09120020CITY OF CUPERTIP O BUILDING PERMIT
BUILDING ADDRESS: 20875 VALLEY GREEN DR CONTRACTOR: FIVE STAR ROOFING PERMIT NO: 09120020
OWNER'S NAME: WOODMONT CORP 387-A UMBARGER RD DATE ISSUED: 12/02/2009
VER'S PHONE: 6505923960 SAN JOSE, CA 95111 PHONE NO: (408)972-7855
❑ LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic. #
Contractor
Date
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:
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
permit is issued.
APPLICANT CERTIFICATION
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,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all - nt source regulations per the Cupertino Municipal Code, Section
9.18.
Sign Datel�� d4
CJ OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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
construct the project (Sec.7044, Business & Professions Code).
1 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
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
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, after making this certificate of exemption, I
become subject to the Worker's Compensation provisions of the Labor Code, I rut
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION
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
nify and keep harmless the City of Cupertino against liabilities, judgments,
and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
MECH r- RESIDENTIAL f- COMMERCIAL f—
JOB DESCRIPTION: RE -ROOF REMOVE EXISTING 1 -LAYER BUR SYSTEM
REPAIR
DECK AS NEEDED, INSTALL NEW 3PKG (ROSIN,BASE,2
GLASS & GRAVEL)SYSTEM CLASS A 16SQ
Sq. Ft Floor Area:
Valuation: $53963
APN Number: 32609064.CARPRTS I Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 D YS FROM ST CALLED INSPECTION.
�- • 6
Issued by: � Date:
RE -ROOFS:
All roofs shall bei rior to any roofing material being installed. If a roof is
installed witt rrst obtaining inspection, I agree to remove all new materials for
inspection.
Signature of Applican . Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
1 have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
-Uc#lth & Safety Code, Sections 25505, 25533, and 25534.
ne or authorized agent:
Date:
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Signature_ Date
Licensed Professional
-� CITY OF CUPERTINO 2, 0 C ->A#
REROOF
CUPEkT1NO PERMIT APPLICATION
APN # // f
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Date:
sal GAP
Building Address: -
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Owner's Name:
Phone #:
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HOA: Yes ❑ No es,
rovide leiter from HOA
Contractor:
Phone #: 4,10 s q �,;Z
Fax #: (x/69) %7_-� - ?�
Cupertino Business License #:f/�J
1 d g
#:
Contractoor License1-(17-717
Type of Roof Covering:
Existin
Propose --
Built-Up Roof
Built -Up roof
❑ Asphalt Shingles
❑ Asphalt Shingles
❑ Wood Shakes
❑ Wood Shakes
❑ Wood Shingles
❑ Wood Shingles
❑ Other (Specify)
❑ Other (Specify)
Number of existing coverings
❑ Provide I.C.C.E.S. Report #
�o be Removed
❑ Provide Mfgr. Installation Specs.
Job Description:��,., „� c� X� f� % - /� y e.^ u ✓� s s 7.' �ti=-
(a g -y Q A-' C1( +� J
c ✓
Residential
Commercial
Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if
Green Building Checklist & attach it
to the application or if there are any restrictions: ❑
applicable, include in plan set & the
sheet index.
Valuation:
o c�
ead, Understand and Will Comply with Cupertino's Tear -Off Policy:
Signature
Revised 02/05/09
i CITY OF C UPERTINO
'' RE1�.00F
CUPEkT]NO FEE SCHEDULE
Number of
Squares
Fee ID
Fee Description
Fee
Group
Permit Type
1REROOFCOM
Re -roof Coinmercial
B
1COMMLROOF
1BEBSC
Cal Bldg Standards
Commissio 1 Fee
B
ALL PERMIT TYPES
1BSEISMICO
Seismic Commercial
B
1RER00FRES
Re -roof Residential
B
1SFDWLROOF
1BCBSC
Cal Bldg Standards
Commissio 1 Fee
B
ALL PERMIT TYPES
1BSEISMICRE
Seismic Residential
B
1 b
1 REROOFMRES
Re -roof ML lti-Family
B
1MFDWLROOF
/
1BCBSC
Cal Bldg Standards
Commissio l Fee
B
ALL PERMIT TYPES
J
1BSEISMICRE
Seismic Re;,,idential
B
1BUSLIC
Business License
B
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408) 777-3228
Fax: (408) 777-3333
Building Department
Subject: Re -roofing policy for the City of Cupertino
1. Prior to permit issuance, you must agree to comply with 2007 IBC Standards
and manufacturers specifications on r: -roofing. All roofs are Class "A" per Cupertino
municipal code 16.04.080.
