12080152 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20800 VALLEY GREEN DR CON IRACI'OR:NEMMER ROOFING PERMITNO: 12080152
OWNER'S NAME: 20800 VALLEY GREEN DR 5348 AUDUBON PARK Cl` DATE ISSUED:08/142012
OWNER'S PIIONE: 4082530200 FRIIMON I'.CA 94538 PlIONE NO:(510)919-2930
❑ LLIICI•:NSEDCON"fRAC'FOR'SDE.CLARA'IION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
License Class ` — J JQLic. 7i;19 30/
�rI I NECH r RESIDENTL\I. r COMMERCIAL r
Contractor
1 hereby affirni Ilan I am licensed under lire provisions of Chapler'J .1013 DESCRIP'T'ION:APT.456-463-REMOVE EXISTING SHAKES AND
(commencing with Section 7000)or Division 3 of the Rosiness S Professions INSTALL NEW UNDERLAYMENT AND TIMERLINE ULTRA
Code and Ihut nry license is in full force and effect. COMPOSITION SHINGLES 6800 SQFf CLASS A
herebyaf6rm under penalty of perjury one of the following two declarations:
1 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 die work forwhich this Sq.Ft Floor Area: \'situation:$34691
permit is issued.
\I'PLIC.\N I'CIiR'I'IFIG\'PION AI'N Number:32609040.00 Occupancy Type:
I cenit'y that I have 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 PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City ol'Cupertinoagainst liabilities.judgments. WITHIN TSU DAYS OF PERMIT ISSUANCE OR
costs,and expenses which may accrue against said City in consequence of the
granting of thispemdt. Additionally,theapplic:mtunderstandsmmdwill comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulatims p the Cupertino Municipal Code,Section
9.18.
Issued b}•: ✓r�+'7/V f^ Dare: �- 4
G �/ 1�-
Signature Date
❑ OWNEIR-111JILDI'➢3 DECLARATION
RF-ROOFS:
I hereby affirm that I tun exempt from the Contractor's License Law formic of All roofs shall be inspected prior to any roofing material beimg installed.Ira roof is
the following two reasons: installed without first obtaining an inspectio ;I t gree to remove all new materials for
1,as owner of the property,or my employees with wages as their sole compensation, inspection.
will do the work,mid the structure is not intended or offered for sale(Sec-7044,
Business d Professions Code) Signature of Applcar Date:
I,as owner of the properly,am exclusively contracting with licensed contractors to
construct the project(Sce.7044,Business& Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETITR
hereby affirm under penally of perjury one of the follow in-three
declarations:
I have and will maintain a Cenilicate of Consent to self-insure for Worker's I IA'LARDOUS MATERIA1 S DISCLOSORE
Compensation,as provided for by Section 3700 of the Labor Code,for the I Ira,I,rend Ilene hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California I lealth&Safety Code.Sections 25505,25533.aced 25534• I will maintain
I have and Will maintain Worker's Compensation Insurance,as provided for by Compliance with the Cupertino Municipal Cute,Chapter 9.12 and lire Health S
Safely Code,Section 255320m)should I store or handle hazardous material.
Section 3700 of the Labor Code,for the perlonnunce 01-111C work for which this Additionally.should I use equipment or devices which emir hazardous air
permit is issued. contaminants as defined by the Ihq Area Air Quality M ar agement District I will
I certify that in the performance of die work forwhich this permit is issued,l shall maintain compliance with tire Cupertino Municipal Code,Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's I Ieallh S Safety Code.Scr1, ms'5505.25533,and 25534.
Compensation laws of California. If,after making this certificate of exemption.I
become subject to the Worker's Compensation provisions of the Labor Code,1 must Owner
forthwith comply with such provisions or this pemnit shall be deemed revoked. Date: O
CONSTRUCTION LENDING AGENCY
APPLICANTCF.RTI FICA HON
I certify that I have read this application and stale that the above information is I hereby affirm that there is a construction lending agency for the performance of work's
correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.)
to building construction,and 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 City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply ARCII ITECI"S DECLARA'T'ION
with all non-point source regulations,per the Cupertino Nlunicipal 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
10300 TORRE AVENUE •CUPERTINO, CA 95014-3255
CUPERTINO
6 (408)8))7777-322288- FAX(408)777-3333•building(akupertino.ora
PROIECJs PSF�S irV �'( ( C /V' �-L/� /t f APN a 2_(_O 9 O a R)e L
Ow'ERl\ACME,1S(� ��1,� - PH`�S S 2 34(oJO IIJE-MAIL `T V
$ F6 V'/&-157,
5 - s -,c.✓` CI ,STAT`ZIP FAx
CO CTRA. OR NAME /� LICENS \UMBER LICENSETYPE BUS.LIC..
