12110064Building Department
City Of Cupertino
10300T6rre Avenue
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRILSS: 10460 PHAR LAP DR
CONTRACTOR: PRINCIPLE ROOFING, INC
PF,RMIT'NO: 12110064 -
OWNER'S NAME: DUONG SON AND FIOEII LINDA
10160 S 1ITRN AVE
DATE ISSUED: 11113/2012
OWNER'S PDONE: 40870289.56
CUPERT'INO. CA 95014
PHONE NO: (408) 898 -7298
❑ LICENSED CONTRACTOR'S DECLARATION
r IJ
BUILDING PERNIIT INFO: BLDG ELECT PLUMB
V- License Class v�"39' I.ic.H ��f�,?-
DIECII r RESIDENTIAL (J COMMERCIALr
Contractor Date 14h
1 hereby affirm that 1 am licensed under the provisions of Chapter 9
JOB DESCRIPTION: REMOVE EXISTING 11'06D SHAKE AND INSTALL NEW
(commencing with Section 7000) of Division 3 of the Business & Professions
OSB AND
COMPOSITION ROOFING(3000 SQFI)
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 phich 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 of the Labor Code, for the performance of the work for which this
permit is issued.
APNNumber: 32635045.00 Occupancy Type:
AI'1'LICANI'CF,R'I'I17ICVTION
I cenifv 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 state laws relating
to building construction, had hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify against
keep harmless the City ofainsts
id City consequence of the
costs, and expenses which ran}• accrue against said City in consequence of the
osts,a and
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 -poini source regulations per the Cupertino Municipal Code, Section
,
Signature l ✓� ---- Date 1( \'l 1 Z—
Issued by: , fl N! l/ Date:
❑ ONVNER- BUILDER DECLARATION
•
RE-ROOFS:
1 hereby affirm that .1 am exempt from the Contractor's License Law for one of
All roofs shall be inspected prior to any rooting material being installed If a roof is
the following two reasons: I
installed without first obtaining an inspection, I agree to remove all new mate }ials 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,
'
I (/� 3 L
Business & Professions Code)
Signature of Applicant: 1 Date:
I, as owner of the property, min exclusively conimcting with licensed contractors to
construct the project (Sec.7074, Business & Professions Code).
ALI, ROOF COVERINGS TO BE CLASS "A" OR BETTER
hereby affirm under penalty of perjury one of the following three
declarations:
1 have and will maintain a Certificate of Consent to self - insure for Worker's
11, \ %.ARDOLIS \IAT'ERLUS 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 permit is issued
California (lealth & Safety' Code. Sections 25505, 25533, and 25534. 1 will maintain
I have and will maintain Worker's Compensation Insurance, as provided for by
compliance with the Cupertino Municipal Coda Chapter 9.12 and the I lealth &'
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
} Qualih• Alenagement District I will
I certify that in the performance of the work for which this permit is issued, I shall
maintain compliance with the Cu perfino Municipal Code. Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's
I lealth & 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 Compensation provisions of the Labor Code, I must
Ownrr or authorized agent:
(I 3 ) L
forthwith comply with such provisions or this permit shall be deemed revoked
�—� Date:
CONSTRUCTION LENDING .AGENCY
,APPI,ICANl' CF.R'1'IFICA'1'ION
I certify than 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 laws relating
for which this permit is issued (Sec. 3097, Civ 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 Iiabilities,judgmcnts,
Lender's Address
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
ARCIIITECI" S DECLARATION
with all non -point source regulation per the Cupertino Municipal Code, Section
9.18.
1 understand my plans shall be used an 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 • buildinoCcuoertino.oro
I ZII�0(,Dq
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PROJECT ADDRESS -I O4 /O I-Ia_K p ntL .
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OWNER NAME -t7� t? V1 o��-- L
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STREET ADDRESS 1404.4o
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CITY, ST 'f E, 21P FAX
CONTACT NAME r
P O E O
E -LIAIL
STREET ADDRESS
CITY, STATE, ZIP
FAX
❑ OWNER . ❑ OWNER-BUILDER ❑ OWNERAGENT CONTRACTOR ❑ CONTRALTORAGENT ❑ ARCTITIECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTORNAP =U /
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LICFNSENUMBER
LICENSETYPE
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BUS, LIC.0
COMPANY NAM E
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CITY, StAI'E, ZIP / ^-� �/
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PHO A
ARCHITECTIENGINEER NANIE
LICENSE NUMB
BUS. LLIIICC.4
COWAN'Y NAME
E -MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF SFD or Duple, ❑ Multi- Family
STRUCTURE: ❑ Commercial
ROOF AREA:
-30
VALUATION: VALUATION:
1 /A aelev
EMSTING ROOF TYPE: ❑BUILT-UP ROOF ❑ ASPHALT SHINGLES WOOD SHAKES ❑WOODSHMGLES ❑ OTHER (SPECIM
RFI.IOVE IREPLACE YES
❑ NO
IF NO-
N LAYERS'
PLYWOOD K- ❑
❑ SB'
PLYWD OSB
❑ C--
PITCH:
1- ,
ROOF
CLASS A
,,.,�
PROPOSED ROOF TYPE: ❑ BUILT -UP ROOF LYASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER
ICGFS REPORT 0
DESCRIPTION OF WORK: AjAM�� ✓� i
F+ 6V-6 3747 17 Wa47P 5J7WCIr nS1zr CQi U S/� f
�S
By my signature below, 1 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 1 have provided is correct. I have read the Description of Work and verify it is accurate. 1 agree to comply with all applicable local
ordinances and state laws relating to buildin construction. 1 authorize representatives of Cupertino to enter the above - identified property for inspection purpose.
