13050161 Id
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21601 STEVENS CREEK BLVD CONTRACTOR:PLATINUM ROOFING PERMIT NO:13050161
INC
OWNER'S NAME: WONN ANNA TRUSTEE 1900 DOBBIN DR DATE ISSUED:05/22/2013
OWNER'S PHONE, 40844619$6 i;; SAN JOSE,CA 95133 PHONE.NO:(408)280-5028
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
RE-ROOF 36 SQ OVERLAY OF 6 MIL TPO SINGLY PLY
License Class Lic..#
CLASS A
Contractor: Date
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'
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:$23456
I have and wilt maintain Workers Compensation Insurance,as provided for by
Section 3700 of the Labor for the performance of the work for which this APN Number:32660001.00 Occupancy Type:
permit'is'issued.
APPLICANT CERTIFICATION
Icertify that I have!read this application and state thatthe 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 80 DAYS OF PERMIT ISSUANCE OR
to building Construction,anal hereby authorize representatives of this city to enter
upon the'above mentioned property fox mspectiorf purposes. (We)agree to save 180
DT
F M LAST CALLED INSPECTION:
indemnify and keep:hnrmlll thel City4Cupertino against liabilities,judgments,
costs,and expenseslwhrch may accrue•against said City in consequence of the
antro of thi a rat ddition'all thei pliant understands and will comply Issued by: Date:
with atl'non Quits urce' e:Cupertino Municipal Code,Section
918 li ' ;
/ RE-ROOFS:
Signature' ? Da ! All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed without first obtainin trap ee to remove all new materials for
l inspection.
❑ WNER-BUILDER DECLARATION
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 ROOF C S TO BE CLASS"A"OR BE : R
1,as.owner of the property,or my employees with wages as their sole compensation,
will doithe work,'and the structure isnot intended or offered for sale(Sec.7044,
Business&Pro fessops Bode) ,'
1,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sc:0044 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 penury 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 mI aintain 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 forwhich this permit is issued. will maintain comp r no unicipal Code,Chapter 9.12 and
I have and will maintain Workers Compensation,Insurance,as provided for by the Health&Safety ection 2 0 5533,and 25534.
Section3700 of the�Labot Code,for the performance of the work for which this Owner or authorized agent Dat
permit is issued.
I certify that in the performance of the work•for which this permit is issued,I shall
not employ any person inj any manner so as to become subject to the Worker's
Compensation lofaws Califomia.' If;afting er;
REROOF PERMIT APPLICATION
12 COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 hl�V
CUPERTIN4 (408)777-3228•FAX(408)777-3333•buildinga-cupertino.org I�
PROJECT ADDRESS Q / / v APN# O U ,
OWNER NAME ,no 11LE-MAIL
STREET ADDRESS CITY, STATE, IP 7 FAX
9SIO�
CONTACT NAME - O� PHONr O b 71 E-MAIL
_Se
STREET ADDRESSCITY,STATE,ZIP FAX
A2 V
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME/ LICENSE NUMBERLICENSE TYPE G� BUS.LIC.#
i J
COMPANY NAME la
E-MAIL FAX
4
STREET ADDRESS/P�00 0 ', CITY,STATE,ZIP �, ^ �� PHO ,/Og
ARCHITECT/ENGINEER NAME LICENSE NUMBER Y BUS.LIC.#a
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑ SFD or Duplex ❑ Multi-Family ROOF AREA: VALUATION: y
STRUCTURE: DVCommercial 6 r 1 �3,
EXISTING ROOF TYPE: BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY)
REMOVE/REPLACE ❑YES I IFN PLYWOOD PLYWOOD I1%x" ❑ PLYWD ❑ OSB PITCH: ROOF
5 0 #LAYERS: Q. THICKNESS: ❑ 5/8" TYPE: IVCDX ,�{/ c} '12 CLASS: A
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES u OTHER Jr ICC-ES REPORT#
DESCRIPTION OF WORK: SCJ
-r90 S14 419
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. 1 have read this
application and the information I have provided is correct. 1 have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relat u 721morize representatives of Cupertino to enter the above-identified property,for inspection purposes.
Signature of Applicant/Age I. Dat
SUPPLEMENTAL I R TION REQUIRED CE, SE' - k
If building is associated with Home Owner's Association,provide letters PLANOHECIC,FYPL houTaNc s>it rr
of approval from HOA. �]_ ovR�rlrcouNTEx L7=13uILDlNGPLANREIEW
Provide Planning approval to verify if there any restrictions. ❑ ExPrzws's ❑.^ANNmcPLAN REUI�W
Provide copy of Manufacturer's Installation Specifications. ❑'STArin�.Rn �( Rc DEPT, _
_Provide signed copy of Cupertino's Tear-Off Policy. ❑ OTHER
ReroofApp_2011.doe revised 03/16/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 21601 SCB DATE: 05/22/2013 REVIEWED BY: MENDEZ
APN: BP#: 'VALUATION: $23,456
*PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY PENTAMATION
USE: Commercial Building PERMIT TYPE: 1COMMLROO i
WORK RE-ROOF 36 SQ OVERLAY OF 6 MIL TPO SINGLY PLY CLASS A
SCOPE
FEE ID ROOF AREA
s.f.
1REROOFCOM 3,600
:'Meeh.Plan Check Plumb,Plan Check Elec.Plan Check
;Uech.Permit Fee: Plumb.Permit Fee: Elec.Permit Fee:
Lfe',h.
Afech.Insp. Other Plumb Imp. Cather Elec.Insp.
Insp.Fee: Pluutb.huh.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,eta). Theseees are based on the relimina information available and are onlyan estimate. Contact the De t or addn7 info.
FEE ITEMS(Fee Resolution 11-053 E . 7ff /1/12) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Supp1.PC.Fee
Plumb.iMech.lE
Permit Fee: $367.00
Suppl: jnsp Fee
Plulnb./Afech:/Elee
Plumb;/Mech.lElec.Permit Fee..
Construction :Tax:
Adininistrative.Fee;
Work Without Permit? ®Yes (j) No $0.00
Adv aced Plarnzing ees,
Travel Docurnentuti6n Fees'.
Strong Motion Fee: 1BSEISMZCO $4.93 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
MEMO REMONNIM
$372.93 $0.00 $372.93
Revised: 04/29/2013
lotREROOF TEAR'-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O.,BUILDING OFFICIAL
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPeR71N0 . . (408)777-3228 FAX(408)777-3333•buildinaecupertino.orp
FiROJECT ADDRESS
APN" N
PHONE E-MAIL
v�
STREET ADDRESS CITY, STATE,ZIP FAX
CO CT LICENSE ER LICENSE TYPE BUS.LIC.4
G S �/
EMAIL FAX.
CO i` f� ✓ W ✓IVd-
STREET ADDRESS CITY,STATE,ZIP PHONE
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 ori-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 8314 and R315 of
the 2010 California Reside
Signature of Applicant/Age Date:
ReroofPo1icy_2012.doc revised 1017112