13030014 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10382 MEADOW PL CONTRACTOR:CD ROOFING PERMIT NO: 13030014
OWNER'S NAME: JEN HSUEH PO 2909 WILBUR AVE DATE ISSUED:03/04/2013
OWNER'S PHONE: 6503039394 - SAN JOSE,CA 95127 PHONE NO:(408)898.6605
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
License Class ! S # .� Chi TEAR OFF(E)WOOD SHAKE,INSTALL NEW OSB,40 YR
-C-'-' COMP
Contractor Date -
1 hereby affirm that.I am lid nse 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 Area: Valuation:$13000
1 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:34229024.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
1 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 D ERMIT 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 DA OM L CALLED INSPECTION.
indemnify and keep ham less the City.of Cupertino against liabilities,judgmrnrs' 3.11
�u
costs,and expenses which may accrue
ag ' t said City inconsequence of the Date: f
granting of this permit. Addition y, derstands and will comply ed by:
with all non-point source re a Cupe ' o Municipal Code,Section
9.18.
RE-ROOFS:
Signature Dates�� All roofs shall be inspected prior to any roofing mate ' being installed.If a roof is
installed without first obtaining an inspectio a to remove all new materials for
inspection.
❑ OWNER-BUILDER.DECLARATION
Signature of ApplicantDate: �
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: ALL ROOF COVERIN O BE CLASS"A"OR BETTER -
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 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. I will
I 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,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505 3 ' 4.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Dater— �
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,atter making this certificate of exemption,I CONSTRUCTION LENDING AGENCY
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 performance 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
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 ARCHITECT'S DECLARATION
indemnify and keep harnless 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 allnon•point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
REROOF PERMIT APPLICATION O
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION to
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 ^ O
CUPERTlNO (408)777-3228•FAX(408)777-3333•buildinciacuoertino.om \
PROJECT ADDRESS r� APN a Li ZJ 07
OWNERNAPHONE E-MAIL.
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STREET C DRESS I CITY, STATE,Z@ FAX
CONTACT AME ` ONE E-MAIL
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STREET AD SS t-�9 / CCTY A`Z@ Q y FAX
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❑ OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT �--TI.VNTRACrOR ❑CONTRACrORAOENr ❑ ARatrrwr ❑ENGNEER ❑ DEVEuovER ❑TENANT
CONTRACTOR NAA LICINSEN(1MBER LICENSE TYPE BUS.LIC.N
COMPANYNAME E d FAX
STREETADDRESS CITY,STATE,Z@ PHONE
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ARCHITECTIENGINEER NAME LICENSE NUMBER BUS.LIC.N
COMPANY NAME / A
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STREET ADDRESS CRY,STATE,Z@ PHONE
USE OF ❑ SFD or Duplex Vfiulti-Family. ROOF AREA: VALUATION:
STRUCTURE: ❑ Commercial S 4;�;7
EXISTINGROOFTYPE: ❑BUILT-UP ROOF ❑ASPHALTsNNGLES WOODSHAKES ❑WOODSHNGLES ❑OTHER(SPECIFY)
REMOVE/REPLACE 11 YES IF NO, PLYWOOD 'h" ❑ PLYWD OSB PITCH: ROOF
❑ N NLA 13n- E' ❑ X :12 PL
A
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHNGLES ❑woOD SNAKES ❑WOOD SHDIGLES ❑OTNER ICC-ES REPORT N
DESCRIPTION OF WORK:
By my signature below,I certify to each of the following: I am the property owner or authodwd agent to act on the property owner's behalf l have read this
application and the information I have provided is correct, have,#ad the Des�ptiegof Workand verify it is accurz[e. I agree to wmply with all applicable local
ordinances and state laws relating to building constn 1. . I Oriz repiesentanv 4 of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENfrL INFORMATIO UIRED OFFICEUSEONLY
_If building is associated with a Home Owners Association,provide letter +�y�" 'PWN CHECK TYPE:' ROUTING SLIP
of approval from HOA. U"OVER-THP.L'OUNTER` ❑ BUILDING PLANrsEnew
_Provide Planning approval to verify if there any restrictions. fff❑ Ex0RESS• ❑ PLANNING PLAN REVIEW
_Provide copy of Manufacturers Installation Specifications. ❑ STANDARD ❑ FIRE DEPT
Provide signed copy of Cupertino's Tear-Off Policy. ❑ O=R,
ReroofApp_201 Ldoc revised 03/16/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 10382 MEADOW PL DATE: 03/04/2013 REVIEWED BY: MELISSA
APN: 342 29.024 BP#: *VALUATION: $15,000
*PERMIT TYPE: Building Permit' PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex PENTAMATION 1SFDWLR00F
USE: p PERMIT TYPE:
WORK TEAR OFF E WOOD SHAKE INSTALL NEW OSB 40 YR COMP
SCOPE
F7 I
kA
V.
recti Plan Check Plumb,Plan Cheek Elcc. Plan Check
bleep. Permit Fee: Plumb. BermilElec. Permit Fee:
Other alech. /n.ep. Other Plumb Insp. Other Elec, Insp.
Li
S-lech.Insp. Fvc: Plumb. h sp. Fee: Elec.Insp.Pee .
NOTE: This esfimate does not include fees due to other Deparhnents('ie.Planning,Public Works,Fire,Sanitary Sewer District,.School
District etc.). These ees are based on the prelintin information available and are only an estimate Contact the Dept for addn7 info.
FEE ITEMS (Fee Resolution 11-053 EfC 7/1/12) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 2,700 s.£ Re-roof
Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 $405.00 IREROOFRES
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee-.0 Reg. Q OT 0,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Construction Tax.
Administrative Fee:
Work Without Permit? O Yes O No $0.00
Advanced Planning Fee: $0.00 Select a Non-Residential
Building or Structure
Travel Docannentalion Fees:
Strong Motion Fee: IBSEIEWCR $1.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
$2.501 $405.00 - TOTAL FEE, FL27.50
Revised: 01/01/2013
M
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
GUPERTINO 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228• FAX(408)777-3333•buildinalp?cupertino.oro
PROJECT ADDRESS L, APN k
OWNERNAME PHONE E-MAIL
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STREA ADDRESS CITY,STATE,ZIP FAX
c9 D�7 CEJ' LICONTRACIORNAxLNSSER CENSE TYPE BUS.LIC.M
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COMPANYNAME &MAR FAX
STREET DRESS ''^^ CnY, TE Z� PH NE
w/>� 1._—till C7 �� 4R
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 pioposed 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 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 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:
ReroofPolicy_2012.doc revised 10/7112