12100036 CITY OF CUPERTINO BUILDING PERMIT
BUIL-DING ADDRESS: 10900 N BLANEY AVE CONTRACTOR•Tn.. ^�Te^:E PERpIIT NO: 12100036
M_Trkli WIP;�
OWNER'SNADIR: PACIFIC GAS AND ELEC'T'RIC CO ✓ �: Ueta YJ DATE ISSUED: 10/042012
OWNER'S PRONE: 5104781111 .� 11110NE NO:
❑ LICENSED CON rRACFO )R'S DECLARATION .JOB DESCRIPTION: RESIDENTIAL COMMERCIAL❑
License Class C 3 Lic.k 6)/, SRE-ROOF 16 SQ-TEAR OFF EXISTING, INSTALL 1/2"
Contractor /4 C E2 }-asQ q�� SECURROCK & 60 MIL PVC CLASS A
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1 hereby affirm that 1 am licensed under the provisions of Chapter 9
(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 cenificate 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. Sq.Ft Floor Area: Voluation:$16400
1 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 AI1N Number:31603045.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state dial the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon die above mentioned property for inspection purposes. (We)agree to save 180 DASX-ROM-LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the 10
granting of this permit. Additionally,the applicant understands and will comply Issued by Dale:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
cG' /A Date �� rty ROOFS:
Signature �- All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection,1 agree to remove all new materials for
inspection.
❑ O\YNER-BUILDER DECLARATION /O
Signature of Applicant: Date:
hereby affirm Thal I am exempt from the Contractor's License L:nr for one of
the following two reasons: ALL ROOF COVERINGS TO RE CLASS"A"OR BEATER
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)
1,as owner of the property,am exclusively contracting with licensed contractors to IIA7yRDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505.25533,and 25534. 1 will
I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Ileallh&Safety Code,Section 25532(x)should 1 store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the flay Area Air Quality Management District
performance of the work for which this permit is issued. will maintain compliance with the Cuperlino Municipal Code.Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code.Sections 25505.25533,and 25534.
Section 3700 of the Labor Code,for die performance of the work for which this
Owner or authorized agent:
is issued.
agent:
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 CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deenned revoked. work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANT CERTI FICATION Leader's Address
I certify that 1 have read this application and slate that the above information is
correct. I agree to comply with all city and county ordinances mid stale Imes relating
to building construction,mid hereby authorize representatives of[his 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, ARC111TECI"S DECLARATION
costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18,
Signature Date
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION I /�
10300 TORRE
VENUE-
(4 8)777-3228 A FAX(4080PER 313 Obui dngacuaerfno.org u
CUPERTINO I�
P0.01ECFADDRESS (�I+C)&6l`vG,L c APNY
OWNERNAME G r. (`r �r� PHONE � E-MAIL
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1 / 1', l
U
STREET ADDRESS /617 I11ACDO��,.r �Y CI1STATE,ZIP�fclln
!� FAX
NAME ` PHONE G EMIL
STREET ADDRESS CITY,STATE, ZIP FAX
❑oB;NER ❑ OWI-BUILDER ❑ OU;UF.RAGGT `❑1 CONTRACTOR ❑CONIRACrORAGENT 11 ARCHITECT ❑ENGINEER 11 DEVELOPER ❑TENANT
CONTRACTOR NANE'4 ^0 'CA r LICENSENUMBER geD LICENSETYPEC,? BUS.LIC.P
CjKERrF
COMPANY NAMEA C, g G LIfi E-nIAIL FAX
STREET ADORES SK0 37� C4 / CL, C CIT(',STATE,ZIP 5PHONE
/6
-24
_72 17
ARCHITECTIENGINEER NAME ` LICENSENUMBER BUS.LILY
COMPANY NAME E-NAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑ SFD Or Duplex ❑ Multi-Family ROOF AREA: VALUATION:
STRUCTURE: ; Commercial 6 JC l6e OD
EXISTING ROOF TYPE,:: rBUILT-UPROOF ❑ASPHALTSHINGLE:S ❑WOODSILAKES ❑WoODsoiNGLEs ❑OTHER(SPECIFY)
REMOVE(REPLACE ;Zyrs IF N0. PLYWOOD ❑ K" 13PLYKD ❑OSB PITCH: ROOF
13 NO I ULAI'ERS' TIICKNE 1156 TYPE ❑CDS �Z'(2 CLASS' r1
PROPOSED ROOF TYPE: ❑BUILT-UPROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES 11 WOOD SHINGLES OTHER ICC-ES REPORTP
DESCRIPTION OF WORK -
;NS ,ALL, " 5�CUAOC-1< IeE60MIL S
By my signature below,I certify to each of the following: I am the property ovvner 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 Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state la,vs relating to building construction. I authorize representatives of Cupenino to enter the above-identified property for inspection purposes.
Signature ofApplicam/Agent: Date: 621�zl ye,
i
SUPPLEMENTAL INFORMA'T'ION REQUIRED OFFICE USE ONLY
_If building is associated with a liontc OWncrs Association,provide letter oiANCIIECK TYPE,. BOUTIN&.SLIP _
of approval from I10A. o CR-TUE-COUNTER_ rr:c PLAN REVIEW _
Provide Planning approval to verify if there am'restrictions. ❑ EXPRESS ❑ PLANNING PLANREVIEW
_Provide copy of Manufacturer's Installation Specifications. ❑ STANDARD ❑ FIRE DEPT,
Provide signed copy of Cupenino's Tear-OfP Policy. O oilir:R:
ReroaJ4pp_2011.doc revised 03/16/11
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
CUPERTINO . Fax: 408-777-3333
CONTRACTOR / SUBCONTRACTOR LIST
JOB ADDRESS: Q OU . PERMIT#
OWNER'S NAME: PHONE#JR
i —
GENERAL CONTRACTOR: USINESS LICENSE#
ADDRESS: O G j— ' CITY/ZIPCODE:
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECI`ION(S) WILL BE SCHEDULED UNTIL THE
F
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OCUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
✓ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring/ Carpeting
Linoleum / Wood
Glass/Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor 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•buildina(akupertino.org
PROJECTADDRESS Q t7Q APN-
r
OWNER NAME .0 PNDN // E-A4AIL
STREETADDRESS/�/ -CITY.STA ,].IP / FAX
COMRACIOR NAME [ LICENSENU.SIBER O LICENSE TYPE BUS.LIC.e
COMPANY NAME C E-MAIL FAX
� `GZ•� CIT\. TTSTRET ADDRESS/0;? LPNIJy/ o n /0
,2_2
1 UNDERSTAND AND AGREE TO THE FOLLOWING:
1. 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 — 10:30an1 and 1:00—3:30pn1 (Mon —Thurs);
7:30 — 10:30an1 and 1:00— 2:30pm (Friday).
4. If plywood is installed, a plvwood 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: 1 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 a=bove.
Signature of Applicant/Agent: / /� Date: LO _� _
ReroofPnlicv_2010.dac re,ased 05/17/70