12100120CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19170 TILSON AVE I C NTRACEOR. ADVANCED ROOPING I PERMIT NO: 12100120
OWNER'S NAME: MILLER MARSHHA M 1 15272 ST'RATFORD DR I DATE ISSUED: 10/162012 I
OWNER'S PHONE: 4084463055 I SAN JOSE, CA 95124 I PBONF. NO: (408)2494937
L3- LICENSED CONTRACf�O--R'S DECLARATION
License Class -3°i Lic.9
Contractor " q. Dated -16 —��
hereby affirm that I am licensed under lltprmisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business & Professions
Code and that tar license is in full force and effect.
hereby affirm under penalty of perjury ane 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 die work for which this
permit is issued.
,u'rLICA� r ceRTrFlcYnoN
I certify that I have read this application mid state that the above infannation is
correct. 1 agree to comply with all city mid county ordinances and state laws relating
to building construction, mid hereby authorize representatives of this city to enter
upon the above mentioned properly 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 Ihi dditionally, the applicant understands and will comply
with all n -point sourc regulatias per th
9.18. i / pertpio Municipal Code, Section
❑ ONVNER- RIIILIIER DECLARA'T'ION
hereby affirm that I am esempl from the Contractor's License Law formic of
the following 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).
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, m provided for by
Section 3700 of the Labor Code, for the performance of the 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 the 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 mad 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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
grunting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
BUILDING PERMIT INFO: BLDG r ELECT Cl PLUMB r
NIECH r RESIDENTIAL rl COMMERCIAL r
JOB DESCRIPTION: REMOVE SHARE AND PLYWOOD, RADIANT BARRIER, TL
LIIT:1'IME PRESIDENTIAL COMP 301.13 PELT 24 SQ CLASS
A.
Sq. FI Floor Area: I Valuation: $9000
AI;N Number: 37540064.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DgYS FROM ST CALLED INSPECTION.
Issued by: (/��7, //�� Date:
V � r/
RE-ROOFS:
All roofs shall be inspected priti • roofing m iat being installed. If a roof is
installed without first obtain an ins action, I gr to remove all new materials for
inspection.
Signature of Applicant: Date:
t
ALI. ROOF COVERINGS TO BE CLASS "A" OR BETTER
IIA %ARDOLIS MATERIATS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health S Safety Code, Sections 25505, 25533, and 25534. 1 will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Ilealth S
Safety Code, Section 25532(x) should I store or handle hazardous material.
Additionally, should 1 use equipment or devices which emit hazardous air
contaminants as defined by the Bay Arca Air Quality Management District I will
m%`'''���mn pliance with the Cupertino Municipal Code. Chapter 9.12 and the
leali th .Y Safety Cods, Sections 25505, 25533, and 25534.
Date16 - /G -i Z
CONST'RUC110N 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
ARCII I TECPS DECLARATION
I understand my plans shall be used as public records.
Date I Licensed
i
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 .
(408) 777 -3228 • FAX (408) 777 -3333 • building� rGuoertino.or�c
PROJECT ADDRESS I (:51 I
U�
`YYV��
JE-MAIL
OWNER NAME �,y� \1 Q —�
\
PI ION C� r� ���1
\p V
STREET ADDRESS Q V
t ll —7 l s w
CITY', TE,ZIP
szc-
FAX
CONTACT NAME
PHONE Q ( E- AIAIL'
STREET ADDRESS
��
TATE
CITY , �'
FAX
Z7
�i.NTRACTOR
,,K
❑ OWNER ❑ OWNER - BUILDER ❑ OWNERAGEM1T oicD��
❑CON RACTORAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
NTRA OR AAfE
LICENSENUMBER
LI£F.NS'H_TYPE
BUS, LIC.4
KC
n N \'NAAIE
6AIA1
FS
NC Too It I
RE�ADD S 2�Q�-
Pt10�e ( ^ ^�r�
Y \�
2.
ARCHITECT/ENGINEERNAME
LICENSE NUMBER
BUS. LIC.. Yl
COMPANY NAME
E -MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF 105�SFD or Duplex ❑ Multi- Family
ROOF ARE
e
'
\' UATION:
�Jr
❑ Commercial
<—
STRUCTURE'
EXISTING ROOF TYPE: ❑BUILT- UPROOF ❑ASPHALTSDINGLES 13 WOOD SHAM ❑N' D'HINGLES ❑ OTHER (SPECIFY)
REMOVEIREPLACE 'ES
IF NO THICKNESS
LYWOOD �Yv-
PL \T \'D ❑O50
PITCH: 7
ROOF
❑
M LAYERS'
❑ l8"
TYPE' ❑ Cox
') `
L
PROPOSED ROOF TYPE: ❑BUILT- UPROOF SPHALTSIIINGLES ❑WOOD SHARES C1 WOOD SHINGLES ❑OTHER
Icc- ESS� REPORT M
DESCRIPTION OF YYORE� ! L Y/ _ r
By my signature below, I ceni(y to of the (olio\ ng: I amt a pr ny owner or authorized agent to act on the property owner's behalf. I have read this
a
application and the information ve provided rtect. I har r the Description of Work and verify it is accurate. I agree to comply With all applicable local
ordinances and state laws Tel ng to b ing a struction. I m ri representatives ofCumLlino to enter the above - identified property for inspection purposes.
