12100040 CITY OF CUPERTINO BUILDING PERMIT
BUILDINC ADDRESS: 10760 S STELLING RD CONTRACTOR:R L'ROOFING& PERMITNO: 12100040
CONSTRUCTION INC
OW'NER'S NAME: MUCH PATRICIA L TRUSTEE&ET Al, 15230 CL\'DELLE AVE DATE ISSUED: 10/05/2012
���OWNER'S PHONE: 4082570821 SAN.IOSIi,CA 95124 PHONE NO:(408)626-9320
J LICENSIiD CO\I'RACI'OR'S D'IECLAA�RA'�'ION BUILDING PERMIT INFO: BLDG r ELECT ri PLUMB r�
License Class Lic.# -ILI 1
�/ DIECII r RESIDENTIAL❑ COMMERCIAL r
Contractor U-0(t Date l C.
1 hereby affirm that I am licensed m der the provisions or Chapter 9 JOB DESCRIPTION: REMOVE EXISTING I LAYER OF WOOD SHAKE,INSTALL
(commencing with Section 7000)of Division 3 of the Business&Professions 72#
Cute and that my license is in full force and effect. CAP SHEET,309PELT&NEW WOOD SHAKES CLASS A 35 SQ
hereby affirm under penalty of perjury one of the following Mn 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(his 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 Sq.Ft Floor Area: Valuation:$29000
permit is issued.
AI'PLIGIN'I'Cl?R'I'IPIC,%'ITON APN Number:35922078.00 Occupancy Type:
I certify that I have read this application and state that the above information is
correct.1 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 sae PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may scenic against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
grams his permit. Additionally,the applicant understands and will comply r
it o�llnon- regula(i theCupeninoMunicipalCode Section
180 D YS FROM T CALLED INSPECTION.
9.is. 1 i
I I 2 Issued by: .� ate:
Signatu Date
❑ ONVINER-BUILDER DECLARA'T'ION
RE-ROOFS:
hereby affirm that I am exempt from the Contractor's License Lac for one of AI s be inspected prior to my roofing material being installed.If a roof is
the following two reasons: ' stalled wntho first obtaining an inspection to remove all new materials for
I,as owner of the property',or my employees with wages as their sole comM1nsmion, inspection. _
will Jo the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code) SignnmT'of-kjDate: a '(7
I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1 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 HAZARDOUS MATERIALS DISCLOSURE
Compensation,m provided for by Section 3700 of the Labor Codc,for the 1 have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California Health&Safety,Code,Sections 25505,25533,and 25534. 1 will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Nlunicipal Code.Chapter 9.12 and the Health&
Safety Code.Section 25532(a)should I store or handle hazardous 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 Bay Area Air
Quality\lanagemenl District I will
1 certify that in the performance of the work(onrhich this permit is issued,I shall mait`n compliance with the Cupertino Municipal Code,Chapter 9.12 and the
not employ any person in any manner so as(o become subject to the Worker's//'' Health ' Safety Cute,Sections 255115,25533,and 25534.
Compensation laws of Cal ifdmia. If,after making this certificate of exemptiotf I
become subject to the Worker's Compensation provisions of the Labor Code,'j mutg� f))"n r a hmrizeJ ' I 1
forthwith comply with such provisions or this permit shall be deemed revoked I x en
Date'
A PPLTCANT CERTD'ICATION \ CONSTRUCTION LENDING AGIiNCY
I certify that I have read this application and state that the above information is I hereby aRrrn that there is a cons(mction lending agency for the performance of work's
correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.)
to building construction,and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned properly for inspection purposes.(We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities.judgments. Lender's Address
costs,and ex eases which may acerae against said City in consequence of the
granting his omit.Additionally,the applicant understands and will comply ARCII I'I'FCI"S DECLARATION
with all non-point rce regulations ppeethe-6m erino Munic,,,iiii���at Code,Section
\ I� I I I understand my plans shall be used a public records.
Signature Date o ' Licensed Profession)
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
C U P E RT I N O Fax: 408-777-3333
CONTRACTOR / SUBCONTRACTOR LIST
JOB ADDRESS: U l N PERMIT#
OWNER'S NAME: TV,—) ALLN-' PHONE #
GENERALCONTRACTOR: —�'6U'F1Q BUSINESS LICENSE# 20/0 c,
ADDRESS: Ills Aaec CITY/ZIPCODE: —12
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL ORNAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND A SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTIN'O
BUSINESS
LICENSE.
