12120036I CITY OF CUPERTINO BUILDING PERMIT I
BUILDING ADDRESS: 20020 DE PALMA LN
CONTRACTOR.+9P-_TQBE I PERMIT NO: 12120036
OWNER'S NAME: ALEXANDER FERTELMEISTER I ( t/) M r-4,011 1 4_lry,,,� 11 /,- I DATE ISSUED: 12/07/2012 I
OWNER'S PHONE: 4083681243 1 1 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIAL
License Class .� Lic. # t '� �%? RE -ROOF 23 SQ- REMOVE AND REPLACE WOOD SHAKE
AND
Contractor Date INSTALL ASPHALT SHINGLES CLASS A
I hereby affirm 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.
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.
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. 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.
Si atu Date 1
❑ OWNER- BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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)
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 performance 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 manner so 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
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
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
Sq. Ft Floor Area: I Valuation: $12000
APN Number: 36932058.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 AYS OF PERMIT ISSUANCE OR
180 DAY M LAST CALLED INSPECTION.
Issued by: Date:
RE- ROOFS:
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.
Signature of Ap TT
Date:
ALL TO BE CLASS "A" O BEER
HAZARDOUS MATERIALS DISCLOSURE
I 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 with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Sect' 5533, and 25534.
Owner or authorized a ate:
CONSTRUCTION LENDING AGENCY
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 Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
AfI;a:Ii-iIIiZ *7
i
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION f�
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 \
(408) 777 -3228 - FAX (408) 777 -3333 - building0cupertino.or4
PROJECT ADDRESS i7 00� ^ (X PPVLM A<
APN #
OWNERNAME PSI -eta r
PH I r
E -MAIL __j
STREET ADDRESS 2LM2L
CITY, STATE, ZIP
FAX
CONTACT NAME
PHONE
E -MAIL
STREET ADDRESS
CITY, STAT , ZIP
FAX
❑ OWNER ❑ OWNER - BUILDER ❑ OWNER..... CONTRACTOR ❑ CONTRACIORAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
�
LICENSE NUMBER/f
`Z
LICENSE TYPE
BUS. LIC. #
COMPANY NAME
(XLZ
E -MAIL
FAX
STREET ADDRESS - /J %1
CITY, STATE, ZIP
PHO }' 4 W2
ARCHITECT/ENGINEERNAME
LICENSE NUMBER
BUS. LIC. #
COMPANY NAME
E -MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF or Duplex ❑ Multi - Family
STRUCTURE: ❑ Commercial
ROOF -) AREA
VALUATION:
2
EXISTING ROOF TYPE: ❑ BUILT -UP ROOF ❑ ASPHALT SHINGLES WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER (SPECIFY)
REMOVE /REPLACE YES
❑ N
IF NO.
#LAYERS:
PLYWOOD ❑ 'h" ❑
THICKNESS: ❑ 5 /S"
PLYWD ❑ OSB
TYPE: ❑ Cox
PITCH:
1
ROOF
CLASS: A
PROPOSED ROOF TYPE: 11 BUILT-UP ROOF fl-ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER
ICC -ES REPORT #
DESCRIPTION OF WORK: (�^ �/
Iv' [ % -' l ,� ,� it i ��7 �0� 1? ✓'A C-��%�L L� �OL'<�� f J.7CrTTI�!/
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. 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 laws rel ' o .on. I nnthnri7e re resentatives of Cupertino to enter the above - identified property for inspection purposes.
Signature of Applicant/A n ' �_ Date:
_ 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.
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 cDcupertino.org
PROJECT ADDRESS
APN #
OWNER NAME PHONE
E -MAIL
STREETADDRESS
CITY, STATE, ZIP
FAX
CONTRACTOR NAME y
LICENSE NUMBER -
LICENSKE
BUS. LIC. #
�.
COMPANY NAME
E -MAIL
A
STREET ADDRESS _
CITY, STATE, ZIP
PHO 77
4 � a
F E'
7
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 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 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 I /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 understand and agree to comply with the re -roof policy stated above. I also understand that
smoke detectors and carbon mon _ are required to be installed in accordance with Sections R314 and R315 of
the 2010 California Resident' �tt�.�,
of
Date:
ReroofPolicy_2012.doc revised 1017112
CUPERTINO
CONTRACTOR / SUBCONTRACTOR LIST
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014 -3255
Telephone: 408 - 777 -3228
Fax: 408 - 777 -3333
JOB ADDRESS:
PERMIT #
OWNER'S NAME:
PHONE #
GENERAL CONTRACTOR: y -
BUSINESS LICENSE #
ADDRESS: 3
CITY /ZIPCODE:
*Our municipal code requires all busiMesses 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.
I am not using any subcontract--- • �
Si Date
Please check applicable subcontractors and complete the following information:
Date
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
JI
Roofing
.
Septic Tank
Sheet Metal
Sheet Rock
Tile
Date