12080021CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20875 VAI.LEY GREEN DR CONTRACTOR: NEMNIER ROOFING PERAIITNO: 12080021
OWNF-R'S NAMEI: KORET FOUNDA'T'ION 5348 AIIDIIBON PARK CI' DATE ISSUED: 08 /0620 1 2
OWNE'R'S PI IONF.: 6505923960 FREIMONI'. CA 94538 1'110NE NO: (510) 919-2930
roti. LICISNS11) COYI'RACf0RRS DECLARATION
License Classy /s Lie._ 4 % /'J 'S 3 O /
Contractor( ^4 Date 9,—G
hereby affirm that I am licensed under the provisions of Chapter 9
(commencing frith Section 7000) of Division 3 of the Business S Professions
Code and that niv license is in full force and effect.
1 hereb%y affirm under penalty of perjury one of the following two declaration:
I have and will maintain a cenificate of consent to self -insure Toru Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
perl'ormance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of die work for which this
permit is issued.
APPLICANT CERTIFICATION
I certify than I hate read this application and state that the above information is
correct. I agree to comply with all city and county ordinances and state laws relating
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands mid will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Signature Date igi_�
❑ OWNEWBUILDER DECLARATION
hereby affirm that I am exempt from the Contractor's License Law for one of
the. following two reasons:
1, as owner of the property, or my employees with wages as their sole compensation,
will do the work, mid the structure is not intended or ollcred for sale (Sec.7044.
Business S Professions Code)
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project(Sec.7044, Business R Professions Code).
I hereby affirm under penalty of perjury one of the following three
declarations:
I have and will maintain a Certificate of Consent to self insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
I cenify that in the performance of the work forwvhich this permit is issued, I shall
not employ any person in any manner sons to become subject to the Worker's
Compensation laws of California. If, after making this cer ifcate of exemption, I
become subject to the Worker's Compensation provisions of the Labor Code, I must
fortbvith comply with such provisions or this permit shall be deemed revoked.
APPLICAN PCliRTI FICATION'
I certify that I have read this application mid state that the above information is
correct. I agree to comply with all city and county ordinances and state Imes relating
to building construction, and hereby authorize representatives of this city no enter
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments.
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
BUILDING PERi1111' INFO: BLDG F- ELECT r PLUMB r
Al11 CII r RESIDENTIAL (- CONIAIERCLAL r
JOB DESCRI PTION: 400-715 - TEAR OFT SRAKESREPLACE WITH GAF WITH
TIGER PAW UNDERLAYMENT CLASS A 5400 SQI--f
Sq. FI Floor Area: I Valuation: $17380
APS Number: 32609064.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAN'S OF PERMIT ISSUANCE OR
180 D/"#YyS� FROM L T CALLED INSPECTION.
Issued by: �'r_ J I I) Date:
nil: ROOFS:
All roofs shall be inspected prior to any roofing material beiig installed. If a roof is
installed without first obtaining an inspection, I agree to remove all nese materials for
inspection.
Signature of Applic n
ur
Ci—e4 —1-/ Pe
Al -1. ROOF COVERINGS TO BE CLASS "A" OR BE 17ER
HAZARDOUS MATERIALS DISCLOSIIRF
hayc read the hazardous materials requirements under Chapter 6.95 of the
California Ilealth \ Safely Code. Sections 25505, 25533, and 25534. 1 will maintain
compliance with the Cupertino Alunicipal Code. Chapter 9.12 and the lieulth S
Safety Code. Section 25532(x) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air QualiyManagement District 1 will
maintain compliance with the Cupertino \municipal Code, Chapter 9.12 and the
Ilealth S Safety Code, Sections 25505, 25533, and 25534.
Owner nhorized a
/l/lrs��tc_� Z
CONSTRUCl'ION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's
ARCIIITF.CI"S DECLARATION
I understand my plans shall be used as public records.
Date I Licensed Professional
CUPERTINO
REROOF TEAR -OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildino(akupertino.ora
PROJECT ADDRFSS
o
�-
APN#
OWE.