I am not using any.subco actors:
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 PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
F 10300 TORRE AVENUE •CUPERTINO,CA 95014-3255
1 �
CUPERTINO (408)777-3228• FAX(408)777-3333•buildino(a)cupertino.oro
✓r
PROJECT ADDRESSrY i fo'r�'^Il C , Ct(1 Sl 1 ) ll/ �o APNI /Z_ D
,OWNER NAME IT I I YY�//UU O�/� O.!•t Gl+li Nlrl PH0;1EI]4Y/- �r(� /1• n l E-MAIL !
STREET ADDRESS tI �At-��U '5 ' (� /n(�1 CITE', STATE,Zi'PJ II ^(q)q FAY
CONTACT NAME v/A M PHONE EVMAIL
STREET ADDRESS CITY,STATE,ZIP FAX
❑OWNER . ❑ OWNER-BUILDER ❑ Ow;NERAGENT / CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTORNAAIE'J� `�� LICENSE NUMB ER �/1�/G � LlrNSETYPE BUS.LIC. •�O
COMPANYNAME u I A E-AIAIL CQ Oyliny (I` q I1C FAX
STREET ADDRESS IJ `I N ^ �e I1.. .� 1 CITY,STATE,ZIP ` _T� In� PIIONE'IJ�_ 'n.r�l%1
ARCHITECT/ENGINEER NAAIE 7 II L LICENSE NUMBER J [ BUS,L10.`N
COMPANY NAME I E-MAIL FAX
STREET ADDRESS N CITY,STATE.ZIP }' PHONE
USE OF SFD rDUpI¢s ❑ Multi-Family ROOF AREA: YALUAtIO.p:
N / IVV
STRUCTURE: ❑ ommercial 5 �II1 VV,
7
EXIST}NG ROOF TYPE' ❑BUILT-UP ROOF 11 ASPHALT SHINGLES I' y00D SHAKES ❑W'OOO SHMGLES ❑OTHER(SPECIFVI
EV O\ PLACE ' 'ES IF NO. PLYWOOD ❑ w ❑ PLYWI) ❑OSB PITCH: ROOF
❑ NLAYERS' THICKNESS' ❑ SA- TY E' ❑CDX :12 LASS' A
PROPOSED ROOF TYPE: ❑D61LT-UP ROOF ❑ASPHALT SHINGLES WOOD SHAKES ❑WOOD SHINGLES ❑OTHER IMES REPORT N
DESCRIPTION OFWORK: �I( l l� INS (� V j1) 1 WK
I „ �
k S "A
By my signature below,I tta each ofthe following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the informs non I ha rovided is coned. I have read the Description of\\'ork and verify it is accurate I agree to comply with all applicable local
ordinances and state law("lating to h I mb Rswctioonn I au n`ze
natives of Cupertino to enter the above-ide+p'fed property for inspection purposes.
Signature o(Appl icanl/Agenr. (�/ Date: 0 Z
SUPPI.CMI?M'AI-INFORMATION REQUIRED OFFICEUSE ONLN, '
_ If building is associated with a Nome Owners Association,provide letter -'PI%W CHECK'i'YPE _ ROUE ING SLIP _
ofapproval from I10A. ❑ OVER-TII=COU1TER. - i ❑'.BUILDING PLAN REVIEW
Provide Planning approval to verify if there any restrictions. :❑ eXPRFss '❑' PLANNING 1'l.AN xeYleW
_Provide copy Df Manufacturer's Installation Specifications. ❑ STANDARD ❑ FIRE Derr
Provide signed copy of Cupertino's Tear-00-Policy. ❑ orHER:
ReroofApp_2011.doc revised 03116/11
a
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•CUPERTINO,CA 95014-3255 .
(408)777-3228•FAX(4400887)7177-33/333•bu{illdding(ftupertino.org
PROIECiADDRESS 1 U J // � 1 OIC�I..�,INI/l ,�I/, APN-
OWNER NAME ! 'PHONE E-MAIL
STREEr ADDRESS II - LItif CITY.STATE.LIP FAX
f r 1 � t1 I
CONTRACTOR NAME 'P4-,'/ I t� rLICENSE NU?IBER 1�) �y 9 LICENSE TY . �.e BUS.LIC• 6 I
COMPASYNAME Ur E-MAIL I 1 �f I FAX
li
STRF:ETADDRES$ I '/ Ly y)1 � �I CITY.STATE.ZIPQ7�I '/t1 PHONE
L I UNDERSTAND AND AGREE TO THEI 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 1/4" 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$126.00. The re-inspection fee shall be paid before another
inspection can be scheduled.
By my signing below, 1 cer each of the following i e: . I am the property owner or authorized agent to act
on the property owner's bchal . ; der tal 1d 5 to' n ly with the re-roof policy su ttRl a Ivc.
Signature of Applic t/Agene ` Date:
ReroofPolicr_2010.doc revised 05/17/10