13010155CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10162 ALPINE DR I CONTRACTOR: KEITH ROOFING CO INC I PERMIT NO: 13010155. 1
OWNER'S NAME: ROOK ANN L AND JAMES W TRUSTEE 1920 LINCOLN AVE I DATE ISSUED: 01/302013
I OWNER'S PHONE: 4082531000 I SAN JOSE, CA 95126 I PHONE NO: (408)295 -8616 I
License
Contractor
I hereby Wrm that I 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
1 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.
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
permit is issued. _
APPLICANT CERTIFICATION
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 save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accme against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non - points p" regulations per the Cupertino Municip Cod , S
9.18 . j Z
❑ OWNER - BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
1, 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 & Professions Code).
I 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, as provided for by
Section 3700 of the Labor Code, for the perforimmance 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 mannerso 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 must
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
corect: 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
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.
Signature Date
JOB DESCRIPTION: RESIDENTIAL
UNIT B ONLY - TEAR OFF (E) T &G, INSTALL TAR &
CAPSHEET CLASS A ROOF SYSTEM
Sq. Ft Floor Area:
Valuation: $6580
APN Number: 32615023.00 (Occupancy Type: -
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS 9FPERMIT ISSUANCE OR
180 DAYS FRO344jaT CALLED INSPECTION.
Date: d
ii ii pill roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtain' inspection, I agree to remove all new materials for
inspection.
SignatureofA licant Date:
ALL ROOF VERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
1 have read the hazardous materials requirements under Chapter 6.95 of the ..
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance wi9AW13pertino Municipal Code, Chapter 9.12 and
the Health & Safety Cod ectio 5505, 25533, and 25534.
Owner or authorize agent: Date
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
ARCHITECT'S DECLARATION
1 understand my plans shall be used as public records.
Licensed
CUPERTINO
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION O'\
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 /)_
(408) 777 -3228 • FAX (408) 777 -3333 • buildinGncuoertino.om \ _/
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PROIECTADDRESS 10/ 2
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OWNERNAME
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STREET ADDRESS
CITY, STATE, ZIP
FAX
CONTACT NAME
Fa
STREET ADDRESS D //
C TATE
FAX
❑ OWNER ❑ OWNER- BIRLD(_ER ❑ OWNEtAGENT ❑ CONTRACTOR ❑CONTRACrORAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TBNAM
CONTRACTOR NA
LIC ENjj� R
LICE SE TYP
BUS, LIC.#a
COMPAMNAME E-MAIL
STREET ADDRESS - CITY, TATS, ,,_
Zcj S' aw
ARCHTTECTIEJGINEER NAME
LICENSE NUMBER
BUS. LIC. #
COMPANY NAME
E -MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ SFD or Duplex Ifi- Family
STRUCTURE: ❑ Conuner'cial
ROOF AREA:
VALUATION:
EXISTING ROOF TYPE: HILT -UP ROOF ❑ ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OWNER (SPECIFY)
REMOVE /REPLAC S
❑
IF NO,
PLYWOOD '" ❑
a/a"
PLYWD ❑OSB
TYPE ❑ D
PITCH: t
'12'
ROOF
LASS A
PROPOSED ROOF TYPE: MT -UP ROOF ❑ ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER
ICC -ES REPORT #
DESCRIPTION OF WORK: T
By my signature below, I certify to each of lowing: I am the property owner or authorized agent to act on the property owner's behalf I have read this
application and the information I hav vi is correct. I haver d the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws mla' built ' g constru ' . I rite re esentffiives of Cupertino to enter the abov idenY red property for inspection purposes.
Signature ofApplicanV ent Date:
S L ORMATIONREQUIRED
P
_ If building is associated with a Home Owner's Association, provide letter
of approval from HOA.
_ Provide Planning approval to verify if there any restrictions.
_ Provide copy of Manufacturer's Installation Specifications.
_ Provide signed copy of Cupertino s Tear -Off Policy.
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ReroofApp_2011.doc revised 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(Wcuoertino.org
PROJECT ADDRESS 1(� /'1 &J C/ &2,k)
,) Y
APN,
-I
OWNER NAME /
PHONE
E -MAIL
STREET ADDRESS
C7Y, STATE, ZIP
FAX
CONTRACTOR NAME . h
LI rf Fes.
L S
COMPANY NAME
E- MAIL
STREETADDRESS 7/n / h `/ ,{,/, -
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I UNDERSTAND AND AGREE TO THE FOLLOWING:
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 proposed throughout, all the nails /fasteners shall be either
completely knocked -down or removed prior to this inspection.
If plywood is installed, a plywood Nailing Inspection is required.
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.
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 1/4" 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 unders d agree to comply with the re -roof policy stated above. I also understand that
smoke detectors and carbon it i detectors are required to be installed in accordance with Sectio s R314 and R315 of
the 2010 California Residen ' Cg�� /�� ''y r
Signature of ApplicanUAge � Date:
RerooJPo1icy_2012.doc revised 1017111
������ CITY OF CUPERTINO
IN'�'G//I FF,F, F,STIMATOR — BUILDING DIVISION
Xtech. Plan Check Plumb. Plan Check Elec. Plan Check
Afech. Permit Fee: Plumb. Permit Fee: F,lec, Permit Fee:
Other Afech. Insp. Other Plumb Insp. Other Elec. Insp.
,4lcch, Insp. Fee Plumb. hisp. Fee: Elec. Insp. Fee'
NOTE: This estimate does not include fees due to other Departments (ie. Planning, Public Works, Fire, Sanitary Sewer District, School
District etc.). These fees are based on the preffinWdn in ormation available and are only an estimate Contact the Dent for addn'1 info.
FEE ITEMS (Fee Resolution 11 -053 E . 7/1/121
ADDRESS: 10162 ALPINE DR
DATE: 01/30/2013
REVIEWED BY: MELISSA
Mi
APN: 32615023
BP #:
'VALUATION:
$6,580
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD Or Duplex
USE:
. 0.0
PENTAMATION 1SFDWLR00F
I PERMIT TYPE:
WORK
UNIT B ONLY -TEAR OFF E T &G INSTALL TAR & CAPSHEET CLASS A ROOF SYSTEM
SCOPE
$0.00
Xtech. Plan Check Plumb. Plan Check Elec. Plan Check
Afech. Permit Fee: Plumb. Permit Fee: F,lec, Permit Fee:
Other Afech. Insp. Other Plumb Insp. Other Elec. Insp.
,4lcch, Insp. Fee Plumb. hisp. Fee: Elec. Insp. Fee'
NOTE: This estimate does not include fees due to other Departments (ie. Planning, Public Works, Fire, Sanitary Sewer District, School
District etc.). These fees are based on the preffinWdn in ormation available and are only an estimate Contact the Dent for addn'1 info.
FEE ITEMS (Fee Resolution 11 -053 E . 7/1/121
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
1,326 s.f.
$210.00
Re roof
1REROOFREs
Suppl. PC Fee: Q Reg. Q OT
. 0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee.0 Reg. O OT
0 0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00.
-
Construction Tits:
Administrative Fee:
Work Without Permit? O Yes O No
$0.00
Advanced Planning Fee:
$0,00
Select a Non - Residential
Building or Structure
0
Travel Documentation Fees.-
Strong Motion Fee: IBSEISMICR
$0.66
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
r�l N � IPR" l� � t
$1.66
$210.00
n,, ,. " `,a,TQTAL FEE
$211.66
' Revised: 10/01/2012