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13050134 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7623 DUMAS DR CONTRACTOR:ROSSETTAS ROOFING PERMIT NO: 13050134 OWNER'S NAME: CHANG HENRY AND KAREN TRUSTEE 401 LINCOLN AVE DATE ISSUED:05/20/2013 OWNER'S PHONE: 4083918837 SAN JOSE,CA 95126 PHONE NO:(408)294-4400 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIAL11 License Class C— Lic.# (38 SQ'S)TEAR OFF(E)WOOD SHAKE,INSTALL(N) r n PRESIDENTIAL COMP Contractor SSc a ` IC nn' Date `�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 Section3700of the Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$23500 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:35925030.00 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 DAY RMIT 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 DAY CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the S Z D113 granting of this permit. Additionally,the applicant understands and will comply ate: with all non-point source regulations per the 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. ❑ OWNER-BUILDER DECLARATION Signature of Applicant: ✓' Date: rX0 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS 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.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: Health&Safety Code,Section 25532(x)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 I have and will maintain Worker's Compensation Insurance,as,provided for by the Health&Safety Code,Sections 25505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date: 0 �� 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 CONSTRUCTION LENDING AGENCY 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 s. REROOF PERMIT APPLICATION 10 COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 .(408)777-3228•FAX(408)777-3333•building Dcupertino.org M ClOt 1114. PROJECT ADDRESS: APN# OWNERNAME PHONE E-MAIL My- CI K0 -391'�w°3� CTTY TATE, FAX STREET ADDRESS CONTACT.NA-Inv ` PHONE V E-MAIL, . �nss�a o� "2r1 STREET ADDRESS `% r /t cr9 Sam . 1,,, 0. n Z FAX ❑ OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT CONTRACTOR ❑CONTRACTORAGENT ❑ ARc=cT13 ENGINEER 11 DEVELOPER ❑TENANT N LICENSENUMBERp LICENS J��jj/ BUS.LIC.# CONTRA sss 6-to a COMPANY NAME - fB 1 flc FA 40U 400 2qf � _W . STREET ADDRESS . CITY, TE,ZIP ol ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC.# COMPANY NAME E-MAIL FAX .STREET ADDRESS CITY,STATE,ZIP PHONE USE OF IRS.FD Or.DupleX. ❑ Multi-Family ROOF AREA: VALUATION: sTxuLCruuRE: . E1Commercial 3 EXISTING ROOF.TYPE: ❑BUILT-UP ROOF '❑ASPHALT SHINGLES WOOD SHAKES ElWOOD SHINGLES 11OTHER(SPECIFY) REMO /iLEPLACE;�.YES IF NO, PLYWOOD ❑%:^ ❑ PLYWD ❑OSB PTTCH: // ROOF ❑NO #LAYERS: THICKNESS: ❑5/8^ TYPE: ❑ CDX -1A—'12 CLASS: A ICC-ES REPORT# PROPOSED ROOF TYPE: .❑BUILT-UP ROOF PASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES Cl OTHER DESCRIPTION OF WORK �+ ' le yam•. .O RZ�4J itS C-�'3WJD N 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 buildinaftonstruction. I au representatives of Cupertino to enter the above-id tifie property for inspection purposes... Signature of Applicant/Agent: Date: `3 SUPPLEMENTAL INFORMATION REQUIRED ••--• _If building is associated with a Home Owner's Association,provide letter of approval from HOA. Provide Planning approval to verify if there any restrictions. - . u Provide copy of Manufacturer's Installation Specifications. . _ Provide signed copy of Cupertino's'rear-Off Policy. Reroof4pp_2011.doc revised 03/16/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION Lai ADDRESS: 7623 DUMAS DR DATE: 05/20/2013 REVIEWED BY: MELISSA APN: 359 25 030 BP#: "VALUATION: 1$23,500 *PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof PRIMARY PENTAMATION SFD or Duplex 1 SFDWLROOF USE: PERMIT TYPE: � WORK 38 SQ'S TEAR OFF E WOOD SHAKE INSTALL N PRESIDENTIAL COMP SCOPE FEE ID ROOF AREA s.f. 1REROOFFRES 3,800 .,tech.Plan(.heck. Ph imb.Plan Check Elec.Plan(.heck Nfech. Permit Fee: Plumb.Permit FCC: Elec. Permit Fee: Ocher Afech. Insp. Other Plumb Insp. Other Elec.Insp. Alech. Insp.Fee: Plumb.hisp.fee: flee.Insp.Fee: NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). Theseees are based on the prelinddha information available and are only an estimate Contact the De t or addn'1 info. FEE ITEMS (Fee Resolution 11-053 E{: 7/1/12) FEE QTY/FEE MISC ITEMS Plan Check 17ce: Suppl. PC Fee Phimb.iiYlech.,/Elec, Permit Fee: $570.00 .Supp/. Insp Fee Plum h.Alfech./E lee Plurnh./Mech.il,;lec Permit Fee: C,"onslruction Tax: Administrative Fee: Work Without Permit? ®Yes (E) No $0.00 Advanced Planning fees: Travel Docuinentation f ees: Strom Motion Fee: IBSEISMICR $2.35 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 ` $573.35OTLFE. $573.35 g am# w a� (� Revised: 04/29/2013 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 GUpER1rIN0 (408)777-3228•FAX(408)777-3333•buildinga a—cupertino.ora PROJECT ADDRESS APN# OwfIERNA2v1E 'p� j�I PHON �� )-bFi�j� &MAIL STREET ADDRESS' l lZi cc�Y, STA E,ZIP (/ FAX 2 ya 2; s� nVy 1 CONTRACTOR n LICEN LICENSE BUS.LIC.# COMPANY NAMES �( IIMAII P 4X�p- /J-7�r,CI STREET ADDRES C^ STA ,ZIP PHONEp _l - Yb� r. ok_ 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. Aroofing which is applied without first obtaining an approved inspection will ny 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'/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 re ed to be installed in accordance with Sections R314 and R315 of the 2010 California Residential Code. Signature of Applicant/Agent: Date: Za 3 ReroofPo1icy_2012.doc revised 1017/12