12110065T(
CUPERTINO
cr- TUCnNTR ACTOR LIST___
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10642 PARALLONE DR
CONTRACTOR: PRINCIPLE ROOFING, INC
PERMIT NO: 12110065
OW'NER'S NAME: YANG RUIGUO & CI IEN ZUI
10160 STERN AVE
DATE ISSUED: 11 /132012
OWNER'S PHONE: 9542821238
CUPERTINO. CA 95014
PIIONF. NO: (408)895-7298 '
❑ LICENSED CON'TRACTOR'S DECLARATION
(- ❑ ID
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class CM. Lic. p e) 1 6 i3 -9 ;--
r (J r
MECII RESIDENTIAL COMMERCIAL
Contractor ��`" Date 114, 3� 11 L
1 hereby affirm that I am IicenseJ under the provisions of Chapter 9
JOB DESCRIPTION: REMOVE EXISTING WOOD SHAKE AND INSTALL NEW
(commencing with Section 7000) of Division 3 of the Business & Professions
OSD AND
COMPOSI'T'ION ROOFING (2 900 SQPT)
Code and that my license is in full force and effect.
hereby affirm under penalty of perjury onepf 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
Sq. Ft Floor Area:
Valuation: $11000
Section 3700 ofthe Labor Code, for the performance of die work for which this
permit is issued.
APN Number: 36933043.00 Occupancy Type:
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 fai inspection purposes. (We) agree to save
PERMIT EXPIRES IF WORK IS NOT STARTED
indenmifyand keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally, the applicant understands and will comply
180 DAYS FROM LAST CALLED INSPECTION.
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
^
Signature l _ "" Date 1 1 � I .L
Issued by: 14, /V- f%TG/^'1 Date:��� /3 �a
.�
❑ O \ \'NF:R- BUILDER DF :CI -. \RA'T'ION
RE-ROOFS:
I hereby affirm that l am exempt from the Contractor's License Law for one of
All roofs shall be inspected prior to any roofing material being installed. If a roof is
the following two reasons:
installed without first obtaining an inspection, I agree to remove all new materials for
I, as owner of the property, or my employees with wages as their sole compensation,
inspection.
will do the work, and the structure is not intended or offered for sale (Sec.7044,
Business & Professions Code) -
Signature of Applicant: Date:
I, as owner of the property, am exclusively contracting with licensed contractors to
fi/I (3--
construct the project (Sec.7044, Business & Professions Code).
ALT, ROOF CO \'FRINGS'1'O ISE CLASS "A" OR BI:1 "1'FR
hereby affirm under pelally*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, as provided for by Section 3700 of the Labor Code, for the
I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this pemnit is issued
California I Ieallh & Safely Cude, Sections 255115, 25533, and 25534. I will maintain
I have and will maintain Worker's Compensation Insurance, as provided for by
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Ilealth &
Section 3700 of the Labor Code, for the performance of the work for which this
Safety Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
permit is issued.
contaminants as defined by the Bay Area Air Quality Management District I will
I certify that in the performance of the work for which this permit is issued, I shall
maintain compliance with the Cupertino Municipal Code. Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's
Death & Safety Code, Sections 25505, 25533, and 25534.
Compensation laws of California. If, after making this certificate of exemption, I
become subject to the Worker's Com enswion provisions of the Labor Code, I must
1 P P
Owner or t utaonzed agent:
Date: IIt/( 1't.
fortMrith comply with such provisions or this permit shall be deemed revoked.
•
CONSTRUCT ION LENDING AGENCY
APPLICANT celrrlFlc,\IIGN
I certify that I have read this application and state that the above information is
I hereby affirm that there is a construction lending agency for the performance of work's
correct. I agree to comply with all city and county ordinances and state taws relating
for which this pennit is issued (Sec. 3097, Cie C.)
to building construction, and hereby authorize representatives of this city to enter
Lender's Name
upon the above mentioned property for inspection purposes. (We) agree to Save
indemnify and keep harmless the City of Cupertino against liabilities ,judgments,
Lender's Address
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicam understands and will comply
ARCIIVfECT•S DECLARATION '
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18. -
1 understand my plans shall be used as public records.
Signature Date
Licensed Professional
CUPERTINO
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
(408) 777 -3228 • FAX (408) 777 -3333 • bullding(OicuOertlnO.OrO
PROJECT ADDRESS 10,-42— A ✓ � "l ✓r WE--
APN M Y
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OWNER NAAE
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STREET ADDRESS
CITY, STATE, ZIP
FAX
❑ OWNER . ❑ OWNER. BUILDER ❑ OWNERAGENI' ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTORNAME hn ".. /�, / _.
