13040186 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 11763 TRINITY SPRING CT CONTRACTOR:INTEGRITY ROOFING PERMIT NO: 13040186
OWNER'S NAME: JEAN CHAN 6820 MOSELLE DR DATE ISSUED:04/26/2013
OWNER'S PHONE: 4087822005 SAN JOSE,CA 95119 PHONE NO:(408)225-9263
�C LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIALE]
License Class Lia#
r (2100 SQ FT)TEAR OFF(E)WOOD SHAKE,INSTALL OSB,
GAF GRAND CANYON COMP
Contracto Date.
I here rr rat I am license under the provisions of Chapter 9
(comm in
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. Sq.Ft Floor Area: Valuation:$18078
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 APN Number:36653034.00 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 DAYSSSUANCE 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 DAY M LAST LED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of theDate: Z
granting of this permit. Additionally,the applicant.understands and will comply ed by:
with all non-point source regulations per the Cupertino cipal Code,Section
9.18.
RE-ROOFS:
Signatur Date All roofs shall be inspected prior to any roofing material being i talled:If a roof is
installed without first obtaining an' tion,I agree to rem o all new materials for
inspection.
❑ OWNER-BUILDER;DECLARATION L/��
I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applic Date:
the following two reasons: AL OVERINGS TO BE CLASS"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.70441 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: 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 Cupertin Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,
!e�
ns 2 0 , 5533,an 3
Section 3700 of the Labor Code,for the performance of the work for which'this Owner or authorized agen Date
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 TRUCTION 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 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 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
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION \n
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 1
CUPERTINO (408)777-3228•FAX(408)777-3333•building(a@cupertino.org `'17
PROJECT ADDRESS 11763 Trinity Springs Court APN# -366 , C 2 O
OWNER NAME Jean Chan PHONE 408-872-2005 E--MAIL
STREET ADDRESS 19123 Via Tesoro Court CITY,STATE,ZIP FAX
Saratoga, Ca 95070
CONTACT NAME PHONE E-MAIL
STREET ADDRESS CITY,STATE,ZIP FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT IN CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME Gregory E. Wilcox 760557 LICENSE NUMBER LICENSE TYPE C 3 9 BUS.LIC.#
COMPANY NAME Integrity Roofing greg@integrity oofing.net FAx -
STREET ADDRESS 6820 Moselle Drive CITY,STATE,ZIP San Jose, CA 95119 PHONE 408-225-9263
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC.#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE r
USE OF SFD or Duplex ❑ Multi-Family ROOF AREA: 2 V IV VALUATION:
$18, 078 . 00
STRUCTURE: ❑ Commercial
EXISTING ROOF TYPE:: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES IIr r� WOOD SHAKES ❑WOOD SHINGLES [3 OTHER(SPECIFY)
REMOVE/REPLACE IN YES IF NO, PLYWOOD 11 w, ❑ PLYWD 0 OSB PITCH: ROOF
❑NO I #LAYERS: IN
THICKNESS: 135/8" TYPE: 11CDX 6 .12 CLASS: A
PROPOSED ROOF TYPE: 13BUILT-UPROOF Iii ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT#
DESCRIPTION OF WORK:
Remove wood shakes Install OSB Sheathing, install Tiger Paw
Underlayment, Install GAF Grand Canyon Shingles .
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 provide is correct. I e read the Description of Work an fy it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to b 1 ' onstni �ia rep tat• of C o enter the above-identified property for inspection purposes.
Signature ofApplicant/Agent Date: 04/26/2013
SUPPLEMENTAL INF ATION REQUIRE OFFICE USE ONLY
If building is associated with a Home Owner's Association,provide letter PLANT
CHECKYPE ROUTING SLIP
of approval from HOA. OVER-T>[EcouTE
xR- ❑ BU[LbINGPLANREVIEW
Provide Planning approval to verify if there any restrictions. D"EXPRESS T1PLANNINGPLANREVkEW ,
Provide copy of Manufacturers Installation Specifications. ❑ sTaxnnRn ❑ FmE nErr
Provide signed copy of Cupertino's Tear-Off Policy. Ll QraER:
ReroofApp_2011.doc revised 03/16/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 11763 TRINITY SPRINGS CT DATE: 04/26/20137REVIEWED BY: MELISSA
APN: 3665 3 034 BP#: *VALUATION: $18,078
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY PENTAMATION
SFD or Duplex 1SFDWLR00F
USE:
PERMIT TYPE: i
woRK 2100 SQ FT TEAR OFF E WOOD SHAKE INSTALL OSB GAF GRAND CANYON COMP
SCOPE.
s
Il+r �P ,
sh. 4tp.
Xlech.Plan(.heck Plumb.Plan Check Elec.Plan(:;heck
Mech. PerwitFee: Plumb.Permit Pee: Elec. Permit Fee:
Other Afech.Insp, Other Plumb Insp. Other Elec.Insp,
A3ech.Insp.-Fee: Plumb. Insp.Fee: Elec.Insp.Fee:
NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,eta). Theseees are based on the relimina information available and are onlyan estimate. Contact the Det or addh7 info.
FEE ITEMS(Fee Resolution 11-053 E f 7/1/121 FEE QTY/FEE MISC ITEMS
Plan Check Feer $0.00 2,100 s.£ Re-roof
Suppl.PC Fee:. (E) Reg. ® OT 0,0 hrs $0.00 $315.00 1REROOFRES
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl.Insp.Fee-.0 Reg. ®OT 10.01hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Construction Tax:
Adininistrative:Fee:
Work Without Permit? ®Yes (E) No $0.00
Advanced Planning Fee. $0.00 Select a Non-Residential 0
Travel Uocrttnentutian.Fees: Building or Structure.
Strong Motion Fee: IBSEIS111ICR $1.81 Select an Administrative Item
B1dp,Stds Commission Fee: 1BCBSC $1.00
AMA H
wn a
I $2.81 $3115.001x OPAL $317.81
IN
11 nax
Revised: 04/01/2013
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE-CUPERTINO, CA 95014-3255
CUPERTINO
(408)777-3228•FAX(408)777-3333•building aC�.cupertino.ora
PROJECT ADDRESS
APN# 1'�(/ / — r O 3
OWNERNAME PHONE O i E-MAIL
JJ
STREET ADDRESS SITS STATE,ZIP FAX
cnorl
CONTRACTOR NAME LIC NSE DNS+BER LCENSEvYPE BUS.LIC.#
COMPANY NAME - E-MAILCob t FAX
t.Cjr144 i
STREET ADDJ -4 C STATE, PHONE
O Lir �J S
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 up 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 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,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 required to be installed in accordance with Sections R314 and R315 of
the 2010 California Residential Code.
Signature of Applicant/Agent: Date:
ReroofPo1icy_2012.doc revised 10/7/12