PHONE
•�.
E-MAIL
OC/
S7ftEEJ'ADO
CI STA ZIP
FAX
CO. CTOR NAME
LIC SE `N_'�UM ERO
LI ENSSEE TYPE
BUS. LIC.0
C(tMPP NY NAME
E-MAIL
FAX
3 BF��Y RES
�/C
CtIY.STAT ZIP
S3
PHONE
1 UNDERSTAND AND AGREE TO THE FOLLOWING:
The re -roof project shall comply with all applicable provisions of the 2010 California Codes.
2. An inspection request can be scheduled up to the day before the inspection date. Please call (408)777-
3228 from 7:30 - 3:30pm (Mon-Thurs) or 7:30 - 2:30pm (Friday) to schedule the next day inspection.
For Tear -Off and Nailing Inspections, you must also call on the day of the inspection only after that
phase of the work is completed. The building inspector will be available within one hour. Progress
and Final Inspections will be given a two hour window.
3. Tear -Off Inspection is required. Any and all dry -rotted wood shall be replaced prior to this inspection.
Unless new plywood roof sheathing is proposed throughout, all the nails/fasteners shall be either
completely knocked -down or removed prior to this inspection:
4. If plywood is installed, a plywood Nailing Inspection is required.
5. Roofing shall not be applied without first obtaining all prior inspection and written approvals from the
building inspector. Any roofing which is applied without first obtaining an approved inspection will
require the removal of all new material down to the sheathing so a proper inspection can be performed.
6. Progress Inspection is required when approximately 50% of roof covering is installed.
A Final Inspection and approval shall be obtained from the building inspector when the re -roofing is
completed. To receive a final sign -off, the following items will be verified:
a. Flat roofs shall have a minimum of Y" per foot of slope and demonstrate there is no ponding.
b. Listings from approved testing agencies for all pre -manufactured products used shall be
available on-site to review at the time of the inspection.
c. Proper spark arrestor installation, vents painted, gutter/downspouts installed, debris removed.
8. NOTE:. If you call for a tear -off or plywood nailing inspection and the work is not complete, you will be
charged a re -inspection fee of $126.00. The re -inspection fee shall be paid before another inspection
can be scheduled.
By my signing below, 1 certify each of the following is true: I am the.property owner or authorized agent to act on the
property owner's behalf. I understand and agree to comply with the re -roof policy stated above. 1 also understand that
smoke detectors and carbon monoxid9i detectors are reguired to be installed in accordance with Sections R314 and R315 of
the 2010 California Residential Co&/
of
ReroofPolicv_2011.doc reviser) 02/16111
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
AA
ADDRESS: 20875 valley green drive y00^ DATE: 081 612 01 2
REVIEWED BY: larry s
Flee. flan Check
APN:
BP#:
VALUATION:
$17,380
*PERMITTYPE: Minor Building Permit
PLAN CIIECK TYPE: Re -roof
PRIMARY
Multi -Family Dwelling
USE:
Building is
, 3 Stories O Yes NO
PENTAMATION
1R2ROOF
PERMIT TI'PE: A
WORK
tear off shakes replace with gaf with tiger paw underla ment
SCOPE
Suppl. Lap Fee
FEE ID ROOFAREA
(S.f.)
1REROOFMRES 5,400
NOTE: This a+'rimae does not includejees due to other Departments (i.e. Planning. Public Work's, Fire, Sanitary Sewer District, School
District. etc.). These feav are baser/ on the prelintinan information available and are mdr an estimate. Contact the Dept for addn'I info.
FEE ITEMS (Fee Resolmion 11-053 IN'' 711/11)
Meth. Plan Check
Phoub. Plan Check
Flee. flan Check
Mech. Permit Fee:
Plumb. Permit Fee:
Flec. Permit Fee:
Other,ilech, Insp.
Other Plumb Insp.
Other Flee. hup.
