13060013 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21533 CONRADIA CT CONTRACTOR:BLACK DIAMOND PERMIT NO: 13060013
DESIGNS
OWNER'S NAME: YIHAN LI 3481 DEL NORTE DR DATE ISSUED:06/03/2013
OWNER'S PHONE: 4083558026 SAN JOSE,CA 95132 PHONE NO:(408)272-5959
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIALEI
License Class Lic.# _ (28 SQ'S)TEAR OFF(E)WOOD SHAKE,INSTALL(N)
LIFETIME COMP&GUTTERS
Contractor Date_D — 3 —� -S
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:$13000
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:35623051.00 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 WIT�IIN 180 DAYS OF IT 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 DAYS FR AS D INSPECTION.
indemnify and keep h the City of Cupertino against liabilities,judgments,
costs,and expenses which y accrue against said City in consequence of the 3 ,
granting of this permit. tionally,the pli understands and will comply Is Date:
with all non-point sour gulations per a ertino Municipal Code,Section
9.18.
� R OOFS:
Signature Date- •3/ All roofs shall be inspected prior to an ofing mater' l g installed.If a roof is
installed without first obtaining an i ct' n, a ove all new materials for
inspection.
❑ OWNER-BUILDER DECLARATIONZ
Signature of Applicant:'' Date: 3
I hereby affirm that I am exempt from the Contractor's License Law for one of
V--
the following two reasons: ALL RO F VE GS 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 al Code,Chapter 9.12 and the
declarations: Health&Safety Code,Section 25532( shoul store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use quipm or devices which mit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by th ay Are it uality ement District I
performance of the work for which this permit is issued. will maintain compliance with t e Cuper' M ici 1 WChapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Se ons 2550 55
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agentF, Dater
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
indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION
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 PERMIT APPLICATION �\
COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION r b
10300 TOR RE AVENUE CUPERTINO, CA 95014-3255 V
3228•FAX(408)777-3333-buildingocupertino.oM
CUPERTIIVQ (408).777
\�
PROJECT ADDRESS 0 C .. J_ ^' APN# �0
OWNERNAME ~J ^`� `-+` PH NE E-MAIL
� D 3SS D
STREET ADDRESS /,533 CITY, FAX
d
CONTACT NAME PHONE � E-MAII,
v
STREET ADDRESS CITY,STATE,ZIP FAX
d,
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC.#
COMPANY NAME ' n E-MAIL FAX
C it'W
STREET ADDRESS CITY,ST TE,ZIP: F S9S'
! oS� T
ARCHrfECT/ENGINEERNAME LICENSE NUMBER BUS.LIC.#
�COMPANY NAME .. E-MAIL FAX - -
STREET ADDRESS CITY,STATE,ZIP PHONE
USE.OF SFD or Duplex ❑" Multi-Family ROOF AREA: VALUATION:
STRUCTURE: ❑ Commercial O f O z>
EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SFRNGLES &?0D,SHAKES ElWOOD SHINGLES ❑OTHER(SPECIFY)
REMOVE/REPLACE YES IFNO, PLYWOOD im% ❑ PLYWD JEKOSB PITCH: ROOF
❑NO #LAYERS` THICKNESS: ❑ 5/8" TYPE: ❑COX '12 CLASS:
ICC-ES REPORT#
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER
DESCRIPTION OF WORK: /
Ito
By,niy signature below,I certify:to"e of the g: I am e o owner or authorized agent to act on the property owner's behalf. I have read this
application and the infomation I havr<proviil co ect. e a escription of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating t¢buildin ons do u or' presentatives of Cupertino to enter the aab`ove-identified/property for inspection purposes.
Signature ofApplicantlAgent: E Date: /P
SljPPLEmE�3ZiNF6RmATioN REQUIRED
If building is associated with a Home Owners Association,provide letter
of,approval from HOA.
Provide Planning approval to verify'if there any restrictions.
I.
Provide copy of Manufacturer's Installation Specifications.
Provide signed copy of Cupertino's Tear-Off Policy.
ReroofApp_2 1.doc rese 3/16/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 21533 CONRADIA CT DATE: 06/03/2013 REVIEWED BY: MELISSA
APN: 356 23 051 BP#: *VALUATION: 1$13,000
PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY PENTAMATION
USE: SFD or Duplex PERMIT TYPE: 1SFDWLR00
WORK 28 SQ'S TEAR OFF E WOOD SHAKE INSTALL N LIFETIME COMP & GUTTERS
SCOPE
FEE ID ROOF AREA
s.f.
1REROOFFRES 2,800
q g.
ry
Mech.f'tun Check Plumb.Plan Check Elec.Plan Check
i1lech.Permit Fee: Plumb.Permit Fee: Elec.Permit Fee:
Other"Vech.Insp, Other Plumb Ins). Other Elee.Insp.
Bfech.Insp.Fete: Plumb. Insp.Fee: Elec,Insp.Fce:
NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc.). Thesefees are based on the prelinmdina 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 1,ee:
Suppl..P(`Fee
Pluinb./Meeh./Elec
Permit Fee: $420.00
Suppl, Insp Fee
Plumb./illfech./Elee
Plumb.Allech.iElee Permit Fee:
Conslr-uction Teri:
At-lininistr atiti=e.ree:
Work Without Permit? Yes (E) No $0.00
Advanced Planning tees:
7'M vel Documentation Fees: �
Strong Motion Feer IBSEISMICR $1.30 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
.�r y =sMN MR
$422.301 $0.000T; > $4NO
22.30
`� 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
CUPERTINO
(408)777-3228 FAX(408)777-3333•buildingCa.cupertino.org
PROJECT ADS/ . APN
OWNER NAME N n PHONE E-MAIL 7 J
1 5
STREET ADDRESS CITY, STATE,ZIP , FAX
CONTRACT AME w LICENSE NUMBER LICENSE TYPE BUS.LIC.#
�Q �
COMPANY NAME ^ n E-MAIL FAX
STREET ADDRESS CITY,S TE,ZIP ^ PHONE
e 6 Z
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 un 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 J/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 lowing is true: I am the property owner or authorized agent to act on the
property owner's behalf. I underst . an a to comply with the re-roof policy stated above. I also understand that-
smoke Aetectors and caibon.mono de d ors requ' d t b stalled in accordance with Sections R314 and R315 of
the 2010 California Residential ode.
Signature of Applicant/Agent: t Date 3
ReroofPoliey_2012.doc revised 10/7/12