2. New roof coverings shall not be applied without first obtaining all inspection
and written approval from the building inspector. A final inspection and
approval shall be obtained from the b-.iilding inspector when the re -roofing
is completed.
3. All roofs shall be inspected prior to ar.y roofing installation.
4. To receive a final sign off from the City, the following steps are
required:
1) Pre -inspection and/or tear off app: -oval.
2) In -progress inspection approval.
3) Final inspection approval.
a) Spark arrester installation.
5. If plywood is installed, a plywood nail inspection is required.
6. Any roofing which is applied without first obtaining an inspection,
will require the removal of all new me.terial down to the sheathing,
so a proper City inspection can be performed.
7. NOTE: If you call for a plywood nail inspection and the job is not ready,
you will be charged a re -inspection fee of $176.18. The re -inspection fee must
be paid before another inspection can be scheduled.
IMPORTANT:
1. Flat roofs must have a minimum of 1/4 " per foot slope and demonstrate
that there is no ponding.
2. An I.C.B.O. report is required to be on the job site at the time on inspection.
I understand and will comply with the above stated policy on re -roofing.
Homeowner's Name:
Job Site Address: 2 U RTS
Roofing Company Name:
Applicant's Signa = ti Date: - A v 9
Greg Casteel
Building Official
Revised 07/30/08
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408) 777-3228
Fax: (408) 777-3333
Building Department
Subject: Re -roofing policy for the City of Cupertino
1. Prior to permit issuance, you must agree to comply with 2007 IBC Standards
and manufacturers specifications on r roofing. All roofs are Class "A" per Cupertino
municipal code 16.04.080.
2. New roof coverings shall not be applied without first obtaining all inspection
and written approval from the building inspector. A final inspection and
approval shall be obtained from the b gilding inspector when the re -roofing
is completed.
3. All roofs shall be inspected prior to ar.y roofing installation.
4. To receive a final sign off from the City, the following steps are
required:
1) Pre -inspection and/or tear off approval.
2) In -progress inspection approval.
3) Final inspection approval.
a) Spark arrester installation.
5. If plywood is installed, a plywood nail inspection is required.
6. Any roofing which is applied without first obtaining an inspection,
will require the removal of all new material down to the sheathing,
so a proper City inspection can be performed.
7. NOTE: If you call for a plywood nail inspection and the job is not ready,
you will be charged a re -inspection fe,� of $176.18. The re -inspection fee must
be paid before another inspection cal be scheduled.
IMPORTANT:
1. Flat roofs must have a minimum of 1/4 " per foot slope and demonstrate
that there is no ponding.
2. An I.C.B.O. report is required to be or the job site at the time on inspection.
I understand and will comply with the above stated policy on re -roofing.
Homeowner's Name: r`
Ar
Job Site Address: 2c) i 7S A77
Roofing Compand�o e: A1 L — r-eZA
Applicant's Signa - Date:
Greg Casteel
Building Official
Revis !d 07/30/08
SO
CITY OF
�MkTINO
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Building Department
OB ADDRESS: - _ j'
PERMIT #
OWNER'S NAME:
PHONE
GENERAL CONTRACTOR:
FAX #
I am not using any subcontractor3'
Si;nature Date
Please check avvlicable subcontractors and complete the following information:
Owner/ Contractor Signature
Date
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/ Contractor Signature
Date