12110106 CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRESS: 10528J0IiNSOMAVE CONTRACTOR' _ _.... PERMITNO: 12110106
O\VNER'SNAME: YENNAIWENANDWUNIING-CITU 1 �oFld� DA'Z'E ISSUED: II/192012
OWNER'S PIIONE: 4088926113 PRONE NO:
❑ LICENSED CO\1'RACI'OR'S DFCLARATION BUILDING PERMIT INFO: BLDG r ELECT IJ PLUMB [I
License Class Lic.N k Z r rj (_•
, MECH RESIDENTIAL COCOMMERCIALContractor' 'N J N �f IL O 0 N i/late c t 7.o t 2
I hereby affirm that 1 am licensed under the provisions of Chapter 9 30R DESCRIPTION: RCMOVE EXISTING COMPOSITION ROOFING AND
(commencing with Section 7000)of Division 3 of the Business& Professions INS'T'ALL
Code and that nmy license is in full force mid effect. NE\4'OSIS AND UNDGRLAI'hiFNf l4'ITFI NEWCOMPOSITION
ROOFING(2000 SOFT) -
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 of 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 : Sq.Ft Floor Area: Valuation:$6000 ,
API'I.ICAN 1'CERTIPICA'1'ION
I certify that I have read this application and state that the above information is APN Number:37528038.00 Occupancy Type:
correct.I agree to comply with all city and county ordinances and state Imes 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 acerae against said City in consequence of the
granting of this permit. Additionally,the applicant understands and 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 V \ Date I 11Z D 1 1.L_ Issued by: Date: ��/9 •/�-
❑ OWNER-Bill LD ER DECLARA'T'ION
hereby affirm that I am exempt from the Contractor's License Law for one of RF--ROOFS:
the follmving oro reasons: All roofs shall be inspected prior to my roofing material being installed If a roof is
I,as owner of the property,or my employees with wages as their sole comM1nsation, installed without first obtaining mm inspection,I 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 of the.properiy,am exclusively contracting with licensed contractors to Signature of Applicant: Once:
construct the project(Sec.7044,Business&Professions Code).
1 hereby affirm under pen ally'of perjury one of the follmving three ALI-ROOF COVERINGS TO BE CLASS"A"OR BE'IT IR
declarations: '
I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCI.OSIIRE
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 read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain Worker's Compensation Insurance,as provided for by California llealth&Safety Cade Sections 255115.25533,and'5534. 1 will maintain
Section 3700 ofthe Labor Code,for the performance of die work for which this compliance with the Cupertino Municipal Code,Chapter 9.l_and the llealth&
Safety Code.Section_553.(x)should I 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 doe work forwhich this permit is issued I shall contaminants as defined by the Ray Area Air Quality\Ianagemenl District l will
not employ any person in any manner so as to become subject to the Worker's maintain room pliance with the Cupertino Municipal Code,Chapter 9.12 and the
Compensation laws of California. If,after making this certificate of exemption,I llealth&Safety Code,Sections 25505,25533.and 25534.
become subject to the Worker's Compensation provisions of the Labor Code,I coast
forthwith comply with such provisions or this permit shall be deemed revoked Owner or authorized
I`'' iDate:
APPLICANT CF-RTI FICATION CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is
correct.I agree to comply with all city and count)'ordinances and stale 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(See.3097,Civ C.)
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Nume
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the Leader'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 ARCHI'I EM"S DECLARATION
9.18.
1 understmmd my plans shall be used as public records.
Signature Date
Licensed Professional
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTINO (408)777-3228• FAX(408)777-333133/•buildino(Mcupertino./orrg (�
PDS-2 'k Dltss S 0#f NSuTA/ K '/ C - ,vo,Y "NO - / (t.-t 7 y' /'�
I
OtVNERNMa L-^tj J 't U Aj ��L�� PHONE t (0 IJP+ E.A/fA-ILS l/ CJ
STREET ADDRESS CRY, STATE,ZIP FAX
5-A fi 6J ✓ C C-vfG 7i
coNT-Hu AIIErj L- T [LANA PHHON $ y Z JI
E-MwR
STREET AD RFSS CITY,STATE,ZIP FAX
I , F S O -Ni= "fo NI -AUc S-A fLA TOL— k G-/l 9S D7
❑OWNER . ❑ OWNER-BUILDER ❑ OWNERAGENT MCONRACrOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVET-OPER ❑TENANT
CONTRACTORNAN¢ LICjE�6;6 r, LICr 1Tj BUS.LIC.a
flu 1" eq-- -7 lt' " JJ
COMPANY MEN spot- T N 4--- E-FAR FAX
STREET ADO,�Fs S CITY,STATE,ZIP PHONE
To G—
ARCHITECTIEN'GINEER NAME LICENSE NUMBER BUS.LIC.9
COMPANY NA?,[: E-NAR FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF 'KSFD Or Duplex ❑ Mulu-Family ROOF AREA:: VALUAAyTIION:
sTRucnlaE: ❑ Commercial
V 0 Do Q 3 \ �
EXISTING ROOF TYPE::: ❑BUILT-UP ROOF ASPHALT SHINGLES ❑WOOD SHAKES ❑WOODSSIHNGLES ❑OTHER(SPECIFY)
REMOVE IRFPLACE yn.YES I IF NO. PLYWOOD 'A' ❑ PLYWD XOSB PITCH: ROOF
❑ q A ICK B' TYPE. ❑ .D >�')2 L A
PROPOSED ROOF TYPE: ❑BURT-UP ROOF ICSPHALT SHNGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPOR a
DESCRIPTION OF WORK:
Ta,v-- F 0P +- &A jus arc- OSLi
) J V B I—c I .S LIS S p
P u T Lir — 7 i M L C.o N1 t' L---/j NJ A -19 Iz K
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. 1 have read this
application and the information 1 have provided is correct. 1 have read the Description of Work,and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building construction, I authorize representatives of Cupertino to enter the above-idemified property for inspection purposes:
Signature of ApplicanUAgenC Date:
SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE O LY
_If building is associated with a Home Owners Association,provide letter j - PIAN CHECK-TYPE �,{� ROUTING SLIP
ofapproval from HOA. ] OVER-TILE-COUNTER ty1.�RUILDIIC.PLAN RFVEW
_Provide Planning approval to verify if there any restrictions. /� T XPR"S LLJ PL tNNnG PI_.AN REVIEW.
