11050104 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19990 OLIVEWOOD ST CONTRACTOR:GORMAN ROOFING PERMIT NO: 11050104
SERVICES,INC
OWNER'S NAME: ESSEX PROPERTY TRUST 2229 E UNIVERSITY DR DATE ISSUED:05/23/2011
ER'S PHONE: 6508151622 PHOENIX,AZ 85034 PHONE NO:(602)262-2423
❑ LICENSED CONTRACTOR'S DECLARATION
Q BUILDING PERMIT INFO: BLDG ELECT' - PLUMB
License Class C 3 1 Li # v
MECH r RESIDENTIAL r COMMERCIAL r
Contractor ^�V 1 A A-, 10 ia[e a
1 hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:APTS A-D,RE-ROOF OVERLAY EXISTING ROOF WITH
(commencing with Section 7000)of Division 3 of the Business&Professions POLYURETHANE FOAM-24 SQUARES
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
1 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
Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area: Valuation:$8232
permit is issued.
APPLICANT CERTIFICATION APN Number:31643003.19990 Occupancy Type:
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 PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and 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 so rc egulations per the Cupertino Municipal Code,Section
9.18.
Signature Date a3 Issued by: Date:
L OWNER-BUILDER DECLARATION
RE-ROOFS:
I hereby affirm that I 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
1,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) Signat A pli t: 0-.O� Date:
1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I hereby affirm under penalty 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 permit is issued. California Health&Safety Code,Sections 25505,25533,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 Health&
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 Health&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 Owner o; ut rized agent: I
forthwith comply with such provisions or this permit shall be deemed revoked. Date:
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
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 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
i-' -unify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
and expenses which may accrue against said City in consequence of the
gi,,iting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. I understand my plans shall be used as public records.
Signature Date Licensed Professional
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION �\
10300 TORRE AVENUE •CUPERTINO, CA 95014-3255
CUPERTINQ (408)777-3228•FAX(408)777-3333•building cDcupertino.org
PROJECT ADDRESSO A
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OWNER NA , PHONE ` E-MAIL
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STREET ADDRESS CITY, STATE,ZIP /' FAX
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❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT �NTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME GN A-i LeTj
LICENSE NUMBER—n 4 4� LICENSEcTYPQE BUS.LIC.# 21-27 q0
COMPANY NAME E-MAIL FAX
STREET ADDRESSCITY TE,ZIP PHONE -75
ARCHITECTIENGINEER NAME LICENSE NUMBER BUS.LIC.#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑ SFD or Duplexulti-Family ROOF AREA: VALUATION:
;TRUCTURE: ❑ Commercial 3
EXISTING ROOF TYPE: LeBUII.T-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY)
REMOVE/REPLACE El YES IF NO, 1 PLYWOOD h" ❑ PLYWD ❑ OSB PITCH: ROOF
NO 1.#LAYERS- l THICKNESS: ❑ 5/8" TYPE: ❑ CDX s •12 CLASS: A
PROPOSED ROOF TYPE: 11BUILT-UPROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES 'OTHER TWAros ICC-ES REPORT#
DESCRIPTION OF WORK: A-s. is)tl Ck A �01 d-W'\
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 provideis correct. I have read the Description of Work and verify it is accurate. I agree o comply with all applicable local
ordinances and state laws relating to bui on tru tion. I authorize representatives of Cupertino tc enter the above- entified property for inspection purposes.
Signature of Applicant/Agent: Date: b1
SUPPLEMENTAL ORMATION REQUIRED ___-� - �02
If building is associated with a Home Owner's Association,provide letter -'p>Alscescxrr 2 � uo stip k
of approval from HOA. MovEiixai cotlrI�Ea� �- ❑ sUII,DIIJG ZSY AN REVIF W x
_Provide Planning approval to verify if there any restrictions.
EXPRESS T❑ "PSA-LVl`tINGPLhNREOIEW
_Provide copy of Manufacturer's Installation Specifications. -
+
—Provide signed coPY Of Cu ertino's Tear-OfPolicy.
_ -
Reroof4pp_2011.doc revised 03/02/11
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION
ALBERT SALVADOR,P.E.,C.B.O.,BUILDING OFFICIAL
2 90300 TORRE AVENUE•CUPERTINO,CA 95014-3255.
CUPERTINO
(408)777-3228• FAX(408)777-3333•buildinaC��pertino.orp
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PROIEcrADDRESS 99 (0 011
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OVYWER NAME�SgE XNape �- PHONE E-MAIL
STREET AD
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CONTRACTOR NAME LICENSE ER LITE-9A
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COMPANY NAME E-MAIL FAX
STREET ADDRESSO s C S ATE.ZIP
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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 shall be scheduled the day before the inspection date. Please call (4013)777-
3228 from 7:30 - 3:30pm (Mon-Thurs) or 7:30 - 2:30pm (Friday) to schedule the next day inspection.
On the day of the inspection, a building inspector will be available within one hour for either a Tear-Off
Inspection or Nailing Inspection if you call again on that day between the hours specified.
3. The following inspections are required:
a. 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 Docked-down or removed prior to this inspection.
b. If plywood is installed, a plywood Nailing Inspection is required.
c. Progress Inspection is required when approximately 50% of roof covering is installed.
4. New roof coverings shall not be applied without first obtaining all 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.
5. A final inspection and approval shall be obtained from the building inspector when the re-rooivsg 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.
6. 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 monoxide d ors are required to be installed in accordance with Sect, 14 and 8315 of
the 2010 California Residential Code.
Signature of Applicant/Agent: Date. 5 /
ReroojPoli&:20 Ldoc revised 02/16/11