13020051 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21370 COLUMBUS AVE CONTRACTOR:NEIGHBORS ROOFING PERMIT NO: 13020051
AND GUTTERS
OWNER'S NAME: THOMAS DUCHIN W AND JOYS W TRU 200 FORD RD STE 236 DATE ISSUED:02/11/2,013
OWNER'S PHONE: 4082525166 - SAN JOSE,CA 95138 PHONE NO:(408)472-3869
13 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
License Class L� Lic.# SS O SZj RE-ROOF 32 SQ-REMOVE EXISTING SHAKES AND WOOD
SHINGLES,INSTALL 1/2 IN OSB CLASS A
Contractor ) , Date j/ —1
I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000),ofDivision 3 of the Business&Professions
Code and that my.license is in full force and effect.
I 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 the Labor Code,for the
performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$21865 -
1 have and will maintain Worker's Compensation Insurance,w provided for by
Section 3700 of the Labor Code,for the performance of the work for which this APN Number:36205007.00 Occupancy Type:
permit is issued.
APPLI ANT CERTIFICATION
I certify that I have read this applicadon and state that 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 W ITIIIN 1A DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above.mentioned property for inspection purposes. (We)agree to save 180 DAY LAST CALLED INPE TION. _
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs',and ezpeuses which may accrue against said City in consequence of the Issued by: Date:! <
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature /�✓> � 3 All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
13 `
OWNER-BUILDER DECLARATION
�� Signature ofApplicant:2 Date: l
Z_
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER .
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,aexclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
m
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,Secdons 25505,25533,and 25534. I 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:; Health&Safety Code,Section 25532(a)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should 1 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 Bay Area Air Quality Management District I
performance of the-work for which this permitis issued. will maintain compliance with the Cupertino 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 the performance of the work for which this Owner or authorized agent: � Dater
permit is issued.
I certify that in the performance of the work for which this permit is issued,I shalt
not employ any person in my manner so as to become subject to the Worker's CONSTRUCTION LENDING AGENCY
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 must I hereby affirm that there is a construct
lending agency for the performance of
forthwith comply with such provisions cr this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANT CERTIFICATION Lender's Address
I certify that I have mad 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
upon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
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 TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT- BUILDING DIVISION
ALBERT SALVADOR, P.E.,C.B.O., BUILDING OFFICIAL
CVPERTINO 10300TORREAVENUE-CUPERTINO, CA 95014-3255
(408)777-3228- FAX(408)777-3333-building(ftuoertino.oro
PROJECT ADDRESS ,Zi 3 7-0 `O / U J Q—V, /i T7'
OWNER NAME -�•� .}. a PHONE
STREE7 ADDRESSJ I U� r/ 9T � Z / ! �J 'GQC FAX
C CfOR NAldE V LICENSE�CNUMB:•R LICENSE TYPE BUS,LIC.N
COMPANY NAA -v!� E-MAIL FAX
rASTREZET ADDIS C ,STATE,ZIP C -oO(\/ Com- PHONE �$t
I UNDERSTAND AND AGREE TO THE FOLLOWING:
1. 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/d' 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. I also understand that
smoke detectors and carbon monoxide detectors are required to be installed in accordance with Sections R314 and R3 IS of
the 2010 California Residential Qode.
