R-6599 APPLICATION FOR CITY OF CUPERTINO
PERMIT R-6 6599
INSPECTION DIVISION PERMIT EXPIRATION
REROOF PERMIT (408)m-3228 PERMIT EXPIRES IF WORKISNOT STARTED
WITHIN IN DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CAIIED INSPECTION.
BUILDING ADDRESS
RESIDENTIAL COMMERCIAL OTHER
OWNER'S HAZARDOUS FIRE AREA .
NAME J _ Jul VES ❑ mo url assembly
is required q e a Class A .
NO ❑ Initial I.C.B.O.
ADDRESS
EXISTING ROOF COVERING
PHONE
\� NUMBER OF EXISTING COVERINGS
R'S ^ UUU
ANT' )�Q^tO TO BE REMOVED TO BE RETAINED
ADDRESS`l./��A � Xl`1`j TYPE OF ROOF COVERING -
CITY&ZIP XI
PHONE CI'lli 'BUILT-UP ROOF ❑
LICENSE
NUMBER ASPHALT SHINGLES ❑
UCENSED CONTRACTORS DECLARATION
I notably alarm bet I am licensed under provisions of Chapter 8(commencing with Section WOOD SHAKES 11rC9Y
]00O)of Division 3 of the Business and ProfesalarM Code,and my license b e e
In lull lance
el WOOD SHIDF
License Cb Lb.Num OTHER(SPData ConireGor OWNER-BUILDER DECLARATION PROPOSEDI hereby shirm that I em exampt from are Contractor's License Lew for the Idkwdng reason.(Sec.7031.5,Business entl Prdessiona Code: Any city or canny which requires a permit to
construct,alter,Improve,demolish,or repair any structure,prior to lb bsuaM , requires the BUILT-UPRapplicant for each permit to file a signed statement that ha Is Ikaroatl pursuant thepnwblonof the Contrector'e License Lew(Chapter 9(commencing with Section]000)al Mebn 3 d tBusiness entl Pretessons Code)or That he is exempt marehom a besi the e1 ASPHALT S
exemption.Any vibleflon of 7031.5 by any applicant lar e t oc nt to
e eivll perelry of not more than f hundred tlollan(SSOo).):
01,m owner of they or my empbyaee hwogee the setlon,will do WOOD SHAKES ❑
the work,and the structure b t Mended w afbr reale( .7 ,Busln entl Prufes
-
shonsCode:TheCom ctor' License Law of tow or property who bulks or WOOD SHINGLES
❑
Improves Iherebn,wd who a Such work himeeIf h1 employee¢,prevdad That
such Improvements are no mterabtl or lar m If, r,the building ar improvement
bsddwlthinoneyeerof mpletbn, aw9�atldiltle Ihavetheburdenofprwinpthathemtl OTHER(SPECIFY)
not Wild w Improve for rpose of .)
❑I,ea owner ollha openly, axduehety Iractkq with Yceneetl comrectore to construct
the projed(Sec.7044, and Prufesalbna ode:The Contractor's License Law does rot ' PROVIDE I.C.B.O.REPORT NO.
appy to on owner of probe ulltls w improves thereon,erg who contracts for such projede
with a contractors)IIoeOSed purl t M the Contractor's Law"Law. PROVIDE MFGR.IN$TAIIATION SPECS.
❑1 em exempt uncar Sac. ,B B P.C.for thI6 reason
Owner Data
. WORKER'S COMPENSATION DECLARATION APPLICATION DATE VALUATION PERMIT FEE
'
h affirm under parelty d perjury one of the following cac eretkn:
have and will mal ntoln a Certificate d Consent to selbinsure for Workers Comwirsason, (^f\ Building 7,
ns r 'detl larch Sectlan 3700 of the Labor Code,for the performance of the work or which lits n'�{. �O
per Mt le Issued. '\ 'Seismic
❑1 bare and woe the
workers Co work
which ra,as required Is I by Sectlod.My Worker's of /
the Labor Code,for the performance d aro work lar which this permll le Issued.My Worker's C
Compensehon IneO�sren�ce carder ePo
d `flay number are- Total
_ .Carrlar�S C-1menR7sJIv PolicyNo� � PERMIT AUTHORIZATION - DATE"
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE N.CQ
(This section need not be completed it the permit Is for ane hundred cause($1 DO)w lase.)
I tartly that In the perlamnan;e of the work flit witch fhb Wmdt Is lasuad,I Shell not emplay
am s h a manner ac,as to beawne w to aie workers' parestwn Laws d Can- . All roof^shall be inspected prior to any rooting material being
an
Installed. If a roof is installed without first obtaining an
Dela Applicant inspection,I agree to remove all new materials for inspection.
.
NOTICE AP CPM: Il,after making this flea of E ilan,your e Zt
A hcant understands and will comply with all non int
Subject to ma Workers'Compensation provisions of the Labor must forth pp PY I�with such provisions or this permd ehal0be doomed revoked. so CB regulations.
I certoty thatI have read this application anti stte that the above In anis toto comply with SII cry anti county wdoances and state laws relating to Whiing soneA f covering to be class' or better.
hereby edhoriza.
e representatives al this city to enlw upon the abennntioned propsdy kr In.
spectlon purposes.
(We)agree to save,Indemnify and keep hannlosa the City of Cupwinro egelmdIIebMiles,
judgments,costa and expenses which cr
may In wry way ecua against sled City In camequwce
of the granting ofthis parmn. SIGNAT PLICANT DATE
PRE-INSPECTION: PLYWOOD: -P GRESS
INSP. DATE INSP. DATE INSP. DATE
TEAR OFF INSPECTION:' - BATTENS: FINAL:
INSP. DATEINSP. V DATE INSP. DATE
NOTE: OSHA APPROVED ACCESS TO ROOF SHALL BE PROVIDED FOR INSPECTION'
OFFICE COPY
• CITY OF CUPERTINO - BUILDING DEPARTMENT
RE-ROOFING POLICY
1. Prior to permit issuance, you must agree to comply with U.B.C. standards and
Manufacturers specs on re-roofing.
2. New roof coverings shall not be applied without first obtaining all inspections and written
Approval from the building inspector. A final inspection and approval shall be obtained
from the building inspector when the re-roofing is completed.
3. All types of roofs shall be inspected prior to any roof being installed.
4. In order to receive a final, you must complete steps 1,2, and 3.
t. Pre-inspection or tear-off approval
2. In-progress inspection approval
3. Final inspection approval
a. Operable smoke detector verification
5. If plywood is installed, a plywood nail inspection is required.
• 6. If any roof is applied without first obtaining an inspection, you will be required to remove
all new material down to the sheating and a building inspector will inspect all sheating at
that time.
IMPORTANT:
1. Flat roofs must have a ''/4" per foot slope, or demonstrate that there is no ponding.
2. I.C.B.O. reports are required to be on the job site at the time of inspection. If you do not
have one, contact the building department.
WE UNDERSTAND THE ABOVE POLICY ON RE-ROOFING AND WILL COMPLY
WITH THE POLICY.
HOMEOWNER'S NAME:
ADDRESS:
RE-ROOFING COMPANY NAME:
APPLICANT'S SIGNATURE:
• CITY OF CUPERTINO
BUILDING DEPARTMENT
Re-rooflwinword