Signature of pphCanUA ent: Date:
SUPP iMEE1 _ I FORMATION REQUIRED
OFFICEUSe
ONLY . .
PLAN CuFCE TYPE
.xovrl�c 3Llr _
_ If building is associated with a Home Owners Association, provide letter
❑' OvER- iNE:COUNTF.R
_ � �
_
❑ BUILDING PLAN REVIEW
Of approval front I'IQA.
Provide' Planning Approval t0 Verify' If there' any restrictions.
❑ ESPRF_SS
❑ 11'LUNNINC I'6N RF. \'IE \V;
Provide copy of Manufacturer's installation Specifications.
❑ STANDARD
❑ FIRE DEPT
Provide Signed copy of CupertlnO s Tear -Off Policy.
❑ 'OTIIER:
ReroojApp_2011.eloc rerised 03116111
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 • building gncuoertino.oro
PROIECT ADO S
APN P
" ` +��
IO
JJ\
STREET ADD
C ,STATE, Z�_C
FAX
r-10
5
CONiAACI'OR N
LICENSE NU Rl
LICE SETYP
BUS. LIC. u
H
Id
��
COMP h'Y E
CP
(�
E -MAIL
FAX
STREET ADDRESS
:STA'T'E,
z
p.�
PHONE
z-S
r0. �.
L
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 one business day before the requested inspection date.
Please call (408) 777 -3228 from 7:30- 3:30pm (Mon- Thurs) or 7:30- 2:30pm (Friday) to schedule
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.
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 pioposed 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. 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.
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.
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. The re- inspection fee shall be paid before another inspection can be
scheduled.
By my signing below, I certify
property owner's behalf. 1 and
smoke detectors and carbon v(
the 2010 California
Sianature of Applical
the following is true: J,9m the property owner or authorized agent to act on the
and agree to compl-v vith the re -roof policy stated above. I also understand that
detectors are reo ' ed tAe installed in accordance with Sections R314 and R315 of
Date:/6--i6 ,/
RerooJPolig, 2012.doc revised 1017112
CITY OF CUPERTINO
lye( /I FEE ESTIMATOR - BUILDING DIVISION
FEE ID ROOF AREA
s.f.
1REROOFFRES 2,400
A 19170
DATE: 10/16/2012
REVIEWED 131': larrys
blech. Permit Fee:
PN:
BP#:
'VALUATION:
$9,000
*PERMIT TYPE: Minor Building Permit
PLAN CHECK TYPE: Re -roof
PRIMARY SFD or Duplex
USE:
Ele.c. Insp. Fee:
PENTA�L+,TION 1SFDWLROOF
PERMIT TITE:
11'ORK
remove shake add plywood,radiant barrier, tl lifetime presidential con .30 lb. felt
SCOPE
FEE ID ROOF AREA
s.f.
1REROOFFRES 2,400
NOTE: This estimate does not btchtdefees clue to other Departments (i.e. Planning, Public /forks, Fire, Sanitary Sewer District, School
District. etc.). These fees are based on the oreliminarr infornnation available and are onh, an estimate. Contact the Dent for addn'I info.
FEE ITEMS (Fee Resolution 11 -053 Eff 71I 112)
blech. Plan Check
Plumb. Plant Check
Elec. Plan Check
blech. Permit Fee:
Plumb. Permit Fee:
Elec. Permit Fee:
Other APech. Insp.
Other Plumb Insp.
Other Elec. L,sp.
ddech. /nip. Fec:
Plumb, b,sp. Fee:
Ele.c. Insp. Fee:
NOTE: This estimate does not btchtdefees clue to other Departments (i.e. Planning, Public /forks, Fire, Sanitary Sewer District, School
District. etc.). These fees are based on the oreliminarr infornnation available and are onh, an estimate. Contact the Dent for addn'I info.
FEE ITEMS (Fee Resolution 11 -053 Eff 71I 112)
FEE
QTY /FEE
D1ISC ITEMS
Plan Check Fee:
Suppl. PC Fee
PlumbJMe ch./Elec
Permit Fee:
$360.00
Suppl. Insp Fee
PlumbAl/ecb./Elec.
Plun,b./A•lech./Elec Perm;, Fee:
Construction Tax:
Administrative Fee:
Work Without Permit? O Yes (j) No
$0.00
Advanced Planning Fees:
A
Travel Documentation Fees;
Strong. Motion Fee: IBSEISMICR
$0.90
Select an Administrative Item
Bldc, Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$361.90
$0.001
TOTAL FEE:
$361.90
Revised: 10/01/2012