12080151 CITY OF CUPERTINO 13UILDING PERMIT
BUILDING ADDRESS: 20800 VALLEY GREEN DR CONI-RACI.OR:NEMMER ROOFING PERMIT NO: 12080151
OWNF-R'S NAME: 20800 VALLEY GREEN DR 5348AUDUBON PARK Cf DA'Z'E ISSUED:08/142012
OWNER'S PDOi\6: 4082530200 FREMONT,CA 94538 PHONE.NO:(510)919-2930
❑ LI CIsNS ED CON'fRACfOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
y
Licenseclass �� - J Lic,q 7 �I �U /
NIECII r RESIDENTIAL r C0111\fERC1AL r
Contractor � h'«t!
G /� �Uate 13 Z
hereby affirm that 1 tan licensed under the pro,isions of Chapter 9 JOB DESCRIPTION:APT.444-755-REMOVE EXISTING SHAKES AND INSTALL
(commencing with Section 7000)of Division 3 of the Business&Professions NEN'UNDERLAYMENT AND TIMBERLINE ULTRA COMPOSITON
Code and(hal ins license is in full force and effect. SHINGLES
hereby affirm under penally of perjure one of the following list,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 ssurk 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 stork for which this Sq. Ft Floor Area: Valuation:$31621
permit is issued.
A 1'1'1.1 CANrf CERTI FICATION APNNumber:32609040.00 Occupancy Type:
I certify that I have read this application and state that the above inflmunion is
correct. I agree to comply with all city and county ordinances and slate laws relating
to building construction,mid hereby authorize representatives of this city to enter
upon lire above mentioned property for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the Cit•of Cupertino against liabilities,judgments,
costs.and expenses which may accrue against said City in consequence of die WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,the pplicam underst:mdsand will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all no,, ort source re lana the Cupertino Municipal Code,Section
9.18.
"f"� rsr Issued by: � /✓ /�f�7—.G Date:
Sign ire Date
❑ OWNER-BUILDER DECLARATION
RF-ROOFS:
I hereby atlirnn that 1 am exempt front(he Contractor's License Ia% for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is
the follnaing(wu reasons: installed without first obtalln g an inspection,I m to remove all new materials for
I,as owner of the property,or limy employees with wages as their sole compensation, inspection.
will do the work,and the structure is not intended or of lered for sale(Sec.7044, �—
Business 3 Professions Code) Signature of Applicln Date:
1,as owner of the property,am exclusiveh.contracting with licensed contractors to
construct the project(Sec.7044,Business S Professions Cade). ALI ROOF COVERINGS TO BE CLASS"A"OR RET`fER
herchy 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 IiA'LARDOUS MATEIRLU S DISCLOSURE
Compensation,as provided for be Section 3700 of the Labor Code,for the 1 have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California Health 3 Safety Code.Sections 25505.25533,and 25534. I will maintain
1 have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code.Chapter 9.12 and the Health S
Safety Code.Section 25532(1)should I store or handle hazardous material.
Section 3700 of the Labor Code,for the performance of the oars for which this Addi(ionally.should I use equipment or devices which emit hazardous air
Permit is issued contaminants as defined by the Bay Areu Air Quality Management District I will
I eenily that in the performance of die work for which this permit is issued I shall maintain compliance with the Cupertino Jlunicipal Code.Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's Health S Safety Code.Sections 25505,25533•mid 25534.
Conmpensation laws ofCalifarnia. If,after making this certificate of exenmption,I
become subject to the Worker's Compensation provisions ofdme Labor Code,I must flsv '(tar author' alp lit: G
forthwith comply with such provisions or this permit shall be deemed revoked "� Dole:
\I'1'LICAN"I'CFR'1'I FIC,Vh10N
CONSTRUC-110N LENDING AGENCY
I eerily that I have read this application and state that the above infornalion is 1 hereby affirm that there is a construction lending agency for the performance of%urk's
correct.I agree to comply with all city and county ordinances mid state Imus relating for which this permit is issued(Sec.3097,Civ C.)
to building construction,olid hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
costs,and expenses which may accrue against said Cit'in consequence of the
granting of this permit.Additionally,the applicant understands and will comply ARCI I ITECI"S DECLARATION
with all non-point source regulatiais per the Cupenino Municipal Code,Section
9.18. 1 understand my plans shall be used as public records.