7' �I3c��
CO NY NAME E-MAIL FAX
C r @ .r
STREET ADDRESS^^ A OpCITY.STATE.ZIP p P 0
3 K /rirc�u �l✓ t !�'. C% Co*0KT % VS
1 UNDERSTAND AND AGREE TO THE FOLLOWING:
I. 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. I understand and agree to comply with the re-roof policy stated above. I also understand that
smoke detectors and carbon monoxid detectors are re fired be installed in accordance with Sections R314 and R315 of
the 2010 California Residential Co
Signature of Applicant/Agent: Date: -8 -13 —LZ,
F
RerooJPolitv_20l Lrloc reriserl0Jl6/ll
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO,CA 95014-3255
CUPERTINO (408)777-3228• FAX(408)777-3333•buildinG6ilcuoertino.orG
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PROJECT ADDRESS 208�� Jape Greer\ Df APNN 32-to
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OWNER NAMB PHONE'J/�� u 7.ru-u.Nmu-
STRETTADDRSS
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CITY,STATE,ZIP
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CONTACT NAME PHONE ILMAIL
STRUT ADDRESS CI'IY,STATP ZIP VAX
❑O WFR ❑ OWNER-BUILDER ❑ OWNTRAGHNI ❑ CON RACroR ❑CONTHACIORAGENT ❑ ARCHUTCT ❑ENGINEER ❑ D6YEIAPER ❑TENANT
CONTRACT OR NANIr-Q0
N A Ltt T:, NEM E UCHNSH NUMBER ^ �^� WCENSL'TYPENbt BUS.LIC.#
COMPANY NAMB E-MAIL TAX
IN em et' @ A�+o(�o1.1CGOr'1 510 5.73- '7
STREm'ADDRESS 53'Ae) AVaUb0r fQfkl.A- LnY SrATEZ fEMOnT CA "1'�J 38 /� 9/ x930
ARCIUTE YENGINEERNAME LIC' SHNUNIBER BUS.WCN
COMPANY NANDI I.MAIL FAX
STREET ADDRESS CITY,SPATE,ZIP PHONE
use OF ❑ SPD or Duplex Multi-Family ROOF AREA: (� VALUATION:
STRU=RH: ❑ Commercial to v -� 34 t0 C1 1
rWSTINGROOFTYPH: ❑BUILT-UPROOT ❑ASPHALTSmNGL. i WOOD SHAKIS ❑WOODSHINGLES ❑OTHER(SPECIFY)
REMOVEIREPLACE 1RYFS IF NO. PLYWOOD of 8" ❑ PLYN'D ❑OSB PITCH: ROOF
0 No
PROPOSHD ROOF TYPH: ❑BUILT-UPROOP .<ASPHALTSHINGLIS 1:1 WOOD SHAKES 13 WOOD SHINGLES ❑OTHER ICGIS REPORT
DISCRIFI'ION Oil WORK:"
ZN7CAL)— laIVOE.(Z L"A mF_hLT 'I' AF -'rTn ERL.\tAF— V •TSA
C-O'MPOS \ROa
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 I have provided is coned I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relatin uilding cons" 'fin. I mahorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applican✓Agen'_ Dater
SUPPLEMENTAL INFORMATION REQUIRED OFFICE.USE ONLY
_If building is associated with a Home Owners Association,provide letter PLANCHECK TA PE ROUn.NGSIdP
of approval from HOA. ❑ OVER-THF.COUNTER ❑ BUILDING PLAN REVIEW
Provide Planning approval to verify if there any restrictions. ❑ Expws ❑ PLANNING PLAN RK%TF.W
Provide copy of Manufacturer's Installation Specifications. ❑ STANDARD ❑ FIREDEPT
Provide signed copy of Cupertino's Tear-Off Policy. ❑ OTHER:
RereofApp_2011.doc revised 03116/11