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13050161 (2) 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 OWNERS PHONE: 4084461956 SAN JOSE,CA 95133 PHONE NO:(408)280-5028 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL GOMMERCIAL� RE-ROOF 36 SQ,OVERLAY OF 6 MIL TPO SINGLY PLY License Class CLASS A Contractor' Date I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Seed on 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 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:32660001.00 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 eorrect',I'agree to complyj'with all city and;county ordinances and state laws relating WITHIN 80 DAYS OF PERMIT ISSUANCE OR to bedding coust;trctiop,;and hereby aNthorize representatives of this city to enter upon tlie'I above mentioned property for mspecUqu purposes. (We)agree to save 180 DA F M LAST CALLED INSPECTION indemnify and keep',harmless,the Crtylof Cupertino against liabilities,judgments, costs and expenses 1which may laccrue,against said City in consequence of the antro of this eniut ddhonall the,applicant understands and will comply Issued by: Date: J with a1Lrton point soq e a Cupertino Municipal Code,Section 918 li, RE-ROOFS:: Signature!' {'I• Dat l All roofs shall be inspected prior to any roofing material being installed.If a roof is installed without first obtaimymiiprs ee to remove all new materials for 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 reas'onsvz,reas'ons' ALL ROOF C S TO BE CLASS"A"OR BE , ER 1,as owner of the propertyor my'employees with wages as their sole compensation, will dolth'e work,and the'structurei. rsl,n6t 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 I have and Iwill 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$ection 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District L performance cf the work fo which this permit is issued. will maintain comp r7agent: , mo municipal Code,Chapter 912 and . I have and will rnaintam Workers Compensation_Insurance,as provided for by the Health&Safety0 5533,and 25534. Section 3700 of the Labor:Code for the performance of the work for which this Owner or authorizeDat permitis,issued. ,III I certify,that in the'perfor fiance of the work for which this permit is issued,I shall not employ any persop in any manner so.as to become subject to the Worker's Compensation laws of California I$after,making this certificate of exemption,I LENDING AGENCY 17 i becomei subject to the,WjTk'er s Compensation-provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of fotthwrtlilcomply,with such',provtsions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) L L; i Lender's Name '1 APPLICANT GaERTIFICATION Lender's Address 1 cert tbat I have,reaaj islapplicatign and state thatithe-above information is correct1II agree to c,.S pll?wirth all cry and county,ordinances and state laws relating to buil g cgpstriidt ;r'd herepy thonze representatives of this city to enter u u n tire!above e t ed roe tq mg action purposes. a agree to save a' p p I( p p rP �) ARCHITECT'S DECLARATION inoernn and keeps harmless the City of Cupertino against liabilities,judgments, costs aril expensesW�tac may'a�crue apaurst said City in consequence of the I understand my plans shall be used as public records. granting of this'pe rl ,Additionally the applicant understands and will comply with al�i}on Ipgintt�ce egullat ons per the Cupertino Municipal Code,Section Licensed Professional 9.1 8-' 18' LI„ ill l . .III i Srgnatnrel ! !I li I'' Date REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT- BUILDING DIVISION �\t 10300 TORRE AVENUE-CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228-FAX(408)777-3333-building a(-cupertino.org �5Dl7 PROJECT ADDRESS o[,p , �/ I�VeWv APN# �� `^ .0 O U 1 OWNERNAME HONE 11LE-MAIL �4mVo8 Z9.S-61 STREET ADDRESS S CITY, STATE, IP n' �.r FAX I O 9J 01 CONTACT NAME - Q� PHONr_* 6.0o 1 b E-MAIL STREET ADDRESS CITY,STATE,ZIP FAX ❑OWNER ❑ OWNER-BUILDER ❑.OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME/ LICENSE NUMBER Q/� LICENSE TYPE BUS.LIC.