11100030 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22392 ST ANDREWS AVE CONTRACTOR:TNT ROOFING CO PERMIT NO: 11100030
OWNER'S NAME: SMITH STEPHEN M AND SUSIE H 1610 BLOSSOM HILL RD STE 6C DATE ISSUED: 10/05/2011
OWNER'S PHONE: 9253723046 SAN JOSE, CA 95124 PHONE NO:(408)277-0800
JJxLICENSED CONTRACTOR'S DECLARATION
i
�� L BUILDING PERMIT INFO: BLDG ELECT PLUMB
S /
License Class Lic.# F f— F
MECH RESIDENTIAL COMMERCIALContractol:z Date ���J ���
1 hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION: RE-ROOF 23 SQ-REMOVE SHAKE ROOF,INSTALL OSB,
(commencing with Section 7000)of Division 3 of the Business&Professions 30LB FELT CLASS A
Code and that my license is in full force and effect.
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:$10344
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
permit is issued. APN Number:35603007.00 Occupancy Type:
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. t agree comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction,
uction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYSP?M LAST CALLED INTPEN*
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the f�Z granting of thispermit. Additionally,the applicant understands and will comply Issued by: Date:
with all non-point source regulation er the Cupertino Municipal Code,Section
9.18.
Sign ure Date ` J/ RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtainin an inspection,1 agree to remove all new materials for
inspection.
OWNER-BUILDER DECLARATION
App
� Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of
the following two reasons: ALL ROOF COVERINGS TO 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)
1,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). 1 have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. 1 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
1 have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should 1 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 1
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,S n �50_5, 3 s and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this �� -
permit is issued. Owner or authorize get Date C
1 certify that in the performance of the work for which this permit is issued,I shall IF
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 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
indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION
—sts,and expenses which may accrue against said City in consequence of the 1 understand my plans shall be used as public records.
sting of this permit.Additionally,the applicant understands and will comply
.,,th all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot :
APN 35603007 . 00
DATE ISSUED. . . . . . . : 10/05/2011
RECEIPT # . . . . . . . . . : BS000014948
REFERENCE ID # . . . : 11100030
SITE ADDRESS . . . . . : 22392 ST ANDREWS AVE
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER SMITH STEPHEN M AND SUSIE H
ADDRESS . . . . . . . . . .
CITY/STATE/ZIP . . . : KENSINGTON CA, 94708
RECEIVED FROM . . . . : M. WILLIAMS
CONTRACTOR WILLIAM TYLER LIC # 22988
COMPANY TNT ROOFING CO
ADDRESS . . . . . . . . . . : 1610 BLOSSOM HILL RD STE 6C
CITY/STATE/ZIP . . . : SAN JOSE, CA 95124
TELEPHONE (408) 277-0800
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
----- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 10, 344 . 00 1 . 00 0 . 00 1 . 00 0 . 00
1BSEISMICR VALUATION 10, 344 . 00 1 . 03 0 . 00 1 . 03 0 . 00
1REROOFRES SQ FEET 23 . 00 322 . 00 0 . 00 322 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT : 324 . 03 0 . 00 324 . 03 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 324 . 03 visa
---------------
TOTAL RECEIPT 324 . 03
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
- ---------------------------- -------- ----------------------------
309 EXTERIOR LATH 311 SCRATCH COAT
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE• CUPERTINO, CA 95014-3255
CUPERTING (408)777-3228 • FAX(408)777-3333 • building aacupertino.org
PROJECT ADDRESS SA I N AtA•_ _�-^r APN# ��I �� /1��
OWNER NAMEPHONE
E-MAm
STREET ADDRESS J _11710
I I CITY, STATE,ZIP FAX
APPLICANT NANS �. . '!� v� r n tl PHONE O !r r` E-MAIL,
STREET ADDRESS (O 0� I cr� STN _ p C./ L�I FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ;2 CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME �vt7 •� LICENSE NUMBER D`fl C Z L.ICENS BUS.LIC.#
1 J
COMPANY NAME C E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC.#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF GfSFD or Duplex ❑ Multi-Family ROOF AREA: VALUATION:
STRUCTURE: ❑ Commercial /�2- V j ` 0
EXISTING ROOF TYPE: 132 BUILT-UP ROOF ❑ASPHALT SHINGLES OOD SHAKES ❑WOOD SHN07 Tr ❑OTHER(SPECIFY)
REMOVE/REPLACE Z�`FS IF NO. PLYWOOD ❑ W. ❑ PLYWD OSB PITCH ROOF
❑ No #LAYERS: THICKNESS: 135/S" TYPE: ❑ CDX :12 CLASS: A
PROPOSED ROOF TYPE: ❑BUILT-UP ROOFICC-ES REPORT#
HALT SHINGLES El WOOD SHAKES 13 WOOD SHINGLES ❑OTHER
DES N OF WORK
w0- 3�s
kt •
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 carr . I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relatu'ig to buil ' co on. I authorize.representatives of Cupertino tc enter the above-identified prope-t�for inspection purposes.
Signature of Applicant/Ageht: Date:
��
SUPPLEMENTAL INFORMATION REQUIRED = = "` _ _
_Ifbuilding is associated with a Home Owner's Association,provide letter
of approval from HOA. N URN 7,,,, � ^�
B1IILIiITGW� Y
_Provide Planning approval to verify if there any restrictions. _
_Provide copy of Manufacturer'S Installation Specifications.
P .��r���-•t rr�-� %iC yT - QT 1��1�T =3 r
—Provide signed copy of Cupertino's Tear-Off Policy.
ReroofApp_201 Ldoc revised 03/02/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 22392 St Andrews PI DATE: 10/05/2011 REVIEWED BY: gs
F,91 APN: BP#: 'VALUATION: 1$10,344
Y°PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD or Duplex PENTAMATION 1 SFDWLROOF
USE: PERMIT TYPE:
WORK Remove 23 sq. of shake roofing replace with life time comp. add plywood.
SCOPE
FEE ID ROOF AREA
s.f.
1REROOFFRES 2,300
T T
NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc. . Thesefees are based on therelirrina information available and are only an estimate. Contact the De t or addn'l info,
FEE ITEMS (I ee Resolution 11-053 Ejf.' %1-11) FEE QTY/FEE MISC ITEMS
Permit Fee: $322.00
Work Without Permit? 0 Yes 0 No $0.00
A
Strong Motion Fee: IBSEISMICR $1.03 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $324.03 $0.00 TOTAL FEE. $3ZA31
Revised: 10/01/2011
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(a-cupertino.org
PROJECT ADDRESSa APN#
z_ `�o PJ
OWNER NAMES P DE 7 E-MAIL
STREET ADDRESS STATE, IP, > FAX
CONTRACTOR NAME , VJ LICENSE NUb,BER l L LICENSE PE BUS.LIC.#
COMPANY NAME �lC�� E-MAIL ��`'� CL FAX
STREET ADDRESS (� CITY, TATE,ZIP GJJ PHONEC
1 c v f��u SS G N1W14 �-- 5 2 2
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 the day before the inspection date. Please call (408)777-
3228 from 7:30 - 3:30pm (Mon-Thurs) or 7:30 - 2:30pm (Friday) to schedule the next day 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. Progress
and 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. Progress Inspection is required when approximately 50% of roof covering is installed.
7. 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.
8. 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 of$126.00. 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 mono 'de detectors are required to be installed in accordance with Sections R314 and 8315 of
the 2010 California Residenti
Signature of Applicant/Age �"� {t Date:
ReroofPolicv_2011.doc revised 02/16/11