12090003 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10037 SCENIC BLVD CONTRACTOR:NEIGHBORS ROOFING PERMIT NO: 12090003
AND GUTTERS
OW'NER'S NAME: DAVID NILSSON 200 FORD RD STE 236 DA'Z'E ISSUED:09/042012
OWNER'S PHONE: 4084463721 SAN,IOSF..CA 95138 PI IONF.NO:(408)472-3869
❑ LICENSED CONIRAC`FOR'S DECLARATION BUILDING PERMIT INFO: BLDG r7 ELECT ELECT 1- PLUMB
License Class� I-ic.N D 'O JR��
' MECTI r RESIDENTIAL r COMMERCIAL r
Contractor19 !SYBf)�yre
hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REMOVE EXISTING WOOD SHAKE AND INSTALL I2'
(commencing with Section 7000)of Division 3 of the Rosiness d Professions OSB'
Code and that my license is in full force and effect. DENSDECK,AND OWENS CORNING COMPOSITION SHINGLES
2300 SQFf CLASS A
I 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 ofthe Labor Code,for the
performance ofthe work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 ofthe Labor Code,for the performance ofthe Work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$18000
.U'PLIC.\N'1'CFI2TIFIC.\TION
I certify that I have read this application and state that the above information is APN Number:35709056.00 Occupancy Type:
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, PERMIT EXPIRES IF WORK IS NOT STARTED
costs,and expenses Which may accrue against said City in consequence ofthe
granting ofthis permit. Additionally,lhcapplicantundcrstandsand will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR
with all non-point source regulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION.
9.18.
Signature ��Od�p-.�- -�Date 9`44—! 2- Issued by: � � /UTl Dale:
❑ OWNER-BUILDER DECLARATION
hereby affirm that I am exempt from the Contractor's License Lawfor one of RF-ROOFS:
the following two reasons: All roofs shall be inspected prior to my roofing material beiig installed.If a roof is
I,as owner ofthe property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,1 agree to remove all new materials for
Will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection.
Business&Professions Code)
I,as owner ofthe property,am exclusively contracting with licensed contractors to Signature of AppHeart: / may={ ti 1�!*� Date:
construct the project(Sce.7044,Business&Professions Code). y_ / .1—
hereby affirm under penalty of perjury one of the following three ALI,ROOF COVERINGS TO RE CLASS"A"OR BETTER
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's
IL\'J\RI)OIIS M.\'I'ERL11S DISCLOSURECompensation,as provided for by Section 3700 ofthe iabor Code,for the „
performance ofthe work for which this permit is issued 1 have read the hazardous materials requirements under Chapter 6.95 of the
1 have and will maintain Worker's Compensation Insurance,as provided for by California Ilealth S Safety Code,Sections 25505,25533,and 25534. I will maintain
Section 3700 ofthe Labor Code,for the performance of the work for which this compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Safety Code,Section 2553_(a)should-store or handle hazardous material.
permit is issued. Additionally.should I use equipment or devices which emit hazardous air
I certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Qualify Management District I will
not employ my person in my manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Compensation laws of California. If,after making this certificate ofexemption,I Flcalth&Safety Code,Sections 25505,25533,and 25534.
become subject to the Worker's Compensation provisions ofthe Labor Code,I must
forthwith comply With such provisions or this permit shall be deemed revoked. Own rent:
t
APPLICANT CFRTIFICATION CONSTRUCTION LENDING AGENCI'
I certify that 1 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 I hereby affirm that there is a construction lending agency for the performance of work's
to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.)
upon the above mentioned property for inspection purposes,(We)agree to save Lender's Name
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence ofthe Lender's Address
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section ARCI IITECI"S DECLARATION
9.18.
I understand my plans shall be used as public records.
Signature Date
Licensed Professional
r •
V
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
(408)777-3228 FAX(408)777-3333•building(a)cupertino.org
PROJECT ADDRESS IU 37 tN�G APNI
7•li'9-o
OM'NER NAME �� �C C PHONE �� E-MAIL
STREEr ADDRESSJ CIN. STATE,ZIP / FAX
GY'P.Pi C� t e.JCA SO
CONTRACTOR NAME I.ICENSENUMBER LICENSETYPE BUS.LIC.N
COMPANY NAME p E-MAIL FAX
0-7
STREET ADDRESS CISSTATE.ZIP O NE Z3
I UNDERSTAND AND AGREE TO THE FOLLOWING: dJ
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 1/<" per foot of slope and demonstrate there is no ponding.
In. 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. 1 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: Dale:
ReroofPa1icv_201 Ldoc reviser/02116111
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 10037 Scenic Blvd DATE: 09/0412012 REVIEWED Bl': Sean
17214 APN: BPH: 'VALUATION: 1$18,000
*PERMITTYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY PENTAMATION
USE: SFD Or Duplex PERMITTYPE: 1SFDWLR00 i
WORK Remove existingwood shakes and install 1/2" OSB Densdeck and Owens Corningcomposition
SCOPE shingles (2300 sq ft).
