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09120007 (2) CITY OF CUPERTIT O BUILDING PERMIT BUILDING ADDRESS: 1110 DERBYSHIRE DR CONTRACTOR:O'NEAL ROOFING INC. PERMIT NO:09120007 OWNER'S NAME: MYERS DAVID R AND MEREDITH 9021 WREN AVE DATE ISSUED: 12/01/2009 IER'S PHONE: 4082552964 GILROY,CA 95020 PHONE NO:(408)848-3958 ❑ LICENSED CONTRACTOR'S DECLAWIONBUILDING PERMIT INFO: BLDG ELECT PLUMB License Class C: Lic.# 46 O,? Q u� / MECH RESIDENTIAL COMMERCIAL Contractor 6;oe, � V Date /Z 1 hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: RE-ROOF TEAR OFF TWO ROOFS INSTALL 15/32 OSB (commencing with Section 7000)of Division 3 of the Business&Professions PLYBOARD 30LBS FELT PAPER ASTM LANDMARK 50YR Code and that my license is in full force and effect. SHINGLES CLASS 24SQ 1 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. 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 Sq.Ft Floor Area: Valuation:$8500 permit is issued. APPLICANT CERTIFICATION APN Number:36221037.00 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 source regulations per the Cupertino Municipal Code,Section 9.18. ' �' Issued by: Date: Signature Dat A /0 / 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 I,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, $ I2�� Business&Professions Code) Si ature of Appli ant: Date: I,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 1 hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE 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 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 Own r aut d ag O Q forthwith comply with such provisions or this permit shall be deemed revoked. Date: J CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I certify that 1 have read this application and state that the above information is I hereby affirm that there is a constriction lending agency for the performance of work's correct.1 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 constriction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save V nify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address C, and expenses which may accrue against said City in consequence of the granting 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. 1 understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERT NO REROOF CUPEkTINO PERMIT APPLICATION APN # h ,,� L U�� • 01 Date/�/�� Building Address: Owner's Name: ,o4, ;lld IW(� 67A S Phone #: Z j�- ,Z.7 !� HOA: Yes ❑ No If yes, provide lelter from HOA Contractor: Phone #: Val 76 —®?V L f , ��/6X Fax #: 'Y'Ot'-- Ng-S'? Z Cupertino Business License #: �--�3 Contractor License #: &�Z> 9S* Type of F;oof Covering: Existing: Proposed: ❑ wilt-Up Roof ❑ Built-Up roof Asphalt Shingles ❑ Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other (Specify) ❑ Other (Specify) �TN ber of existing coverings ❑ Provide I.C.C.E.S. Report # o be Removed ❑ Provide Mfgr. Installation Specs. oe Job Description: a '.1C' -mowl c cr 'S - jos l 1'Sr,�2 y aA,t c 16 CL Residential Commercial El 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: & 0��( Signature Revised 02/05/09 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-Ading 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 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 or.the job site at the time on inspection. I understand and will comply with the aboN a stated policy on re-roofing. Homeowner's Name: U�� Job Site Address: ll W-n' a I �� r irs � � 0 -mac Roofing Company Name:&Koh. 9 J Date: Applicant's Signature: r Greg Casteel Building Official Revised 07/30/08