_Provide copy of Manufacturer's Installation Specifications. I.O, STANDARD eIRE Dl:rr
Provide signed copy of Cupertino's Tear-ORPolicy. 0 OTHER:
ReroojApp_2011.doc rerlred 03/16/11
Building Department
I
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
12s ADDRESS: 10528 Johnson Ave DATE: 11/19/2012 REVIEWED BY: Sean
APN; BP#: WALUATION: $6,000
*PERMIT TYPE: Minor Building Permit PLAN CRECK TYPE: Re-roof
PRIMARY SFDor DU lex PFNTAMATION 1SFDWLR00F
USE: P PERMITTY'PF.:
WORK Remove existing composition roofing and install new OSB and underla ment with new com osition
SCOPE roofing (2000 sq ft).
ROOFAREA
FEEID (s f)
1REROOFFRES 2,000
Heck Plan Check Plumb.Plan(:heck Elec. Plan r"'heck'
i
aluci�. Permit Fee; Phnnb.Permit Fee: Elec.Permit Eve:
i
Other Meeh. hup. Other Plumb Imp. Other Elect Insp.
Ll I
Mech.Irtrp.E4e: Plumb.Imp. Fee: Elea htcp. Fee:
NOTE: This esrintate does not includefees due to other Departments(i.e. Planning, Public II'orks• Fire,Sanitny Server District,School
District,etc. . These ees are baser/on the prelintinan information available and are onlr an estimate. Contact the Dejujor addis'I info.
FEE ITEMS (Fee Resolution 11-0531-,ff. 7/1/121 FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Supp1.PC'Fee
P1umh.lHech•:`Elec
Permit Fee: $300.00
Suppl. Imp Fee
Phnnb.iMech•IElec
Plumb. Hec/t.:Elec.Peruth Fee:
ConsIrticrion Tm' :
Adnn'nislralive Fee:
Work Without Permit? O Yes Q No $0.00
,Advanced Planning;Fees:
Travel Documentation Fees: A
Strom Motion Fee: IRSEISMICR $0.60 Select an Administrative Item
Blda Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $301.601 $0.001 TOTAL FEE: 1 $301.60
Revised: 10/01/2012
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
ALBERT SALVADOR, P.E.,C.B.O., BUILDING OFFICIAL
CUPERTINO
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228 • FAX(408)777-3333 • buildina(a)cuoertino.orq
PROIECr ADDRESSI APN4
N
I o oP �' o ti S o A/ -f} ✓�
OWNER NAMEPHONE E-MAIL
>4'L.'fi'l�-7 ,t,' o J rJ 4- 0 s �.' JC z 6a 1-5
STREET ADDRESS CRY, STATE,ZIP FAX
SAM -A511 J ,r GJA� K i
CONTRACTOR NAME LICENS NUMBE LICENSE TYPE I BUS.LIC.k
; k S $ f 9
COI.BANY NAME ;Al 4- E-MAIL FA%
r
SIRF.ET ADDRESS - CY,STATE,ZIP PHONE
1 8 9 S o r o Pi p v � Rs '� R-A �0 G— -li r-",n y o 8 �4 -7
1 UNDERSTAND AND AGREE TO THE FOLLOWING:
i. The re-roof project shall comply with ali 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 7:30-3:30pin (Mon-Thurs) or 7:30-2:30pn1 (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 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 wrinen 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'A" 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.
7. 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 each of the following is true: I 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 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: Date: II
ReroofPo1iry_2012.doc revised 10/7/12