13060128 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 5915 SUTTON PARK PL CONTRACTOR:QUALITY FIRST HOME PERMIT NO:13060128
IMPROVEMENTS
OWNER'S NAME: IKEMOTO HIROYUKI AND SHERYL E 6545 SUNRISE BLVD STE 202 DATE ISSUED:06/14/2013
OWNER'S PHONE: 4082535069 CITRUS HEIGHTS,CA 95610 PHONE NO:(916)788-2921
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIALS
License Class C`Z Lic.# _8 75'77 Z RE-ROOF 32 SQ-TO INCLUDE TEAR OFF,NEW COMP
SHINGLES CLASS A
Contractor ' _Date-�-]y/2p1
I hereby affirm 4at 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:$23000
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:37535036.00 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 andcounty ordinances and state laws relating WITHIN 180 DAYS OF PERMIT 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 7M OM LAST 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 �3
granting of this permit. Additionally,the applicant understands and will comply Issued by: Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
`- RE-ROOFS:
Signature Date-4�/ 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
Signature of Applicant: Date:
1 hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: ALL ROOF COVE 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 isnot 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 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. 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,Sec'ons 25505, 5533,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 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 PERMIT APPLICATION �(
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 �Q
CUPERTINO (408)777-3228•FAX(408)777-3333•buildingCoDcupertino.ong
PROJECT ADDRESS r n /� APN#
OWNER NAME NEj7 E_MAn,
'ra o q Z63 61 to
STREET ADDRESS 6__5� /�� ,g-e—
CITY STATE,ZIP FF
71Pank P&
CONTACT NAME [PHONE E-MAIL
STREET ADDRESS CITY,STATE,ZIP FAX
❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTO AME �� LICENSE NUMBER LICENSE TYPE BUS.LIC.#
-r
COMPANY AME - Awiavlc" IE-MAIL FAX
-- -
STREET ADDRESS CITY,STATE,ZIP PHONE
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC.#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF )�"SFD or Duplex ❑ Multi-Family ROOF AREA: 1G,
ION:
STRUCTURE: E] Commercial 3?� aeo
EXISTING ROOF TYPE: ❑BUILT-UP ROOF ASPHALT SHINGLES SWOOD qI FS WOOD SHINGLES IROTHER(SPECIFY)CL" Ti I es
REMOVE/REPLACE 1YES IF NO, PLYWOOD ❑ Y." ❑ PLYWD ® OSB PITCH: ROOF
El NO #LAYERS: THICKNESS: 518" TTYPE: ❑ CDX •12 CLASS: A
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT#
DESCRIPTION OF WORK:
r
1. /7zi .n LL•
C
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 relay building construe' . I authorize representatives of Cupertino to enter the above identif d property for inspection purposes.
Signature of Applicant/Agent: z Date:
SUPPLEMENTAL INFO ATION REQUIRED OFFICE USE ONLY
_If building is associated with a Home Owners Association,provide letter PLAN CHECK TYPE ROUTING SLIP
Of approval from HOA. OVER-THE-COUNTER BUILDING PLAN REVIEW
Provide Planning approval to verify if there any restrictions. 000 ❑ EXPRESS ❑ PLANNING PLAN REVIEW
Provide copy of Manufacturers Installation Specifications. ❑ STANDARD ❑ FIRE DEPT
Provide signed copy of Cupertino's Tear-Off Policy. ❑ OTHER:
ReroofApp_2011.doc revised 03/16/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: DATE: 06/14/2013 REVIEWED BY:
MIAPN: BP#: "VALUATION: 1$23,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY SFD or Duplex PENTAMATION 1 SFDWLROO
USE: PERMIT TYPE:
WORK
SCOPE
Jklec:h.Pkin Check Plumb.Pleat Check Elec.Plcan Check
il�tc,ch.Permit Fee: Plumb.Permit Fee: Elec.Permit Fee:
Other-Alech.Irtsp. Other Plumb Insp. Other Elec.Insp.
/tech.Insp.Fee: Plumb. htsp.Fee: Elee.Insp.Fee:
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,eta). These&q are based on the prelimina information available and are only an estimate. Contact the Dept-for addn7 in o.
FEE ITEMS(Fee Resolution 11-053 E(f. 7/1/12) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 3,200 s.f. Re-roof
Suppl.PC Feer Reg. ® OT0.0 hr's $0.00 $480.00 1REROOFRES
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp.Fee-0 Reg. ®OT 0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Construction Tire:
Administrative Fee:
Work Without Permit? ® Yes (E) No $0.00
Advanced Planning Fee. $0.00 Select a Non-Residential 0
Travel Documentation Fees: Building or Structure
i
Strong Motion Fee: 1BSEISMICR $2.30 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00
$3.301 $480.00 $483.30
Revised: 04/29/2013
I REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
ALBERT SALVADOR,P.E.,C.B.O.,BUILDING OFFICIAL
C U P E RT I N O 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333-buildinp(cDcupertino.ora
PROJECT ADDRESS <f/ "A"',
/G� APN#
OWNERN C �F
C�-D C .�H'LO—J-6 PHO w �5�3 6-00 E-MAIL
STREET ADDRESS Y,STATE,ZIP_,,7 FAX
CONTRACTOR NAMELI NSE NUMBER LICENSE TYPE BUS.LIC.#
56 772
COMPANY NA4E �� E-MAIL FAX
CcLc / T L
STREET ADDRESS CITY,STATE,ZIP PHONE
r Com(•
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/"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 fora 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 Residen Code.
Signature of Applicant/Agent: Date: 3
ReroofPolicy_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-3n 3563to
JOB ADDRESS: ,� PERMIT#
OWNER'S NAME: e PHONE#
GENERAL CONTRACTOR: T BUSINESS LICENSE
ADDRESS: CITY/ZIPCODE
*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 ACITY 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
F-I Tile
Owner/Contractor Signature Date