Signature of Applicant/Agent: Date: 1
RerooJPolicy_2012.doc revised 10/7/12
REROOF PERMIT APPLICATION
0COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION �h
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 n
CUPERTlN0 (408)777-3228•FAX(408)777-3333•builtlingCa)cuoertino.org nQ'v
PROJECT ADDRESS '-7 I ' APN a \Nn
OWNER NAME PONE '��`�/ � / E-MAIL
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STREET ADDRESSCITY, TA7'E,_ZH' FAX
1/ Gu tar o _c3 �S`D�
CONTACT NAME /_ e PHO E y Z3 5 6 EMAIL
TREET �
ADD SS (^J CITY.STATE,ZIP L' FAX
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❑OWNER ❑ OWNER-BURom ❑ OWNERAGENT CONTRACTOR ❑CONIRACroR AGENT ❑ Aacar ECr ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NA LICENSE MIftBs O LICENSE TYPE BUS.LIC.q
COMPANYNAME C� I� E-MAIL FAX
N I Vim'
STREET ADD I CITY,STATE,Z[P - PHONE
ARCHITECT/ENGrNEER NAME LICENSE NUNIBER BUS.LIC.k
COMPANY NAME E-MAI. FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF Pf SFD or Duplex ❑ Multi-Family, ROOF AREA: VALUATION:
STRUCTURE; ❑ Commercial o 1 t
EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES JPWOOD SHARES A WOOD SS�HINGLES ❑OTHER(SPECIFY)
REIIOVE/REPLACE 1YES IF NO, PLYWOOD ❑ 'h" ❑ PLYWD ' OSB �Z PITCH: nn ROOF
N q ❑ TYPE ❑ DX :IG LA A
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF SQASPHALTSMNGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT k
DESCRIPTION OF WORK:
w0 S nC �S
I l 1 OsnxdS e
I , 0. o s s 0 111 2L)
o 1"r riyu. L
By my signature below,I certify to each of the following: lam the property owner 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 withal[applicable local
ordinances and state laws relating to building constru ion. I au orize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: - Date: I '--' •�
SUPPLEMENTAL INFORMATION REQUIRED _ OFFICE USE ONLY
_If building is associated with a Home Owner's Association,provide letter �-^N C��TATE' 0P ROUTING sue
of approval from HOA. OVER-THECOUNTER BUILDING PLAN REVIEW
_Provide Planning approval to verify if there any restrictions. ❑ PLANNING PLAN REVIEW'
_Provide copy of Manufacturers Installation Specifications. ❑ STANDARD ❑ Fore DEPT
Provide signed copy of Cupertino s Tear-Off Policy. ❑ UTTER:
ReroofApp_201 I.doc revised 03/16/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 21370 columbus ave DATE: 02/1112013 REVIEWED BY: mendez
APN: BP#: 'VALUATION: $21,865
.-PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY PENTAMATION 1 SFDWLROOF
USE: SFD or Duplex PERMIT TYPE:
WORK re-roof 32 sq te__ _
SCOPE
FEE ID ROOF AREA
S.t.
1REROOFFRES 3,200
r;.11r.ny}�.�1u ids
S6tech. Plan Check Plumb. Plan Check Elec. Plan Check
X&Ch. Permil Fee: Plum h.Permil Fee: I Elec. Permit Fee:
Other blech.Insp. Other Plumb Insp. Other Elec. Insp.
:t4ech. Insp.Fee: Plumb. hnp. Fee: Elec.Insp.Free:
NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc. . These ftes are based on the prefintina information available and are only an estimate. Contact the Deter addn'i info.
FEE ITEMS (Fee Resolution 11-053 E . LL121 FEE QTY/FEE MISC ITEMS
Plan Check ree:
Supp[. PC Fee
Plumb:/Meeh:/Elec
Permit Fee: $480.00
Sul�pl. Insp Fee
Plumb.FMechaElec
Plur h.7Mech./ElecPermitFee:
Construction Tax:
Administrative Fee:
Work Without Permit? 0 Yes O No $0.00
Advanced Planning Fees:
Travel Documentation Fees:
Strong Motion Fee: 1BSEISMICR $2.19 Select an Administrative Item
Bldg Std s Commission Fee: 1BCBSC $1.00
t $483.19 $0.00111A
OT E $483.19
Revised: 01/01/2013
Building Department
City Of Cupertino
10300 Torre Avenue
-Cupertino,CA 95014-3255
C U PERTI N O Telephone: 408-777-3228
Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: G I v G'-V, PERMIT# C /
OWNER'S NAME: " ye 1O PHONE# VOFI " V,
GENERAL CONTRACTOR: fvG 5 Y-0 e>1=' BUSINESS LICENSE-.# {
ADDRESS: 2-0 v S o vd yam! CITY/tiIPCODE cl l
*Our municipal code requires all businesses working in the city to have a City-Of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL,BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A .CITY OF CUPERTINO
BUSINESS LICENSE. A�
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
7
Electrical
Excavation
Fencing
Flooring/Carpeting
Linoleum/Wood
Glass/Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting/Wallpaper
Paving
Plastering
Plumbing
Roofing F
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date