13050124 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22356 RANCHO DEEP CLIFF DR CONTRACTOR:SORENSON& PERMIT NO: 13050124
ASSOCIATES ROOFING INC
OWNER'S NAME: MARY BARRY PO BOX 786 DATE ISSUED:05/16/2013
OWNER'S PHONE: 4082551989 BRENTWOOD,CA 94513 PHONE NO:(925)626-7682
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIAL❑
License Class�o�r7 Lic.# 6 **CLUB HOUSE ONLY**NOT PRIVATE UNIT**
TEAR OFF(E)WOOD SHAKE,INSTALL(N)PRESIDENTIAL
Contractor&),e44,,, iQ o�.,zx-pate AA:- 3 COMP SHINGLE - a2 'wCj
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. Sq.Ft Floor Area: Valuation:$61000
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:35602047.00 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 UERMIT 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 180O 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 /6
granting of this permit. Additionally,the applicant understands and will comply Issued b
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature A Date s.*13 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 -17
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: ALL ROO VERINGS 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)
1,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(a)should I store or handle hazardous
1 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 25505,25w,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: 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
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 certifi 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
` 1
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION O '
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•building(Doupertino.orct
Qho
CUP.ER'i�:Tt+t '. � I
PROJECT ADDRESS �, /D /� APN# 2 L0 O Z O q
OWNERNAME /j�j `'�RvJlri'Y <j� MIT P S �7{ E-MAIL
�tkv�l� De O•W'I � .
ISTREETADDRES$ CITY,STATE,ZIP FAX
CONTACT.NAME ) 1 PG jQ(Gv�C O/'-GQ PHONE �ba'- ` 33.6 E MP IL
STREET ADDRESS !� IL CITY,STATE,ZIP ,fare �S e c,11, FAX
� ,C,!]S in/0,( J
ONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
❑OWNER 11 OwNER-BUILDER ❑ OWNER AGENT
CONTRACTOR NAME LICENSE VMCENSE 3 BUS.LIC.#
93yo
COMPANY NAME E-MAIL FAX
Sbr e i # ss J a'- .)err ` ••^ qL%G z 7.ici'
STREET ADDRSS ECITY,STA ,ZIP Q PHONE
0o
ARCHTTECT/ENGTNEERNAME / _ LICENSENUMBER BUS.LIC.#
COMPANY NAME E-MAIL FAX
STREET ADDRESS: CrTY,STATE,ZIP PHONE
USE of . r C3SFD or DupleX.' ❑ Multi-Family
ROOF AREA: w VALUATION:
STRUCTURE: . ❑ Commercial 1R Z
EXISTING ROOF.TYPH: ❑BUILT-UP ROOF: 13V W
ASPHALT SHINGLES OOD SHAKES ❑WOOD SHINGLES (�❑OTHER(SPECIFY)
REMOVE/REPLACE, YES IF NO. PLYWOOD 11%- ❑ �Lyr�E
PTTCH: ROOF
❑NO #LA THICKNESS: ❑51r '12 CLASS: A
ICC-ES REPORT#
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT 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 building construction. I au rize enres n___ tat�ives of Cupertino to enter the above-identified property for inspection purposes...
Signature of Applicant/Agent: Date: ! ^�
SUPPLEMENTAL TION REQUIRED C -Tis
_If building is associated with a Home Owner's Association,provide letter =-
of approval from HOA. o
Provide Planning approval to verify if there any restrictions.
_Provide copy of Manufacturer's Installation Specifications.
Provide signed copy of Cupertino's Tear-OffPolicy.
ReroofApp 201 Ldoc revised 03116111
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
{ ADDRESS: RANCHO DEEP CLIFF DR DATE: 05/13/2013 REVIEWED BY: MELISSA
APN: I BP#: *VALUATION: $61,000
*PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD or Duplex PENTAMATION 1SFDWLR00F
USE: P PERMIT TYPE:
WORK TEAR OFF WOOD SHAKE INSTALL PRESIDENTIAL DEMENSIONAL LIFETIME COMP
SCOPE
FEE ID ROOF AREA
s.f.
1REROOFFRES $,200
M EQ
n
Xlec:h. Plan Check Plumb, Plan Check Elec_ flan Check
Nlech.Permit Fee: Plumb.Permit Fee: Iles. Permir 1 ee:
Other :L9ecFi.Insp. Other Plumb Insp. Li Other Elec.Insp.
heck. Li
In.sp..Fee: Plumb.hasp.Fee: Elec.Insp,Fee
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). These fees are based on the prelindna inormation available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 E . 7f /f 1/12) FEE QTY/FEE MISC ITEMS
Plan Check Tee:
.Suppl. PC-Fee
Plumb.%illfech.;Elec
Permit Fee: $1,230.00
Suppl. Insp Fee
PI um b.Alvfech.;Elec
Plumb.i;Wech.lElec Permit Fee:
Consiruction :Tcax:
Adinini.strative Fee:
Work Without Permit? Yes No $0.00
Advanced Phanning Tees:
Travel Documentation Fees: �
Strong Motion Fee: IBSEISMICR $6.10 Select an Administrative Item
BldgStds Commission Fee: IBCBSC $3.00
j_gaon
g�x )c0' AL 1 239.10
3WE Is� . $1,239.10 $0.00 3 ....., k $ x
Revised: 04/29/2013
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
lot
CUpERT1K0 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333-buildingecuoertino.org
PROJECT ADDRESS Z V3[ -J
OWNERN Cf V V P
CnHO
GW
STREET ADDRESS Y, STATE,ZIP FAX
9
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC.#
5ore_Ns• t '-c&- y aye
COMPANY NAME p E-MAM FAX
SG rP/110 v K
STREET ADDRESS CITY,STATE,ZIP �P PHONE
lei�-�� e4 ��.s �3 '
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 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-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
Building Department
City Of Cupertino
- 10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: 408-777-3228
C U P E RT I N O Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: 2 23$6 *,Cj, QfV CM49t PERMIT# 3Os-dj 2
OWNER'S NAME: -U-19ltDtl�v PHONE# 6$ZSS—1
GENERAL CONTRACT R: r s f 14boc_ y BUSINESS LICENSE#
ADDRESS: PU 1),, -2�-4 CITY/ZIPCODE: �l3
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTIONS) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS"HAVE °OBTAINED A.CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information.
V SUBCONTRACTOR BUSINESS NAME ]BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring/Carpeting
Linoleum/Wood
Glass/Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting/Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date