12080319CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10341 N BLANEY AVE CONI'RACI'OR: BUCK'S ROOFING PERMIT NO: 12080319
OWNER'S NAME: MAUREEN KHOO 6853 W RIVERSIDE WAY DATE ISSUED: 08/302012
OWNER'S PHONE: 4082038616 SANJOSE, CA 95129 PHONE NO: (408) 313-3429
LICENSED CONTRACT'OR'S DECLARATION
License ClassG-3 Lie.k
Contractor ' uCl/C DateW.711// Z
I hereby affirm that 1 am licensed and the provisions of Chapter!)
(commencing with Section 7000) of Division 3 of the Business & Professions
Code and that my license is in full force and effect.
hereby affirm under penalty of perjury one of the following two 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.
APPLICANT CERTIFICATION
I certify that I have read this application mid state that the above infommion 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 accme 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.
Signa ate
36 it,
❑ & VN?R-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
I, as owner of the property, or my employees with wages as their sole compcosmion,
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 & Professions Code).
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 die work for which this
permit is issued.
I certify that in the performance of the work for which this permit is issued, I shall
not employ any person in any manner so as to become subject to date Worker's
Compensation laws of California. If, after making this certificate of exemption, I
become subject to the Worker's Compensation provisions of the Labor Code, I an
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
correct. I agree to comply with all city and county ordinances mid state Imus 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 and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Signature Date
BUILDING PERMIT INFO: BLDG r ELECT IJ PLUMB M
AIECII C RESIDENTIAL ❑ COMMERCIAL F-7
JOB DESCRIPTION: REMOVE SHAKE AND INSTALL 30 SQ CLASS A
Sq. F1 Floor Area: I Valuation: $10000
ANN Number: 31633006.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by:,�---
RE-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 new materials for
inspection.
Signaturc of Applicut
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
have read the hazardous materials requirements under Chapter 6.95 of the
California llealth S Safety Code, Sections 25505, 25533, and 25534. 1 will maintain
compliance with the Cupertino dlunicipal Code, Chapter 9.12 and the llealth &
Safety Code, Section 25532(x) should I store or handle hazardous material.
Additionally, should I use equipment or devices e'hieh emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
llealth & Safety Code, Sections 25505, 25533, and 25534.
or mfthorized agent:
t� Dote: C
CONSTRUCI'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
ARCIIITECI" S DECLARATION
I understand my plans shall be used as public records.
Licensed
CITY OF CUPERTINO
FEE ESTIMATOR -BUILDING DIVISION
NOTE: This estimate does not include jeer due to other Departments (i.e. Planning, Public IVorks, Fire, Sanitary Sewer District, School
District, etc.). These fees are based on the Preliminan, information available and are onh, an estinate Contact the Dept for addn'I info.
FEE ITEMS (Fee Resolution 11-053 Elf 7/1/1l)
ADDRESS: 10341 n. blaney ave.
DATE:
REVIEWED BY: bobs.
ffal
APN:
BP#:
'VALUATION:
$10,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE:
Elec. Insp. Few:
PPENTAMATION 1SFDWLROOF
ERMIT TYPE:
NVORK
remove shake install comp shingles.
SCOPE
$0.00
NOTE: This estimate does not include jeer due to other Departments (i.e. Planning, Public IVorks, Fire, Sanitary Sewer District, School
District, etc.). These fees are based on the Preliminan, information available and are onh, an estinate Contact the Dept for addn'I info.
FEE ITEMS (Fee Resolution 11-053 Elf 7/1/1l)
Alech. Plan Check
Phunh. Ilan Check
Elev. Plan Check
Alech. Permit Fee:
Plumb, Permit Few:
Elec. Pennir Fes
Other Much. Insp.
Odrer Plumb Insp.
Other Elcr. Insp.
Mech. Imp. Fee:
Plumb. btvp. Fee:
Elec. Insp. Few:
NOTE: This estimate does not include jeer due to other Departments (i.e. Planning, Public IVorks, Fire, Sanitary Sewer District, School
District, etc.). These fees are based on the Preliminan, information available and are onh, an estinate Contact the Dept for addn'I info.
FEE ITEMS (Fee Resolution 11-053 Elf 7/1/1l)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
FEE s.f.
$450.00
Re roof
IREROOFRES
Suppl. PC Fee: Q Reg. O 07
0-0 Thas
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee:Q Reg. O.OT
0,0
1 hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax:
Administrative Fee:
O
0
Work Without Permit? O Yes Q No
$0.00
Advanced PlanningPee:
$0.00
Select Non -Residential
Building or Structure
O
i
Travel Dacumenialion heer:
Strong Motion Fee: 1BSEISAIICR
$1.00
Select an Administrative Item
Hldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$2.00
$450.00
TOTAL FEE:
1 $452.00
Revised: 07/01/2012
7
CUPERTINO
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT' BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildino(G-cuoertino.oro
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❑ OWNER ❑ OWNER -BUILDER ❑ OWNER ADi r ❑ CONTR1C0R ❑CONERMcTORAOENT ❑ ARCKDECr ❑ ENGINEER ❑ DEVELOPER ❑ TENAN'T
CONtRACTOR NAME
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USE OF SFD or Duplex ❑ Multi -Faintly,
CICOHIMercial
ROOF ARE&:
3 /, 06 `-'
VAVALUATION:STRUCTURE:
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EXISTING ROOF TYPE::. ❑BUILT-UP ROOF 13 ASPHALT SHINGLES 1q WOODSHAKES ❑WOOD SHINGLES 11 OTHER (SPECIFY)
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PROPOSED ROOF TYPE: ❑ BUILT-UP ROOF ASPHALT SHINGLES WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER
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DESCRIPTION OF WORK: �A / ^U / / ���a /j• -, / /f�N dG
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By try signature below, l certify to each of the following: 1 am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I have provided is correct. I have read the Description of Wort: and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building construction. I audiorize representatives of Cupertino to enter the abboovee�dentifie/Q.pmperty' for inspection purposes.
Agent' \ Date: O)Mz
Signature of Applicant/Agent / 3CC
SUPPL MEN'f: NFORAIATION REQUIRED
_ If building is associated with a I Ionic Owners Association, provide ktrer
of approval from HOA.
Provide Planning approval to verify if there any restrictions.
_Provi copy of Manufacturers Installation Specifications.
ovlde signed copy of Cupeltino's Tear -Off Policy.
OFFICEUSLORLY
_ Pl:k.N CHccKS'i•PE _
ROUT ING SUP.
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oWL}�S'ER-TNE-COUNTER I
❑ EXPRESS . _
❑ STANDARD
�y�
LJ BUILDING PLAN REVIEW
Cl PLANNING PLAN REVIEW
❑ ITREDEPT
• ❑ onnm
ReroojApp_1011.doe revised 03/16/11
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 • buildinq(Dcupertino.orq
PROJECT ADDRESS /03
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OWNERNAME 1 I/
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I 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/" per foot of slope and demonstrate there is no podding.
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: 1 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 are required to be installed in accordance with Sections R314 and 11315 of
the 2010 California Residential -eve. 1 , e
of Annlicant/Apenf i( 1 Date:
RerogtPolicv_201 I.doc revised 0211611/