# n e COMPANY NAME // E-MAIL FAX STREET ADDRESSIgoo Y 0 CITY, PHO O8 S,b ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC.# COMPANYNAME E-MAIL FAX STREET ADDRESS - CITY,STATE,ZIP PHONE USE OF ❑ SFD or Duplex ❑ Multi-Family ROOF AREA: ,6 VALUATION- STRUCTURE STRUCTURE: Commercial 6 r l / •y S� EXISTING ROOF TYPE: BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY) REMOVE/REPLACE ❑YES IF NO, PLYWOOD 21%" ❑ PLYWD ❑ OSB PITCH: i ROOF lWN0 #LAYERS: Q. THICKNESS: 115/8" TYPE: VCDX c_�'12 CLASS: APROPOSED ROOF TYPE: ❑BUILT-UP ROOF El ASPHALT SHINGLES ❑WOOD SHAKES 11 WOOD SHINGLES OTHER J� ICC-ES REPORT# - DESCRIPTION OF WORK: Sy 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 1 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 relat u orize representatives of Cupertino to enter the above-identifid property,for inspection purposes. Signature of Applicant/Age t: Dat SUPPLEMENTAL[ R TION REQUIRED _If building is associated with Home Owner s Association,provide letter PLAN'czcxx>'>*� hotGsi ` ' of approval from HOA. p" t>uER rouMTx � BUIL111Nc P> �v REFSW r Provide Planning approval to verify if there any restrictions. ��©, priss © Pl �N�INCt'LAN�KEIIE r > f : Provide copy of Manufacturer's Installation Specifications. _Provide signed copy of Cupertino's Tear-Off Policy. Q oxxEa ReroofApp_2011.doc revised 03/16/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 21601 SCB DATE: 05/22/2013 REVIEWED BY: MENDEZ APN: BP#: *VALUATION: 1$23,456 *PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof PRIMARY Commercial Building PENTAMATION 1 COMMLROOF USE:. PERMIT TYPE: WORK RE-ROOF 36 SQ OVERLAY OF 6 MIL TPO SINGLY PLY CLASS A SCOPE FEE ID ROOF AREA s.f. 1REROOFCOM 3,600 Wch.flan Check Plumb.Plan Check Elec.Plan Check Lleclr. Permit Fee: Plumb.Permit Fee. Elec•.Permit Fee: LthNlech.In,sr� C?t/!er Plumb Insp, (Jther Elee.Insp. Li .Insp.Fee: Plumb. Insp.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.). Theseees are based on the relimina information available and are onlyan estimate Contact the De t or addn'l in o. FEE ITEMS'(Fee Resolution 11-053 E. 711112) FEE QTY/FEE MISC ITEMS Plan Check Fee: Suppl.PC.Fee Plumb.lMech.lFlec Permit Fee: $367.00 .Suppl: Insp Fee Plumb.lMech./l,lec Plumb:lMech.lFlec Permit T'ee;. C'f)l2StY Z!C llDYt .T['T.C: dministrative I � ee Work Without Permit? ® Yes 19 No $0.00 F�C,�LfInC`.et�PICTYlfZlnf�,7�''G'e5'; Cr�av l'Doczsrnentuti6rl Fees: Strong Motion Fee IBSEISMICO $4.93 Select an Administrative Item B1di�Stds'Cornmission Fee: 1BCBSC $1.00 $372.93 $0.00 $372.93 Revised: 64/29/2013 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 CUPERTIko (408).777-3228 FAX(408)777-3333•building aC-cupertino.org PROJECT ADDRESS APN# 0 .. .NAME . . PHONE E-MAIL, ' VY AJ ADDRESS CITY, STATE,ZIP FAX CO CT LICENSE / LICENSE TYPE BUS.LIC.# G S ,I EMAIL FAX. CO Il� l� WC /A/C 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-roofmg 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 R314 and R315 of the 2010 California Reside Signature of ApplicantJAge Date: ReroofPo1icy_2012.doc revised 10/7/12