13030092 (2) CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20810 PEPPER TREE LN CONTRACTOR:SOLIS ROOF REPAIR PERMIT NO:13030092
OWNER'S NAME: MICHELE LUM 2789 GUM DROP DR DATE ISSUED:03/19/2013
OWNER'S PHONE: 4083152960 SAN JOSE,CA 95148 PHONE NO:(408)238-9233
13 LICENSED'CONTRACTOR'S bECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
License Class C Lic.# �,3ftp�E TEAR OFF(E)WOOD SHAKE,INSTALL PRESIDENTIAL
Q COMP,CLASS A
Contractort` --ow- 1NbO a0`1Z- Date t (�
I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000)of Division 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:$13700
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:35911041.00 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 DAYS 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 DAYS FROM T CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments, e
costs,and expenses which may accrue against said City in consequence of the
Is
Date: 7
granting of this permit. Additionally,the-applicant understands and will comply
with all non-point source regulations per Cupertino Municipal Code,Section
9.18. RE ROOFS
Signature Date 3 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 materials for
inspection.
❑ OWN -BUILDER DECLARATION
Signature of Applic ate:
I hereby affirm that I am exempt from.the Contractor's License Law for one of
the following two reasons: ALL ROOF CO E GS TO ASS"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)
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: s 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
1 have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533 nod 25534.
Section 3700 of the Labor Code,for the-performance of the work for which this Owner or authorized 9g Date'Z3
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 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 theabove information is t
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.
Signature Date
- V
REROOFPERMIT APPLICATION pQ Cl
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 �O
CUPERTINO (408)777-3228 FAX(408)777-3333•building0t).cupertino.org \
PROJECT ADDRESS
Q . ..��7-� ._ I APN# 35
OWNER NAME ` l•- O / r7 /T EMAIL
IVB 1 .1\ L V
STREET ADDRESS
F.r �n
CITY,STATE, ,na FAX
CONTACT NAME PHONE ✓ E-MAILnO(l`iRi7T1`G
STREET ADDRESS Qa� (: w, CITY,STATa kyr/ FAX
l�(9
OWNER- ❑ OWNER-BUILDER ❑ OWNER AGENT 9---CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME 1 r Jn� LICENSE ER r a/ LICENSr BUS.LIC.#
COMPANY NAME T 7 7- ! E-MAIL r roof �� FAX
STREET ADDRESS/r/J g/I IC/�'(%«A't 9 V C T Ped
G�C_��', PHOTT jay6 y
ARCHITECT/ENGINEER'NAME LICENSE NUMBER C c•/ BUS.LIC.#� L
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF R"SFD or Duplex ❑ Multi-Family ROOF AREA: E VALUATION: �
- STRUCTURE: ❑ Commercial Z-3> � 7"/J`�
EXISTING:ROOF TYPES�,//❑BUILT-UP ROOF ❑ASPHALT SHINGLES OOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY)
.REMOVE/REPLACE L+JYES IF NO, - - PLYWOOD /:" ❑ PLYWD EhOSB PITCH: ROOF
❑NO #LAYERS: THICKNESS: ❑ 5/8" TYPE: ❑CDX '12 CLASS: L1
ICC-ES REPORT#
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF 11ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER
DESCRIPTION OF WORK:'
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 correct., I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances.and state laws relating to buildin onstructio . I e representatives of Cupertino to enter the above-� ifi property for inspection purposes.
Signature of Applicant(Agent, Date:
SUPPLEMENTAL INFO ON REQUI D _
If building is associated with a Home wner's Association,provide letter
of approval from HOA.
Provide Planning approval to verify if there any restrictions.
Provide copy of Manufacturer's.Installation Specifications.
Provide signed copy of Cupertino's Tear-Off Policy.
ReroofApp_2011.doc revised 03/16/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 20810 PEPPER TREE LN DATE: 03/19/2013 REVIEWED BY: MELISSA
APN: 35911041 BP#: "VALUATION: 1$13,700
*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 PRESIDENTIAL COMP CLASS A
SCOPE
:L1ech.Plan Check rPhanb. 7Cheek Flee.Plan Check
Gtech.Permit Fee: Permit Fee: Elec.Permit f ee:
_L_Ocher.Vech.Insp: Other Plumb Insp. Other Elec.Insp.
N.fech.Insp.Fee: Plumb. Insp.Fee: Elec.Insp.Fee:
NOTE:This estimate does not includefees due to other Departments(Lem Planning,Public Works,Fire,Sanitary Sewer District,:School
District etc). These ftes are based on the pregmin information available and are only an estimate. Contact the Dept-for addn7 info.
FEE ITEMS (Fee Resolution 11-053 E . 711112) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 2,300 s.f. Re-roof
Suppl.PC Fee: G) Reg. Q OT 0.0 hrs $0.00 $345.00 IREROOFRES
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp.FeelD Reg.. 0 OT 0,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Conswuction Tax:
A.dininistrative.Fee:
Work Without'Permit? 0 Yes 6) No $0.00
Advanced Planning Fee: $0.00 Select a Non-Residential
Travel DoetwnentativnFees: Building or Structure
Strong Motion Fee: IBSEISMICR $1.37 Select an Administrative Item
Bldg Commission Fee: IBCBSC $1.00
$2.371 $345.00 - $347.37
Revised: 0'1/01,/2013
REROOF TEAR-OFF POLICY
Ell COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERTTNO (408)777-3228•FAX(408)777-3333•building
a-cupertino.ora
PROJECT ADDRESS 9/��(�� Y•`Q Q-• -n APN# �[� I n Lt/
OWNER NAME Oi((�sh, �` LoLtir • I PHON ��S��}�Q E-MAIL C/
STREET ADDRESS , l CITY, TATE,ZIP �C FAX
LVI -;C4-
CONTRACTOR NAMFy./^�, r� LICENSE NUMBER` LICENSE T BUS.LIC.#
-CL Ih n (� FAX
COMPANY NA 142-rwrF Q,lf�p��
Iola?I?Wr �e, cr EJ
STREE.T'ADDRESS/. p e,(" CITY �TE', i�,
.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 un 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 I/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-siteto 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 re ired to be installed in accordance with Sections 8314 and 8315 of
the,2016 California Residential CodQ.
Agent�' Date:
Signature of Applicant/ j 3.
ReroofPolicy_2012.doe revised 10/7/12