FEE ID ROOFAREA
s.f.
1REROOFFRES 2,300
Meeh.Plan Check Pow& Plan Check Flee...Plan Cheek
,Meeh. Permit Fee: Plumb.Permit Fee: I Elec.Permit Fee:
Other,Meeh./nrp. Other Plumb Insp. Other Elco.hsp.
11e.ch.hasp.Fec: Plumb, hasp. Fee: Elec.Insp.Fee:
NOTE: This evtinuae doer not includejees due to other Departments(i.e. Planning. Public 11'orks, Fire,Sanitary Sewer District,School
District,etc.). These fees are hared on the preliminarl information available and are only an estimate. Contact the De t or adrin'I info.
FEE ITEMS (Fee Resolution 11-053 E/L 711/1/) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Suppl. PC Fee
Phtmh.htlech./Elec
Permit Fee: $345.00
Supp/. lisp Fee
Plurnb.lMech.7Elec
Plunrh./11ech.10ec Per•nw Fee:
Construction Tai':
Administrative Fee:
Work Without Permit? Yes Q) No $0.00
Advanced Planning Fees:
Travel Documentation Fees: A
Strong Motion Fee: /BSE/SMICR $1.80 Select an Administrative Item
BI&,, Stds Commission Fee: IBCBSC $1.001 1
SUBTOTALS: $347.80 $0.00 TOTAL FEE: $347.80
Revised: 07/01/2012
Z� o00 3
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE -CUPERTINO,CA 95014-3255
CUPERTIN0 (408)777-3228• FAX(408)777-3333•buildinq(dcuoertinD.0m
PRO:__ AINa
OWNE_&A ASPHONE E-AlA1L
b O Z
STREET.MDRESSCITY, STATE,ZIP / FAX
he) Cq
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CONTACT NAME PHONE E-MAIL
STREET ADDRESS CRY,STATE.ZIP FA%
❑ OWNER ❑ OWNFAbNIDER ❑ OWNERAGENT WCONTRACTOR ❑CONTRACTORAGENT ❑ ARCHITECT ❑ENgNEER ❑ DEVELOPER ❑ TENANT
CONTRA ORN fE LICENSENUAIBER LICENSE TIDE BUS LIC.0
-5-0,!5 5a L G'06 50
COMPANY NAME _ !� E-ALAIL Li V 2-9
6 G 7�/
S ZOO ¢ES5` CITY.SPATE.ZIPO e YS�3 P�-LO� L/ r2 `Sy 6
ARCHITECTIENGINEER NAME LICENSE NUS®ER BUS.LIC.M
COMPANY NAME E-0IAIL FA%,
STREET ADDRESS CM*.STATE ZIP PHONE
USE OF P1 SFD or Duplex ❑ Multi-Family. ROOF.AREA: VALUATION:
STRUCTURE: ❑ Commercial 23�-a�� 1q-, 000
EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES pp11 WOOD SHAI:FS ❑WOOD SHINGLES 11 OTHER(SPECIFY,
REh10VE(REPLACE 19 M IF NO. PLYlYOOD 4 '5' ❑ PLMD RFOSB PITCH: ROOF
El No eL THICKNESS' ❑ SB' TYPE' 13 .17 AC• A
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF p.ASPHALT SHINOLES ❑WOOD SIA ES ❑WOOD SHINGLES ❑OTHER ICC-FS REPORT 0
M=71
OF tVORK: /
yO0 -10.�
�fOrne 1�_ o d�
fli= c)c,
By my signature below.I certify to each of the followine: I am the propem•owner or audiorized agent to act on the property owner's behalf. t have read this
application and die information 1 have provided is correct. [have read the Description of Work and verify it is accurate. I agree in comply widt all applicable local
ordinances and state laws relating tahiiilditi constrru�ction. 1 nu/Qiorize representatives of Cupertino to enter the above-identified propery for inspection purposes.
Signature of ApplicandAgent: Date: C/— Ll— /2
SUPPLEMENTAL INFORMATION REQUIRED OFFICEuSEorvLY__'
_If building is associated With a Home Owners Association,provide letter PLAN CHECK TYPE _ :ROUTING SLIP,.
of approval from HOA. qT OVER-THE-COUNTER I- BUIL NG PLAN REVIEW
_Provide Plannine approval to verify if there any restrictions. ❑ EXPRESS /❑ PLANNING PLAN REVIEW
_Provide copy of Manufacturer's Installation Specifications. ❑ sranuARn ❑ ,nae nc .
Provide signed copy of Cupertino's Tear-Off Policy. ❑ OTHER: -
Reroof4pp_1011.doc revised 03/16/11