C/I.GN
LICENSENUhIDER_
LICENSETYPE
BUS, LIC.a
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COMPANY NAME B»?Y
E -MAIL
FAX
S"rREET ADDRdSS
CITY, STATE, 21P
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ARCHITECT/ENOINEERNAME
LICENSE NUM AR
BUS. LIC.4
CONIPANY NAME
E -MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE of FD or Duplex ❑ Multi - Family
STRUCTURE: ❑ Commercial
ROOF AREA:
VALUATION: i
�l�000
EXISTING ROOF TYPE: ❑ BUILT -UP ROOF ❑ ASPHALT SHINGLES 19WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER (SPECIFY)
R IOVEIREPLACE - 1-ES
❑ O
I IF NO.
a LAYERS
PLYWOOD K" '❑
THICKNESS ❑ n-
PLYWD OSB
13 D%
PITCH:
� :12
ROOF
CLASS' A
,.,�
PROPOSED ROOF TYPE: 11 BUILT-UP ROOF DYASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER
ICC -ES REPORT M
DESCRIPTION OF WORK:
By my signature below, I certify to each of the following: 1 am the property owner or authorized agent to act on the property owner's behalf. 1 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 relating to building construct]. n. 1 authorize representatives of Cupertino to enter the above - identified property for inspection purposes.
Signature of Applicant/Agent: Date: L
SUPPLEMENTAL RQFORMATION REQUIRED
_ If building is associated with a Home Owners 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.
OFFICE
USE ONLY _
FLAn aD:cK Trre
ROUTING SLIP _
OVKR =TI HI COUNTER
EXPRESS
' ❑ RANDARD.
BUILDING PLAN REVIEW
❑ PLANNING PLAn.REPIEwi
❑ FIRK DECr -
❑ orHER:
ReroofApp_201 l.doc revised 03116111
REROOF TEAR -OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
AWTI0 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
(408) 777 -3228 • FAX (408) 777 -3333 • buildina(ftuoentino.org
PROJECT ADDRESS O ! ^ J�: Ui� I APN M
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OWNER NAME PHONE �F Li72 12-3 8 E -MAIL
STREET ADD UU' 9"�ZN _ / / _
CRY, STATE, 2� ,Zl �o a,
FAX
CODJIRACn)R NAME � _ _ _ L- LICELSE"UNER LICENSE TYRE
I BUS. LIE.4
COMPAWNAME t� ?
! ✓`/
E-MAIL
FAX
STREET / OR71 0, �I,� _ _I ✓�.
CRY. STATE, ZIP ,
PHONE �� � y d
I 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- 2:30pin (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 /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. 1 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 R315 of
the 2010 California Residential Code.
Signature of Applicant/Agent, — Date: �L-
RerooJPo1icy_2012.doc revised 1WI12
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
FEE ID ROOFAREA
s.L)
1REROOFFRES 2,900
ADDRESS:•10642 Farallone Dr.
DATE: 11/13/2012
REVIEWED BY: Sean
\
APN:
I BP #:
'VALUATION:
$11,000
*PERMITTYPE: Minor Building Permit
PLAN CHECK TYPE: Re -roof
PRIMARY
USE: SFD or Duplex
Elce. Insp. Fee:
PENTAD/, \TION
PERD117' Tl'PE: 1SFDWLR00
WORK
Remove existing wood shake and install new OSB and composition roofing 2900 sq ft).
SCOPE
FEE ID ROOFAREA
s.L)
1REROOFFRES 2,900
NOTE: This estimate sloes trot include fees slue to other Departments (i.e. Planning, Public B'ork,s, Fire, Sanitary Sewer District, School
District. etc .). There fees are based an the nrelintinan• information available and are only rot estimate. Contact rise Dent for nddn7 info.
FEE ITEMS (Fee Resolution 11 -053 EfT 711112)
Mech. Plan Check .
Plumb. Plan Check
Dec. Plan Cheek
• Aleeh. Permit Fee:
Plural,. Permit Fee:
Elec. Penni! Fee:
Other Alcch. lasp.
Other Plumb Insp.
Other Elec. It
Adech. Insp. : Fee:
Plumb. leap. Fee:
Elce. Insp. Fee:
NOTE: This estimate sloes trot include fees slue to other Departments (i.e. Planning, Public B'ork,s, Fire, Sanitary Sewer District, School
District. etc .). There fees are based an the nrelintinan• information available and are only rot estimate. Contact rise Dent for nddn7 info.
FEE ITEMS (Fee Resolution 11 -053 EfT 711112)
FEE
QTY /FEE
MISC ITEMS
Plan Check Fee:
Stipp/.. PC .F ee
Flamb.414ech.7Clec.
Permit Fee:
$435.00
Suppl. Insp Fee
PhtmbAA•lech.lClec
Plumb.ld•Iech.lElec Permit Fee:
Consrtvction Tar:
Administrative Fee:
Work Without Permit? 0 Yes Q No
$0.00
Advanced Planning Fees:
A
Travel Documentation Fees:
Strong Motion Fee: IBSEISAfICR
$1.10
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
1 $437.10
$0.001
TOTAL FEE:
$437.10
Revised: 10101/2012