13060073 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 6692 JOHN DR CONTRACTOR:R E ROOFING& PERMIT NO: 13060073
CONSTRUCTION INC
OWNER'S NAME: SITYNG SHIOU-PING 15230 CLYDELLE AVE DATE ISSUED:06/10/2013
OWNER'S PHONE: 4082570864 SAN JOSE,CA 95124 PHONE NO:(408)626-9320
LICENSED CONTRACT-OAR'S DE�7CLARATION JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIAL11
License CI Lic.# ` 2 l ` (22 SQ'S)TEAR OFF(E)COMP,INSTALL(N) 1/2'CDX
l 30 LBS FELT&LIGHTWEIGHT CONCRETE TILE(5.8 LBS
Contr for to PER SQ FT)
I hereby a irm 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:$20000
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:36923007.00 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 pi!57
T 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 D 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
granting of this permit. Additionally,the applicant understands and will comply e Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signa a::�� Date Al oofs shall be' spected prior to any roofing material being installed.If a roof is
i talled without fr an jnspe on,I agree to remove all new mate' s for
in ection.
❑ OWNER-BUILDER DECLARATION
Signatur Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: ALL ROOF-C INGS 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(See.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 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. * hance with the Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by th ealth&Safe Code,Sections 25505 25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this caner or authoriz d ge 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 CONSTCTION LENDING AGENCY
RU
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 P
ERMIT APPLICATION �
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION (_ O
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 IQ
CUPERTINO
(408)777-3228•FAX(408)777-3333•building a)cupertino.org ""!
\
PROJECT ADDRESS !,1 1_ I 1�p� 1, r APN# 2 6 Zf q - 3 / a �
OWNER NAME 'j I ^ 1 f' I� �- PHONE / E-MAIL V
STREET ADDRESt. `
� (^J :�' CITY,STATE, IP FAX
CONTACT NAME`M(� Tl Cj( 1V,��( `C PIAK141j UN
�V� j 1 l2t/ E-MAIL
STREET ADDRESS r(n�fl� CITY,STATE,ZIP 'j10 G)( .J FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME�l + LICENSE NUMBER _?n 7'� LICENSE TYP� ( BUS.LIC.#
COMPANY NAME 1 E-MAIL [ J I FAX �J I
STREET ADDRESS I / } Cog I`I GV G J CITY,STATE,ZIP I PHONE ��(�J ( - 1 2
ARCHITECT/ENGINEERNAME ll LICENSE NUMBER BUS.LIC.# G
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF SFD r Duplex ❑ Multi-Family ROOF AREA: i }+ VALUATION* r/7 (� 0
STRUCTURE: E] Commercial 22 Y 1 G-_0 1 O Uv.
EXISTING ROOF TYPE: ❑BUILT-UP ROOF ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLESTHER(SPECIFY)
007
REMOVE/REPLACE, S IF NO, PLYWOOD %:" ❑ PLYWD ❑ OSB PITCH: ROOF
❑ NO #LAYERS: THICKNESS: ❑5/8" TYPE: CDX 12 CLASS: A
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES F ❑WOOD SHAKES ❑WOOD SHINGLES OTHER�l L IlC FREPOR(C i�7
DESCRIPTION OF WORK: cy-
6mj �" r
By my signature below,I certify toe 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 infonnation I ave provi d is correct. I have read the Descriptio Work and verify it is accurate. I agree to comply ith all applicable local
ordinances and state laws relatin to building c ns 1 rrze re se�,vesofrt oto enter the above-identified o fr in ection purposes.
Signature of Applicant/Agent: te:
SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY
If building is associated with a Home Owner s Association,provide letter PLAN CHECK TYPE ROUTING SLIP
of approval from HOA. DIVER-THE-COUNTER ❑ BUILDING PLAN REVIEW
Provide Planning approval to verify if there any restrictions. ❑ EXPRESS ❑ PLANNING PLAN REVIE
_Provide copy of Manufacturer's Installation Specifications. ❑ STANDARD ❑ FIRE DEPT
Provide signed copy of Cupertino's Tear-Off Policy. ❑ OTHER:
ReroofApp_201 1.doefe,ised 03/16/11
r
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
ALBERT SALVADOR,P.E.,C.B.O.,BUILDING OFFICIAL
CUPERTINO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•buildina(cocuoertino.or4
PROJECT ADDRESS ' APN#
OWNER NAME C ' _ ` r �, ! PHO � 2-51 - E-MAIL
STREETADDRESS r /IV Y ITY,STATE,Zltu� ' FAX
CONTRACTOR NAME 1 fN r LICENSE NUMBER `7 2 1�(q LICENSE//TYYP�tj Qj BUS.LIC.# �r 1l [
COMPANYNAME U u� IV E-MAIL ( L (J t FAX SCJ
STREET ADDRESS 40
/I �o \�, _ Lh,G, CITY,STATE,ZIP G G��� PHONE / 2/ ,9� r1 )
I UNDERSTAND AND AGREE TO THE FOLLOWING: 6/ {�
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/"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. There-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 unde and agree to comply with the re-roof policy stated above. I also understand that
smoke detectors and carbon noxide etectors are r ed to ed in accordance with Sections R314 and R315 of
the 2010 California Residenti Code.
Signature of Applicant/Agent: Date:
ReroofPo1icy_2012.d6c revised 10/7/12