+Meeh, h+sp. Fee:
Plumb. ln,p. Fee:
Flee. Insp. Fee:
NOTE: This a+'rimae does not includejees due to other Departments (i.e. Planning. Public Work's, Fire, Sanitary Sewer District, School
District. etc.). These feav are baser/ on the prelintinan information available and are mdr an estimate. Contact the Dept for addn'I info.
FEE ITEMS (Fee Resolmion 11-053 IN'' 711/11)
FEE
QTY/FEE
MISC ITEMS
Plan Chet% Fee:
suppL PC Fee
Pham b./d'lech./Elec.
Permit Fee:
$810.00
Suppl. Lap Fee
Plnmb.lHech./F.lec
Phanh.lMech./61ec Pamir Fee:
Consnttction Tax:
Administrative Fee:
Work Without Permit? O Yes (F) No
$0.00
Advanced Planning Fees:
Travel Docntnewation Fees:
Stron_ Nlodon Fee: IBSEISMICR
$1.74
Select an Administrative Item
13lde Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$812.741
$0.001
TOTAL FEE:
$812.74
Revised: 07/01/2012
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
CUPERTINO (`108) 777-3228 • FAX (408) 777-3333 •-buildino(cDcuDertino.org
Z-W 1 hurl - 5// S
1.7,0��(-)al
PROJECT ADDRESS O p C /I / n
APN >
OWNERNAME/ ��
HONE S J ^60
GJ
E-AfALL
STREET .ADDRESS�OSd /� �N
/p
C ST TE. ZIP
�O I FAX
A
CONTACT NAME1 j,
/ € ,+ p�j /
O O
E-MAIL
STREET ADDRESS ..r G� I
CTTY,CSTJA�TjE,UZIP n
FAX
❑ O%VNER Cl OWNER -BUILDER ❑ OWNERAGENT .CONTRACTOR ❑CONIRACTORAGENT ❑ ARCHITECT ❑ ENGINEER, ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAM 6N t (� m C�
LICENSE NUMBER LICENSE TYPE
BUS. LIC. a
COMPANY NAME
E -MAR.
STREET ADDRESS /
CITY' STATE, ZIP
PHONE
ARCHITECrIENGWEER NAME
LICENSE NUMBER
BUS. LIC.0
COMPANY NAME
E, JAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ SFD or Duplex [vlUlti-Fa1nIIy,
STRUCTURE. ❑ Commercial
ROOFAREA::VALUATION:
590-6
(jam
pv
EXISTING ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES 444100D SHAKES ❑ WOOD SHINGiFs ❑ OTHER (SPECIFY)
RaIOVE /REPLACE �~
❑ No
IF NO.
n LAYER '
PLYWOOD Elh" ❑
THICKNESS' Is
ICKN,"
PLYWD 11OSB
11 Cox
PRCH:
' (-,�
RMF ,
L A
PROPOSEDRMFTYPE: ❑BUILT-UPROOF ❑.ASPH.ALTSHINGLES ❑WMDSHAKES ❑WMDSHINGLES ❑OTHER
ICC -ES REPORT
DESCRIPTION OF WORK:
/
By my signature below, I certify to each of the following: 1 am the property owner or authorized agent to act on the property owner's behalf. 1 have read this
application and the information [have provided is correct. [have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ardinanaes and state laws relating to ilding conswctian. 1 orize represenatives of Cupertino to enter the above -identified property for inspection purposes.
Signature ofAppliunt/Agrnt: Date: f$'6 -./-t-
SUPPLEMENTAL INFORMATION REQUIRED
_ If building is associated with a Home Owners Association, provide letter
Of approval from HOA.
Provide Planning iglpfOVal to verify ifthere any restrictions.
Provide copy of Manufacurrer's Installation Specifications.
Provide signed copy of Cupertino's Tear -O@ -Policy.
OFFICEUSEONLY
_
PLAN CHECK TYPE -
ROUTING SLIP .
VER-TRE{OUNTER
❑ EXPRESS
❑ STANDARD
- ❑ BUILDING PLAN REVIEW
❑ PUNNING PLAN REVIEW_
❑ FIRE DEPT
'❑- OMER: ;
Reroof4pp_201 Ldoe revised 03/16/11