Signature of ApplimnUAgent: Date: 2--
SUPPLEMENTAL INFORMATION REQUIRED
_ If building is associated with a Home Owmers Association, provide letter
of approval from I10A.
_ 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
-% Pl.w cul cl: TYPE
ROU'rmG sLIP _
O\ LR =1'1I IiCOUN I ER
E,YI RESS
❑ STANDARD -
Ir W Y
❑ JUNI DING 1 I AN REVIEW
❑ :I'unNHN I LAN' ur Y IEW '
❑ EIRE DEP7 - -
D OTHER'
ReroojApp_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 • buildina0cuoertino.orD
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PROJECT ADDRESS /G A�G
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OWNER NAME S`-fayl -/ l/ L{i/�/Lr�w
E -MAIL
STREET ADORES$ GYOU
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CTr- STATE, Z�, _ :A;7 /`J�/
/�a`/'rLIICENSSSE
FAX
CON'RACrOR NAME
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LICDtSE AJNSER- �'YS}6
TYPES
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BUS. LIC.0
COWANN NAME _
E -MAIL
FAX
STREET ADDRESS ,/ !
Q'l�U �e/i7 /,- /Y'I�L
CnY, STATE, Z� / L/
PH .E
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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.
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- 2:30pin (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.
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 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.
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 R315 of
the 2010 California Residential Code.
Signature of Applicant/Agent: Date: Z
RerooJPolicy_2011.doc revised 1017111
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
imADDRESS:
10460 Pharlap Drive
DATE: 11113/2012
REVIEWED BY: Sean
Mech. Permit Fee:
APN:
BP#:
- VALUATION:
$11,000
*PERMIT Tl'PE: Minor Building Permit
PLAN CHECK TYPE: Re -roof
USE: SFDorDuplex
PUSS:Y
Elec. Insp. Fee:
PENTAMATION
PERMITTYPE: 1SFDWLR00 At
WORK
Remove existing wood shake and install new OSB and composition roofing 3000 sq ft).
SCOPE
FEE ID ROOFAREA
s.f.
1REROOFFRES 3,000
NOTE: This estimate does not include jeer due to other Departments (i.e. Planning, Public 11 arks, Fire, Sanitary Sewer District, School
District. etc). These lees are baser) on the arelintinan, information mailable and are onb• an estimate Contact'the Dept for addn'I info.
FEE ITEMS (Fee Resolution 11 -053 FT 711112)
blecir. flan Check
Plumb. Plan C /tee6
Elec. Plan Check
Mech. Permit Fee:
Phtmh. Permit Fee:
Elec. Permit Fee:
Other Hech. Insp.
Other Plumb losp.
Odrer Elce. Insp. Ll
,Neclt. Insp. FeL:
Plumb. la..p. Fee:
Elec. Insp. Fee:
NOTE: This estimate does not include jeer due to other Departments (i.e. Planning, Public 11 arks, Fire, Sanitary Sewer District, School
District. etc). These lees are baser) on the arelintinan, information mailable and are onb• an estimate Contact'the Dept for addn'I info.
FEE ITEMS (Fee Resolution 11 -053 FT 711112)
FEE
QTY /FEE
MISC ITEMS
Plan Check Fee:
S11PPI. PC Fee
Phrmb. 11&Zch./Elec
Permit Fee:
$450.00
Suppl. Insp Fee
Plamh.I.Hech./Elec
P1umh. 1rb1ech. 1E1ee Permit Fee:
ConsnLCtion Tar:
Administrative Fee:
Work Without Permit? O Yes (j) No
$0.00
Advanced Planting Fecs:•
Travel Documentation Fees:
Syone Motion Pee: 11ISFISHICR
$1.10
Select an Administrative Item
I31dg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$452.101
$0.00 TOTAL FEE:
F $452`10
Revised: 10/01/2012