R-6322 rr
PERMIT R_ 6322
APPLICATION FOR CITY of CUPERTINO NUMBER
INSPECTION DIVISION PERMIT EXPIRATION
REROOF PERMIT (408)777.3228 PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 1W DAYS OF PERMIT ISSUANCE OR
- - 180 DAYS FROM LAST CALLED INSPECTION.
BUILDING ADDRESS -
t
CUPLR RESIDENTIAL COMMERCIAL OTHER
OWNER'S - - - - HAZARDOUS FIRE AREA
NAME S✓IVI/YLAI /✓fANJ< vas ❑ Iry-f -I�mdelsland meds Class ,
roof essemdy Is required.
��,,�/,,,, NO ❑ Initial LC.B.O.
If
ADDRESS( �w�2rftikld EXISTING ROOF COVERING
PHONE 7VY pC��• 4�OV I NUMBER OF EXISTING COVERINGS '
CONTRACTOR'S �n " /. I
/�✓R.'t_ [ U/JL:2JCr1 o'N TO BE REMOVED TO BE RETAINED
NAME
ADDRESSII TYPE OF ROOF COVERING
CITY&ZIP - d `0 plT1i R-S .
!_ EXISTING
PHONE p� - B -UP ROOF ❑
LICENSE
NUMBER GY 7 i - S HINGLES [kaf
LICENSED CONTRACTORS DECLARATION -
I hereby affirm that I em licensed under provlelane of Chapter g(commencing with Section WOOD ❑
7000)of Division 3 of the Business and Proleeebna Code,and my license In lull force and
enact. _ igy IN
License Class Us.Number 3l /y O�In ) E]
Dated'nj� Contractor Aft?— OTHER�FRYIFY) ❑ -
OWNER-BUILDER DECLARATION
I hereby affirm that I em exempt from the Contractors License Lew for the fol I(Sec.7031.5,Business and Professions Code: Arty city a county w r permit talter.improve,demolish,a repair any structure,prior to as once, it "th ROOF - ❑ap0cau t for schi permit to file a signed statement that he Is Oc t talon"
of the Contractors License Lew(Chapter a(commend^g win )a(Olvlebn 30the
Bulli^ass entl Pmfeasforre Cade)or that he le exempt iherelrom e t be"is-for tfq,allpeSHINGLES
exemption.Arty vlotstion of Section 7031.5 by anry aPdicent lora per bJa civil penalty of not more then five hundred dollars(5500).):I,as owner of me property,or my employees with wages as mel a compensation,will doHAKES ❑the work,end tla structure Is not Intended or offered for safe(Sec.7 ,Business entl Profes-
Slons Code:The Contractors License Lew does not apply to en owne property who police,orHINGLES
Improves,hereon,and who does such work hlmaeH or through hie oven provltl ❑
Such Improvements are not intended or offered for sale.If,however,th le
Is sold within one year of compietbn,me owner-bulmer will have the bur gthet nada OTHER(SPECIFY) ❑
not bulk!or Improve for purpose of sale.).
❑I,as owner of the property,art!exdu"Ively contracting with IkanaeE contractors reconstruct
the project(Sea.7044,Business and Profe"algne Code:The Contractors Ucemse Lew daee na PROVIDE 1.13,13.0, REPORT NO.
apply to an owner of property who bulWs or improves thereon,and who contracts for such projects'
with a contractons)ikeneed pursuant to me Connector.Ucanee Lew, PROVIDE MFGR.INSTALLATION SPECS.
I em exempt under Sec. ,B&P.C.for this reason
Owner - Data APPLICATION DATE VALUATION PERMIT FEE
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury ane of the fallowing tlecieretlon: - g ��
q I have and will maintain a CertiHoate of Consent to aelf- acre for workers Compeneatfon, Buildin
as provided for by Section 3700 of the Labor Code,for the performance of me work for which this / '3 yy--Q
permit is Issued. Ir, `�7•.
❑I have and will maintain Workers Compensation Insurance,se required by Section 3700 of ��J V V $BISmIC{��(�v�JV.
me Labor Code,for the performance of the woM for which this permit Is Issued.My Worker" Total ✓ S�4.Y v
Compensation In"umme carrier and policy number are:
Cerner
STIPw&60 Patsy No. Olo13d2 PERMIT AUTHORIZATION DATE
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE N.C[I Q
(This section need not be completed it the permit Is for one hundred dollars($100)of less.)
1 cera fy met In me performance of the work for which this permit is Issuac! I shell nor employ
arry person In any manner so ae to become subj o the Workers'compensation Laws of call All roofs shall be inspected prior to any roofing material being
fomle. installed. If a roof is Installed without first obtaining an
Data l �� "W Appikam inspection,I agree to remove all new materials for inspection.
NOTICE TO APPLICANT: If,after making t Cenlflrate of Exemption,you should become Applicant.understands and will comply with all non point
subject to me Workers'Compensation provisions of me Labor Cade,you must forthwith comply
MM such provlsfona or this permit shall be deemed revoked. sourceteaulations.
I sanity that I hese reed this application and state that the above Infomtstfon is canect.I agree
to comply with ell city all county ordinances and Nate laws relating to building construction,end All roo c verings to be claor better.
hereby authorize representsmm N Ova city to enter upon the above-mentioned property for in. - -
spectlon purposos, - -
(We)agree M save,Indemnify and keep harmless the City of Cupertino egdnat Ilabllltle",
Judgments,scale and expenses which may In any way accrue against sem City In consequence SI AT E OF APPLIOANT DATE
of me pmntlnp of this Permit.
PRE-INSPECT PLYWOOD: IN-PROS: // Q
INSP. DATE INSP, DATE INSP. DATE 91e
TEAR OFF INSPECTION: BATTENS: FINAL:
INSP. DATE INSP. DATE - INSP. DATE
NOTE: OSHA APPROVED ACCESSTO ROOF SHALL BE PROVIDED FOR INSPECTION
-
0F FIC E.CO PY -
Plan Check Division
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
Fax(408) 777-3333
� W. �Ciityv of
npertino
Building Department
Subject: Reroofing policy for the City of Cupertino.
1. Prior to permit issuance, you must agree to comply with 1994 UBC Standards and
manufactures specifications 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 roofs shall be inspected prior to any roofing installation.
4. To receive a final sign off from the City the following steps are required.
1) Preinspection and/or tear off approval.
2) In progress inspection approval.
3) Final inspection approval.
a) Spark arrester installation.
• 5. If plywood is installed, a plywood nail inspection is required.
6. Any roofing which is applied without first obtaining an inspection, will require the
removal of all new material down to the sheathing so that the proper City inspection
can be performed.
We understand the above policy on reroofing and will comply with this policy.
Homeowners Name: S'Vv�✓YUtW �nA���
Address: c� GAF JIE'_ 2lArl
Reroofing Company Name: /_'//Z`
n`
Applicants Signature:
Joe Antonucci
(Chief Building Official)