12080256CITY OF C.UPERTINO 13UILDING PERMIT I
RIIILDINC ADDRESS: 10679 FARALLONE DR CONIRACFOR: MARX ROOFING PERMITNO: 12080256
OWNER'S NAME: ROBINSON RICHARD C AND KATHLEEN AT 450 CIIILGERG CI' DATE ISSUED: 08242012
OWNER'S PHONE: SANJOSE. CA 95111 PI IONF- NO: 14081+01-0047
❑
LICENSED CONFRAM'OH'S DEC'�LARCAfTION
License Class C 3 ry 1JJ1 n Lie((.'`�# 1 3 1
Contractor 1kXX KOI�h ✓\`Date 2`{
1 hereby affirm that 1 :un licensed under the provisions of Chapter 9
(commencing wish Section 7000) of Division 3 of the Business S Profemions
Code and that my license is in full force and effect.
hereby affirm under penalty of perjury one of the following mo declarations:
I have and will maintain 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 tris pemnit 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.
A VVI ICANI' CERTIFICATION
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 laws relating
to building construction, mrd hereby authorize representatives of this city to enter
upon the above mentioned properly for inspection purposes. (We) agree to save
indemnify and keep harmless lire 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 no Dint source regulatims per the Cupertino Municipal Code, Section
9.18.
Sign Dale
❑ OWNER -BUILDER DECLARATION
1 hereto• affirm that I am exempt from the Cmuractor's License Llol for One of
the fulluwing two reasons:
I, as owner of the property, or my employees with wages as their sole compensation,
will do the work, and the structure is not intended or offered for sale (Sec.7044,
Business & Professions Code)
I. as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business R Professions Code).
1 hereby affirm tinder penalty of perjury line 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
perlbri ance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance, is provided for by
Section 3700 of the Labor Code, for the pertbnnance of the work for which this
permit is issued.
I certify that in the performance of the work for N% this permit is issued. I shall
not employ any person in any manner so as to become subject to the Worker's
Conipansation laws ofC.difornin. If, after making this certificate of exemption, I C
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked.
API'LIC\NTCERTI FICVf10N
1 certify. that 1 have read this application and state that the above information is
correct. I agree to complywith all city and county ordinances mid 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 sate
indemnity 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-Xoint source regulations per the Cupertino Municipal Code, Section
9.18. \ ,
Date
BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
MECH r RESIDENTIAL r COAINIERCIAL r -
JOB DESCRI PTION:: RE -ROOF 25 SQ TEAR OFF SHAKE, INSTALL OSB CLASS A
Sq. Ft Floor -Area: I Valuation: $11900
ARS Number: 36935007.00 1 Occupancy'I) pe:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAZ'1/,
ROM LAST CALLED INSPECTION.
Issue(fb`�-
.. / Date:
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. Ira roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection. /)
/- Date: C�57,Ly
AL1- ROOF COVERINGS TO BE CI,kSS "A" OR BETTER
IL\%ARDOUS MATERIALS DISCLOSURE'
1 hayc read the hazardous materials requirements under Chapter 6.95 of the
California Il cal th S Safety Code, Sections 25505, 25533, and 25534. I will maintain
compliance with the Cupertino Municipal Code. Chapter 9.12 and the Health S
S defy Code. Section 25532(a) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the BayArca Air Quality Management District I will
maintain compliance with the Cupertino Municipal Code, Chaptcr9.12 and the
11411h S Safely Code, Sections 25505. 25533, and 25534.
Dale:i-- 2 Y
CONSTRUCPION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of vork's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's
ARCHITECT"S DECLARATION
I understand my plans shall be used as public records.
Licensed
G
x
\�I
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE,- CUPERTINO, CA 95014-3255
CUPERTINO �(408)777-3228' FAX (408)777-3333• buildinofalcuoerino.om
On,
PROJECT ADDRESS / V/ 1q nl� I
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OWNER NATE ��I
PHONE� O
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CITY, STATE.ZIP
FAX
CONTACT NAME
PHONE
E-AUIL
STREET ADDRESS
CRY. STATE, ZIP
FAX
❑ OWNER ❑ OWHEt-BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑ com1 CrOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR N
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LICENSE NN®E
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BUS. LIC.e
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COMPANY N.4NtE /x1
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FAX
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ARCHITECOENGINEER NAME
LICENSE NUNMER
BUS. LLIC.9
COMPANY NAME
E-MAIL
FAX
STREET .ADDRESS
CITY. STATE, ZIP
PHONE
USE OF 12-SFD or Duplex ❑ Multi -Family.
STRUCTURE: ❑ Commercial
ROOF.4REA:
2 SV`
VALUATION:
1 f ( 9
EXISTINGROOFTYPE: ❑BUILT-UPROOF ❑ ASPHALT SHINGLES e'07-001) SH.4AES ❑WOOD SEEING LES ❑ OTHER (SPECIFY)
RFl.IOtT (REPLACE KYEI
e[F ANOVERc I
riS' ❑ 5R,"0
PLYWTJ I? `oSB
TNTE ❑ CD.