Signature Date Licensed Professional
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
GUPERTINO 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228• FAX(408)777-3333•buildinD(DDcupertino.orci
PROJECT ADDRESS e ` APN0 32(p0g O' ,QO
OWNER NAME PHONE •J lV E-MAIL �-
1Q t t
STREETADDR SI (J 50 (\ CITY.STATE ZIP ODZ FAX
CONTRACTOR NAME, A _ LICENSE NUMBER 3 q Ia t7D LICENSE TYPE BUS.LIC.a_
a=t11Mc 2L+9 30
COMPANYME EMAIL FAX
�W I e cher @ hcv r .13 to 573 - y7 56
STREETADD ESS l) CIT A,! .ZIP { J PHONE
tAdCo
1 UNDERSTAND AND AGREE TO THE FOLLOWING:
1. . 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.
7. 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 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 S 126.00. The re-inspection fee shall be paid before another inspection
can be scheduled.
By my signing below, I certify each of the following is true: I am the property owner or authorized agent to act on the
property owner's behalf. 1 understand and agree to comply with the re-roof policy stated above. I also understand that
smoke detectors and carbon monoxide detectors ar equired to be installed in accordance with Sections R314 and R315 of
the 2010 Califomia Residenti Qode.
Signature of Applicant/Agent: Date:
ReroofPolicv_?011.doc revised 02116/11
I Zvi pL
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT' BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO,CA 95014-3255
CUPERTINO (408)777-3228• FAX(408)777-3333• buildinG(ftuoertino.orG
y�t4- �IsS
PROJECTADDRE S 20800 Ja1k f Green t)r ArNq 3Z Q—I L11 o
o
O\lT'6R NAMEKOP—E D PHONE ? � 2,0
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STREET ADDRESS ^ 1 L CITY,STATL+,ZII/1'✓ ELMONT ghl CA q FAX
CONrAcr NAmi fT1-J PHONE E-NIAIL
STREETADDRESS CITY,STATF.,ZIP FAX
❑ OWNER ❑ OWNIR.BUIMER ❑ OWNERAGINI ❑ CONTRACTOR ❑CONIRACIORAGENT ❑ ARCHITECT ❑PNOEMM ❑ DLVELOPER ❑TENANT
CONrRAGTOR NAnIt:---)ONRLO F. N�rvt 1 E ucrosl?NUMBER CENZuOF PN61 Dus.11c.,��,�04
COMPANY NAMit !G ILMAIL FAF
90-rAM9 r- IN 2f @ a�t0o-C.Or''1 Sf0 5"73- LA`7
STREET ADDRESS CITY,STAI'1?,%Nf'2M«`�
C � 1� PHOO 9( .1930
ARCHTTCUENGW6ER NAME LICENSE NTJMBER r{ J BUS.LIG4
COMPANY NAME CMAII. FAX
STREET ADDRESS CITY,STATIL ZIP PHONE
USE OF ❑ SPD or Duplex Multi-Fancily ROOF AREA: VALUATION: _
S"I'RUCfURE: ❑ Commercial � 1� � 31
I YJ 2 1
W
ECISTGROOFTYP6: ❑BUILT-UPROOF 11 } {ASPHA LT SHWGLFS % WOOD SHAKES ❑WOODSHWGLES ❑OTHER(SPECIFY)
REMOVEIREPI.ACH AYES IF NO. PL)WOOD W e ❑ _ PLYWD 11 OSB PITCH: y1 ,) ROOF
❑ :ft : I THICANFSS ❑ Sir I-] —+—')- CLASS A
PROPOSED ROOF TYPE: ❑BUILT.UPROOF 4ASPHALTSHINGLES 13 WOOD SHAKO 1:1 WOOD SHINGLES El OTHER ICC-ES REPORTq
DESCRIPTION OF M ORK-"
IEP o FF Sk}AK —S )
— SNS�Pv— UNOE2 L A`� MEPIT + GAF "��rnpt2l�NE UL -A
C-.O W\PpS YT-1D� '
1)y my signature below,I cenify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I hale provided is correct. I haye read the Description of work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to bui g construction. III eprecentatives of Cupertino to enter the abyve-identified property for inspection purposes.
SignatureofApplicant/Agene R Date: —/ O
SUPPLEMENTAL INFORMATION REQUIRED DFFICKUSEONLY
_ If building is associated with a Home Owner's Association,provide letter PI.ANCHECKTVPE ROUTING SLIP
of approval from HOA. ❑ OVER-THH-COUNTER ❑ BUILDING PIAN REVIEW
Provide Planning approval to verify if there any restrictions. ❑ EXPRESS ❑ PIANNING PLAN REVIEW
Provide copy of Manufacturers Installation Specifications. ❑ STANDARD ❑ FIREDEn'
Provide signed copy of Cupertino's Tear-Off Policy. ❑ OTHER:
RerotjApp_2011.doe revised 03/16111