Uniform Building Code.
Ser 1w110he1 C151laIICCIcated ,Vmounted cil lon the acllingl or Wadwclle!Pclrexceed
lglroom and otnn
point 0
purposes111lflexiS6116 Smoked detecthe doof of area pq, ,cess is cOmPly, no new detcclorosh�ll used for
required.•
purposes.
l undcrsland the above rcquircincul and certify that we now have smoke defectors
installed that do comply.
a 800
ADDRESS:
.�70
PERMIT NUM.uLR:
IIOMI�OWNI�IiS SIGNA'1'URL:
5
DAT13:
winword/smkdel
TMT1�11 0 ri
RPR-21-1995 14: 1? TAYLOR ROOFING 408 9711380 P.01
i
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• CIt, 1 of CWpC111110 •
r.o.aa�soo
Cupettlno,CA 95015•Os00
10100 I N rc Avcn,tC
('.upciUno,CA 95011.]255
Tplr,Ithu,tc:
(4001251-4505.
i
rAX:t40111 252-0753
COMMUNITY UFvr.IorMU+r
SM ICIs UG'1'L 1 It CL'K'lll'ICn'1'L ' COMP
LInNCG �.
1 undlcrsland and comply will+ Scclion 1210-a of the uniform 13uilding Code-
moke
Scclion 1210-;1 requiresl"luou,led+rs 10on the c+cit ngf or 1wt B
a, inleachesteep inglroom alsd t
dlctector will be installed,
used
or
ill
we
Ipw poses+(+lflexisolcng simoked dotectdoos comply, 6o new detectors ShIlllbe requlred sleeping
•n
l understand the above requirement and certify that now have smoke detectors
•
illsallcd that do comply-
.
ADDRESS:
plat MIT NUM.UIRn J
1lOtvt130WNGRS SIGNn'11111L:
DATE:
„ I
winwordIsnil(dcl '
T(1T(11 fi A1
I
APR-21-1995 14: 17 TAYLOR ROOFING 408 9711380 P.01
,
Clh� 0{ CU�IePtlf10
r.o.00%5110
CupmUno,CA 95015.0500
10.100 INm AvinuC
Cupr.,lino,CA 75011.0255
Tcirl�hpuc;(1001 251-1505. !
(40111252-075J
CoMMVNITY pCV@lOrM[NT
SMO1C1 UGTL• 'h Il CL1t�1'II;ICA-I'C OF M 'LIA11C6
I undcrstand and comply will) Scction 1210-a of the Uniform Building Code.
Scction 1210-a 1cquires whclln,led11on the cicil ogly Dodo
or Iwa 1`inlle�ch sleep oglroom and nt(1
dctector Will be installed, n o
SEd
Nr
POOL'�oses IrMly lf exisoling slill ie utoked deotec((Ofs comply, no new detectoros
Ixh�lll6eu ,fired sleeping
•
I understand 111c above requirement mud certify that we now have smoke detectors
hgwitcd that do congtly-
o�ao
ADDRESS:
pl:RMIT NUM.ULR:
1'10MI-OWNERS SIGNA'hURL:
�s /9 7--
w.jjjWOrd/sjjil(dqL
--winwOrd/sn11(dcl
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RPR-21-1995 14:17 TAYLOR ROOFING 4oe 9711380 P.m
I
C1fq of Ct l)ert1110 �!
r.o.not Soo
Cu{�cltinn,CA 95DIS•0500
lOJUO Im�c"venue
CA 95oii,,1255
.A505
fclrplivnc:t I I
' rAX: (AUl{l Z5 bU75J
COMMVN,fY UEv@LOrMENi
SM ICI t't C]"Oli CL^til II ICA'IC O1' 0�'I,IANCG
I
IluilJing Cole.
undcrstgnd and conlPlY will, Section 1210.1 of the Unifonu
Section 12 10 a requires 1wn owil¢dlls to IN on the e{eilu>5ic f orlllwadllvill Pichicifillp esleep uglroom and Olca
dcteclor will be inslgllcc,
hos t, cs'lllf cxisola,g simoked dcleclole os cou,Ply, no new detectors sl lltlbc required.sleeping
• lnl
I utulcrsland ti,c gbovc requircluent and certify that we now have smoke Jeleclors
inslallcd that do congJlY. -
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Al)DRLSS:
370
PERMIT NUM.UGR:
.I'IOMJ?OWNI�ItS SIGNA'CURE:
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• S11111LC"I': I11:It0OFING POLICY ,;Olt 'I-III; CITY OP CUPEIf17NO BUILDING DEPAItTMENT
plt101t'I'O ISSUANCI;. 01° pI;ItMI I AND INSpl;C'I'ION III IASF,.
1 Prior to Pcnuil issu:mcc, you must agicc to comply will, U.U.C. slnndards and manufeclurers slice's
Oil reroofing. .
hout
2. Oom Illwl bo Iding inspcclool br. A ❑nal iilispceliou ;mdl opprovalgsh.,ll be obtniucd frontlthe buildbrg
Inspector when the reroofing is completed.
be inspected Prior to lily roof being installed.
7. All types of ioo(sh;d1
4. In order to receive a final, you nnisl eomPlctc slops 1, 2, and J.
I,) I'rciuspecliou or tear off npprovol.
2.) In Piogress inspccliou approval.
3.) Final inspcction approval.
a.) Opciablc smoke dcicclor vel ificatiou
. b ) Spark aucslor iuslallaliou
J. If plywood is installcd, a plywood nail inspccliou is requiled.
G. If any roof is applied without first oltniniul, em inspection, you will be requiicd to remove all new
material down to the sheathing and a building inspector will inspect all sheathing at that time.
WG UNDERSTAND ]HE AUOVf: POLICYON ItBIt001TING AND WILL COMPLY Wff11 "1'11E
POLICY
IIOMI:OWNL•ItSNAME' 0990 Nor4- ,
Pa,`r
ADDIII?SS: 7S f
I(1iItOOFING COMPANY NAME:
APPLICANT'S SIGNAfUlili:
CITY OF CUPERTINO
BUILDING 1)17PAI(I ML'_NT
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