PITCH:
12
ROOF (A^)
PROPOSED ROOF TYPE: ❑ BUILI-UP ROOFq�. PIAALI SSWNGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER
ICC -FS REPORT A
DESCRIPTION OF WORK:
1/ems r Q� 1'
Ti
By my signature below, I certify m property of the following: I am the prope• owner or authorized agent to act on the property owner's behalf. I have read this
application and the infomation I have provided is correct. I have read dre Description of Wort: and verify it is accurate. I agree to comply with all applicable local
--identified property for inspection purposes.
ordinances and slate laws relating tt�1bwldin onstmction. I authorize representatives of Cupertino to enter the above
Signature of Applicant/Agent: /�" Date:
SUPPLEMENTAL INFORMATION REQUIRED
_ If building is associated with a Home Ownees Association, provide letterP
of approval from hIOA.
_ Provide Planning approval to verify if there any restrictions.
_ Provide copy of M1falmfacwter's Installation Specifications.
Provide signed cop of Cupertino's Tear -Off Policy.
_ OFFICE Use ONLY
ss cxceK r'rrE,..
ROOTING sl:iIP-
411MIC-COUN-TER
❑ ct6aESs
❑ STAbiDARti
-
❑ 60iLDINO PLAN. REVIEW
❑ rLANNING PLav REVIEW
❑ FIRE or"
❑ OTHER:
Reroofdpp_2011.doc revised 03/16/11
CITY OF CUPERTINO
�� FEE ESTIMATOR—BUILDING DIVISION
jg4rADDRESS:
10679 FARALLONE DR
DATE: 08/24/2012
REVIEWED BY: Sylvia
Mech, Perudt Fee:
APN:
BP#:
'VALUATION:
$11,900
*PERMIT TYPE: Minor Building Permit
PLAN CHECK TYPE: Re -roof
PRIMARY
USE: SFD or Duplex
Elea Insp. Fee:
PENTAMATION
PERMITTYPE: 1SFDWLR00F
WORK
RE -ROOF 25 SQ- TEAR OFF SHAKE INSTALL OSB CLASS A
SCOPE
FEE 11) ROOFAREA
(s.f.)
1REROOFFRES 2,500
NOTE: This estimate does not includejees due to other Departments (i.e. Planting, Public I1'orks, Fire, Sanitary Sewer District, Schaal
District. etc.). These fees are baser/ on the nrelintinan• information available and are onh• an estimate. Contact die Dent for at/cbt'l info.
FEE ITENIS (Fee Resolaion 11-053 Eff 7111112
Mech. Hon Check
Plumb. Plat Check
F-lec. Plan Check
Mech, Perudt Fee:
Plurnh. Permit Pee:
Flee. Pennit Fre:
Other Alech. Insp.
Other Plumb Insp.
Otter Elec. Insp.
A1e.ch. /lisp. Fee:
Plumb. htsp. Fee:
Elea Insp. Fee:
NOTE: This estimate does not includejees due to other Departments (i.e. Planting, Public I1'orks, Fire, Sanitary Sewer District, Schaal
District. etc.). These fees are baser/ on the nrelintinan• information available and are onh• an estimate. Contact die Dent for at/cbt'l info.
FEE ITENIS (Fee Resolaion 11-053 Eff 7111112
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
Suppl. PC Fee
Pl um b.lA/ecl n.lF.l ec
Permit Fee:
$375.00
Supp/. Insp Fee
Phimb.4fech.lElee
Plunth.11fech.lElec Permit Fee:
Construction Tar:
Administrative Fee:
Work Without Pennit? O Yes (D No
$0.00
Advanced Planning Fees•:
A
Travel Documentation Fees:
Strong Nlolion Fee: IRSFISMICR
$1.19
Select an Administrative Item
131(IpStds Commission Fee: Fee: IBCBSC
$1.00
SUBTOTALS:
$377.19
$0.00 TOTAL FEE:
$377.19
Revised: 07/01/2012
REROOF TEAR -OFF POLICY
2 COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
CUPERTINO (408) 777-3228 • FAX (408) 777-3333 • buildingt@cuoertino.org
PROJECTADDRESS 1 0 V�
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APN.
OWNERNAME Kat I e) C,n `\
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PHONE
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E-MAIL
STREETADDRESS
CITY. STATE. ZIP
FAX
CONTRACTOR NAME J ^ n O
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LICENSE NUMBER '7 Oq
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LICENSE
BUS. LIC. a
COMPANY NAME u�
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EMAIL
FAX
STREET ADDRESS 7 _Z
4611Z
CITY.STATE. LP NI.n30 Ct sl)Z
PNONEO //O� Ono
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.
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 Y<" per foot of slope and demonstrate there is no ponding.
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, 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. 1 also understand that
smoke detectors and carbon monoxide detectors are required to be installed in accordance with Sections R314 and R315 of
the 2010 California Residential Code.
Signature of Applicant/Agent: Date:
ReroofPo1ico_20/ l.doc revised 02/16/11