11010080CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20875 VALLEY GREEN DR CONTRACTOR: NEMMER ROOFING
OWNER'S NAME: KORET FOUNDATION
V"NER'S PHONE: 4082530200
D LICENSED CONTRACTOR'S DECLARATION y
License Class ( Lic. # 7 / q 3 f
Contractors ate �'3 —!
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:
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 w'c 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
ffl
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, applicant understands and will comply
with all non -poi source regul i the Cupertino Municipal Code, Section
9.18.
Signature
OWNER -BUILDER DECLARATION
5348 AUDUBON PARK CT
FREMONT, CA 94538
PERMIT NO: 11010080
DATE ISSUED: 01/13/2011
PHONE NO: (510) 919-2930
BUILDING PERMIT INFO: BLDG [_ ELECT r PLUMB r
MECH [_ RESIDENTIAL r COMMERCIAL r
JOB DESCRIPTION: BLDG 706 -CARPORT 1,2,5 & 6 - RE -ROOF TEAR OFF TAR
& GRAVEL & INSTALL SAME REPLACE ANY DRYROT.
INSTALL RED ROSIN, BASESHEET & 2 PLYS AND GRAVEL
[ hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
[, 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
construct the project (Sec.7044, Business & Professions Code).
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
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 must
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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
+.s, and expenses which may accrue against said City in consequence of the
.rating of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Signature_
Sq. Ft Floor Area:
Valuation: $44840
APN Number: 32609064.CARPRTS I Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued b
Date_ 1-3'Itl
RE -ROOFS:
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. `r -,/3 l�
Signature of Applicant:4�Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I 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
Health & Safety Code, Se 5505, 25533, and 25534.
Ow r author' f �% 3
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.
Date I Licensed Professional
REROOF TEAR -OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
CUPERTINO 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333 - building(�i_)cupertino.org
PROJECT ADDRESS ifv ,jo,„ ree►� J T(-,,qe
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APN#
OWNER NAME
PHONE - ..- ^„
E-MAIL
STREET ADDRESS c..7�.� ` I la`� V�
11, STATE ZIP �2
FAX
CONTRACTOR NAME�On .� `-e1 mro Q r
LICENSE N�JAjB J_qT
LICE^ SEXY
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BUS. LIC. #
COMPANY NAME e� �•
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E-MAIL
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FAQ
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STREET ADDRES ✓ �V I(I G1ii l
CITY re`rY` IP CA 1 ���
PHONE - /G% - ; / 3 o
I UNDERSTAND AND AGREE TO THE FOLLOWING:
The re -roof project shall comply with all applicable provisions of the 2007 California Building Code.
2. You must schedule all needed inspections a minimum of one day before the requested inspection date.
Please schedule inspections online or call (408)777-3228 between 7:30-3:30 (Mon -Fri).
3. Tear -off roof inspection is required. Please call for tear -off inspection after the roof is torn off and all
the nails/fasteners have been removed. Any and all dry -rotted wood shall be replaced prior to this
inspection. A building inspector will be available within one hour.
There are special hours for this service: 7:30 — 10:30am and 1:00 — 3:30pm (Mon — Thurs);
7:30 — 10:30am and 1:00 — 2:30pm (Friday).
4. If plywood is installed, a plywood nailing inspection is required.
5. In -Progress roof inspection is required. Call for an in -progress roof inspection to verify building is
weather tight after installation of approximately 25% of the roofing material.
6. New roof coverings shall not be applied without first obtaining all inspections 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.
7. A final inspection and approval shall be obtained from the building inspector when the re -roofing is
complete. 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 must 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.
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 be I unders agree to comply with the re -roof policy stated above.
Signature of Applicant/Agen Date:
ReroofPolicy_201 0. doc revised 05/17/10
CITY OF CUPERTINO
-viv>c >cCT7M A TFnI] — RTTTT ,n"INC nIVIRInN
FEE ID ROOF AREA
s.f.
1REROOFMRES 14,300
ADDRESS: 20875 valley green dr #706
DATE: 01/13/2011
REVIEWED BY: bobs.
APN: I BP#: "VALUATION: $44,840
*PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re -roof
PRIMARY
USE: Multi -Family Dwelling __T>3
Buildina is
Stories ® Yes (F) No
PENTAMATION 1 R2ROOF
PERMIT TYPE:
WORK
4car ort roof tear offs only, tar and gravel, class A 143 squares
SCOPE
Phold). Iil"h.
FEE ID ROOF AREA
s.f.
1REROOFMRES 14,300
a ii ..,i _ —i., _ n.4-nia /'nntaM /ho Dont far addn'l info.
Nui,E: mese fees are ouseu un tree reurrur•u• v 6•• �•
FEE ITEMS (Fee Resolution 09-05I E '. 7i1%701
;I'l,"lt. Plan Chcrk
Phnttl�>. 1'lun ('iret'!, �
Eie,'. l'iart C`h,(
L1c'cr`t. P'r't tit I't'i':
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L;lec. Powlii t";,
Other. Akch. Insp,
P-
Uth , 1>icc Irish.
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a1�rc{t. Imp. Fcc
Phold). Iil"h.
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Nui,E: mese fees are ouseu un tree reurrur•u• v 6•• �•
FEE ITEMS (Fee Resolution 09-05I E '. 7i1%701
•••�••��•• ..
FEE
- --
QTY/FEE
--
MISC ITEMS
Plan Check Fee:
Sllppl. PC.' Fee
PlTllt117.;.1:Ict'It.;'I:'Ic'c; Plan (711c'c:k:
Permit Fee:
$1,859.00
Snpp/. hisp Fee
Plrnnl�. %_11et 1i.'I:lec: t %nit Fee:
hltaTil�. ,"��TkCl!✓1�IPC 1"cri71itFcc:
(construction 7,ax
ri t;O LLSI'lCf t I llt' 1'JE'11` �` F'(':
Work Without Permit? ® Yes 0 No
$0.00
Plannin), Fees:
7 i-cavel l )ocitlne'ntatitm 1' e'.C.S:
Strong Motion Fee: IBSEISMICR
$4.48
Select an Administrative Item
Bldg, Stds Commission Fee: 1BCBSC
$2.00
SUBTOTALS:
$1,865.48
$0.00"TOTAL FEE:
$1,865.48
Kevisea: uitustzu-i-i
CITY OF
CUPERTINO
CITY OF CUPERTINO
REROOF
PERMIT APPLICATION
/l cel 00�-o
APN #
0q
-
If residential, is house an Eichler? Yes ❑ No N If yes, needs planning approval.
Building Address: Z� 9-s_�� ( ����
V r� ��e e,r` � r � v ,5 - � C 1
Owner's Name: nc ,o -V k Phone #:
HOA: Yes ❑ No [E If yes, provide letter from HOA
Contractor:
Phone #: 510 — C)
Fax#:
Cupertino Business License #:
Contractor License #:
� y C)
Type of Roof Covering:
Existing: Proposed:
,s Built -Up Roof --�k 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 #
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description: f,
d
7`
�
R �
Av��
Reside tial ,gym �` S �n l� Commercial ❑ c i,
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:
i Have Read, Understand and Will Comply with Cupertino's Tear -Off Policy:
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