12100050 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10171 RICIiWOOD DR CONTRACTOR:BECKS R0017INC PERMIT NO: 12100050
OWNEWS NAME:: BOSE SIIARADA 6191 OCIIO RIOS DR DATE ISSUED: 10/092012
OWNER'S PBONE: 4086913074 SAN.IOSE.CA 95123 PRONE NO:(408p65-8979
❑ , n ,ic. /2 /
1,ICENSF,D ONTRAC`FOjR'S DECLARATION
�/• BUILDING PERMIT INFO: BLDG r ELECT r PLUMB Ci
License Class �/ N ✓
~�/Z 111ECH r RESIDENTIAL r COMMERCIALr
Contractor Date
I hereby affirm that l am licensed under the provisions of Chapter 9 •JOB DESCRIPTION:TEAR 01717 OSB b40 YR COMI'CLISS A 40 SQ
(commencing with Section 7000)of Division 3 of the Business& Professions
Code and thin my license is in full force and effem
hereby affirm under penalty of perjury one of the following twu declarations:
I have and will oiaintain a certificate ofconsent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Cade,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 Sq.Ft Floor Area: Valuation:$12000
Section 3700 of the labor Code,for the performance of die work for which this
permit is issued.
AI;N Number:36908039.00 Occupnney Ty pe:
,\I'PI,ICA1 1'CER'1'IpICA'PION
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 and state laws relating
to building construction,and hereby authorize representatives of this city to enter PERMIT EXPIRES IF WORK ISNOT STARTED
upon the above mentioned property for inspection purposes. (We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,mid expenses which may raceme against said City in consequence ofthe Igo DAYS FROM LAST CALLED INSPECTION.
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source egulatirns per the Cupertino Municipal Code,Section
9.18, �7 Issued by: / Date:/D
Signature V Date�!/— ! — 1 —
❑ OWNER-BUILDER DECLARATION RF,-ROOFS:
All roofs shall be inspected prior to any roofing material being installed.If a roof is
I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an' spccuo agree to remove all new materials for
the following two reasons: inspection,
I,as owner of the property,or my employees with wages as their sole connp:nsation, Q
will do the work,and the structure is not intended or offered for sale(Seo.7044, Signature of Applicant: DateO' /
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVF,RINGS TO BE CLASS"A"OR BETITR
hereby affirm under penalty of perjury one of the following three
declarations: IIA%ARDOUS\IATEIRIALS DISCLOSURE
I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the
Compensation,as provided for by Section 3700 of the Labor Code,for the California Ileal th&Safety Code,Seel inns 25505,25533:and 25534. 1 will maintain
performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code.Chapter 9.12 and the Health&
I have and will maintain Worker's Compensation Insurance,as provided Ior by Safety Code.Section 25532(a)should 1 store or handle ha7airdous material.
Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air
permit is issued. contaminants as defined by the Bny Area Air Quality Management District I will
maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code.Sections 25505.25533,and 25534.
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California. If,after making this certificate of exemption,I Ow'i eCguthori^Qaaent:
become subject to the Worker's Compensation provisions of the Labor Code,I must Dale
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING,%CENCI'
APPLICAN`f CERTIFICATION I hereby affrin that there is a construction lending agency for the performance of work's
I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.)
correct. I agree to comply with all city and county ordinances and state laws relating Lender's Name
to building construction,laid hereby authorize representatives of this city to enter
upon die above mentioned property for inspection purposes.(We)agree to save Lender's Address.
indemnify and keep harmless the City of Cupertino against liabilities•judgments,
costs,anti ezpenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply ARCIIITECI"S DECLARATION
with all non-point source regulation;per the Cupertino Municipal Code,Section I understand my plans shall be used as public records.
9.18.
