13040061 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 908 BROOKGROVE LN CONTRACTOR:ARMSTRONG PERMIT NO:13040061
INSTALLATION
OWNER'S NAME: GE GAO 4575 SAN PABLO AVE DATE ISSUED:04/05/2013
OWNER'S PHONE: 6502158216 EMERYVILLE,CA 94608 PHONE NO:(510)777-1234
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIALL]
e Class�.r_33-x_'SqLic. '—t S FOAM OVERLAY FLAT ROOF,CLASS PAINT EDGE
Licen s
FLASHING
Contractor Date S 20 SQ
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. Sq.Ft Floor Arca: Valuation:$18000
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 APN Number:37539037.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application 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 WITHIN 180 AYS 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 rM LAST CALLED INSP TON.
indemnify and keep harmless the City of Cupertino against liabilities,judgments, ?
costs,and expenses which may accrue against said City in consequence of the Issued Da
ssued bte: \
granting of this permit. Additionally,the applicant u de stands and will comply
with all non-point source regulations per the Cupert o Municipal Code,Section
9.18.
RE-ROOFS:
Signature Date? `� 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 materi for
inspection.
❑ OWNER-BUILDER DECLARATION
Signature of Applic �
1 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,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
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,Sections 25505,25533,and 25534. 1 will
1 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 I 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 permit is issued. will maintain compliance with the Cupertino Municipal Code,C pter 9.12 and
the Health&Safety Code,Sections 255 5533,and 25534.
I have and will maintain Worker's Compensation Insurance,as provided for by 1�
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agentt%i.ye� Dater 71 J
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 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 construction lending agency for the perfomrance of
forthwith comply with such provisions or 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
1 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 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.
Signatu Date
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
AVENUE•CUPERTINO, CA 95014-3255
10300 TORRE
its (408)777-3228• FAX(408)777-3333•building akupertino.org
CUPERTINO I
PROJECT ADDRESS +� f O G r 9`-�+ APN# 2 ��
OWNERNAME / /u PHONE J E-MAIL
e
STREET ADDRESS CITY/�STATE,ZIP //r FAX
CONTACT NAME�GCJ 1/ C �I I�/ PHONy f �f / �'�y E l.0 JG L/- Jh �j .C O
/SLY
STREET ADDRESS /' S S,AN A .LL C Y,STATE,ZIP J� L FAX U /
❑OAR ❑ OWNER-BUILDER ❑ OWNER AGENT J0 CONTRACTOR ❑C RACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAMET 3
^f s �r` �hf T f/ i LICENS2�BER��/ LICE�E e BUS.LIC.#FAXn
COMPANY NAME /I/�y�i S JfGyj ��S E-MAILr,Z
STREET ADDRESS� �S CITY,STATE,ZIP/"� l / e C J4 //d PHONE/GJ'7,77—
y 7/J�Z 7 y
5�S7S l a 4 G �/ �" � .Yy l
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC.#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF SFD Or Duplex ❑ Multi-Family ROOF AREA: VALUATION:
sTRucruRE: ❑ Commercial
EXISTING ROOF TYPE: BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY)
REMOVE/REPLACE ❑YES IF NO, PLYWOOD El %" 11 WD PLYEl OSB PITCH: 7� ROOF
NO #LAYERS: 1 THICKNESS: 115/8" TYPE: ElCDX '12 CLASS: A
ICC-ES REPORT#
PROPOSED ROOF TYPE: )i�BUILT-UP ROOF 11ASPHALT SHINGLES 11WOOD SHAKES ) ❑WOOD SHINGLES OTHER L
DESCRIPTION OF WORK_ O / .
(fi/'t' /�ci✓
a rwve, / e 's /,h Cly ss �� - Sl-Z -'� 3 i
C el
By my signature below,I certify to each of the following: I am the property oer or authorized agent to act on the property owner's behalf. I have read this
application and the information I have provided is rrect. I have read the De ription of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to b ilding tructio autho repr tatives of Cupertino to enter the above entifi�property for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY
_If building is associated with a Home Owner's Association,provide letter PLAN CHECK TYPE ROUT]IING SLIP
of approval from HOA. ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW
_Provide Planning approval to verify if there any restrictions. ❑ EXPREss ❑ PLANNLING PLAN REVIEW
_Provide copy of Manufacturer's Installation Specifications. ❑ STANDARD ❑ FIRE DEPT
Provide signed copy of Cupertino's Tear-Off Policy. ❑ OTHER`
ReroofApp_2011.doc revised 03/16/11
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 908 brookgrove lane DATE: 04/05/2013 REVIEWED BY: larrys
AI BP#: `VALUATION: 1$18,000
'PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD or Du lex PENTAMATION 1 SFDWLROOF
USE: P PERMIT TYPE:
WORK erlay flat roof, class paint edge flashing 20 s
SCOPE
FEE ID ROOF AREA
s.f.
1REROOFFRES 2,000
:llech. Pig 'hwib. Plan Check "Ion C hLL
Plumb. PCI-M%(1" Elec. Permit Fee:
Fh
•Hech.Insp- Other Phrmb Insp. he•Elec.Ins/- L]
_Insp.Fee: Piumb. hisp. fC
NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works, Fire,Sanitary Sewer District,School
District,etc. . Theseees are based on the relimina information available and are onlyan estimate. Contact the Dept or addn'1 in o.
FEE ITEMS (Fee Resolution 11-053 E fl. 7,11%12) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Sup1�l. PC Fee
Phu nb./blech./Elec
Permit Fee: $300.00
Supp[ Insp Fee
Ptttrnt�.,�tech.,I'le:
Plumb. 11ech.%Elec Permit Fee:
Constrzrction Tax:
c1dlnhii.Ctrative Fee:
Work Without Permit? Yes E) No $0.00
,Idvunced Planning Fees:
Travel Doctnnentation Fees: A
Strong Motion Fee: IBSEISMICR $1.80 Select an Administrative Item
Bldy,Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $302.801 $0.00 TOTAL FEE: $302.80
Revised: 04/01/2013
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
CUPERTINO (408)777-3228-FAX(408)777-3333-building @cupertino.org
PROJECT ADDRESS �/ Q�Ua ,�] C APN# /
OWNER NAME & PHONE
H�E E-MAIL
STREET ADDRESS CjTY, STATEIP FAX
CTOR N ME LICENSE NUMBER
TYPE BUS.LIC.#
CO
/1 f»^s�rr� y 11)) J
COMPANY
AAJ)d M�
_Zr�!K G. r E-MAIL FAX
STREET ADDRESS �, /J CITY,STATE,ZIP - ) PHO�F Cv
I UNDERSTAND AND AGREE T 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'/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 th re-roof policy stated above. I also understand that
smoke detectors and carbon monoxide de ctors are required to b installed in accordance with Sectio R314 and R315 of
the 2010 California Residential Code. ^ �/
Signature of Applicant/Agent: Date;:
RerooJPolicy_2012.doc revised 10/7/12