Licensed Professional
Signature � Date
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
ALBERT SALVADOR,P.E., C.B.O., BUILDING OFFICIAL
C U P E RT I N O 10300 TORRE AVENUE•CUPERTI NO,CA 95014-3255
(408)777-3228•FAX(408)777-3333• building(okupenino.oro
PROJECT ADDRESSt/ O APNa
OWNERNAME PHONE 61V q 79;e I E-MAIL
STREETADDRESS ' 7 Z / CITY.STATE. U FAX
CONTRAQORNAME / LICH SENUXINER LICE,; T' E BUS,LIC.a
COMPANYNAME ^/� t' E-MAIL FAX
STREET ADDRESS (� CITY.STATE.ZIP ' �I7 ^ PHONE
I UNDERSTAND AND AGREE TO THE FOLLOWING:
I. The re-roof project shall comply with all applicable provisions of the 2007 California Building Code.
2. You must schedule all needed inspections a minimum of one day before the requested inspection date.
Please schedule inspections online or call (408)777-3228 between 7:30-3:30 (Mon-Fri).
3. Tear-off roof inspection is required. Please call for tear-off inspection after the roof is torn off and all
the nails/fasteners have been removed. Any and all dry-rotted wood shall be replaced prior to this
inspection. A building inspector will be available within one hour.
There are special hours for this service: 7:30 — 10:30am and 1:00— 3:30pm (Mon—Thurs)-,
7:30 — 10:30am and 1:00—2:30pm (Friday).
4. if plywood is installed, a plywood nailing inspection is required.
5. In-Progress roof inspection is required. Call for an in-progress roof inspection to verify building is
weather tight after installation of approximately 25% of the roofing material.
6. New roof coverings shall not be applied without first obtaining all inspections 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.
7. A final inspection and approval shall be obtained from the building inspector when the re-roofing is
complete. 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 must 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.
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 agent4act
on the property owner's behalf. I ndersta and agree to comply with the re-roof policy stated above.
Signature of Applicant/Agent:__ _ Date:
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REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO,CA 95014-3255
CUPERTINO (408)777-3228• FAX(408)777-3333•building Gncupo
ertino.or
PROJECTADDRLSS �f APN0 1 _ iQ--'� 0 3
(/ 4
OWNERNAAIE / PHONE DL lP E-MAIL 1
STREET ADDRFSS , CITY, STATE,ZIP L FAX
CONTACT NAME �(' PHONE Gr�•7j/i;3' D ` E-MAIL
STREET ADDRESS / J CITY,STATE, ZIP I((�/�� '/(� 9,17-0
11
FAX
❑OWNER ❑ OWNER(-BUILDER ❑ OWNERAGENr CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT C ❑ENGINEER ❑ DEVEOPER ❑TENANT
CONTRACTOR NAME / ^ /— LICENSE NUMBERI LICENS T1R / BUS.LIC.M
COMPANY NAME ) C�GG.tI E-SIAIL FAX
STREET ADDRESS T /U CITY,S"TATE,ZIP -5� PHONE
ARCHITECLENGINEERNAME LICENSE NUMBER BUS.LIC.0
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑ SFD or Duplex ❑ hlllhl-Fm»IIV ROOF AREA: VALUATION: O
STRUCTURE: ❑ Commercial
l� o
EXISTING ROOF TYPES/❑BUILT-UPROOF ❑ASPHALT SHINGLES ❑W'OOD SHAKES ❑WOOD�SHIINGLES ❑OTHER(SPECIFY)
REMOVE BIEPLACE }'1 YES IF N0. PLYWOOD ❑ K- ❑ PLYN'p ILl OSB PITCH: ROOF
' I ❑ NO M LAYERS THICKNESS ❑ 518- TYPE ❑ D. '712 ICLASS A
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT M
DESCRIPTION OF WORK: l S V
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the propeny owner's behalf. 1 hove read this
application and the information 1 have provided is correct I have read the Description of Work and verify it is accurate. I agree to comply withal]applicable local
ordinances and state laws relating to building co E ' 1. I audio represematives of Cupenino to enter the above-identified property for inspection purposes.
Signature of Applicanl/AgenD Date:_�ir se �/
SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY
_If building is associated with a I Ionic Owners Association,provide letter PCANCHECK'TYPE. ROIs IN'G SLiv
of approval from I10A. OVERdnF.COONTER O BUILDING PLAN REVIEW
Provide Planning approval to verify if there any restrictions. e_�PRESS. ❑ PLANNING PI-AN REFIEN'
Provide copy of Manufacturer's Installation Specifications. O STANDARD -FIRE DEPT
Provide signed copy of Cupertino's Tear-Off Policy. ,0 OTHER[:
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