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13070011 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21181 HAZELBROOK DR CONTRACTOR:R E ROOFING& PERMIT NO: 13070011 CONSTRUCTION INC OWNER'S NAME: BOWERS BETTY R TRUSTEE 15230 CLYDELLE AVE DATE ISSUED:07/02/2013 OWNER'S PHONE: 4082062480 SAN JOSE,CA 95124 PHONE NO:(408)626-9320 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r— PLUMB Lice asLic.# ( .#/ I MECH r— RESIDENTIAL r COMMERCIAL ntractor G Date l I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REMOVE SHAKE ROOFING&INSTALL NEW 30#FELT (commencing with Section 7000)of Division 3 of the Business&Professions PAPER Code and that my license is in full force and effect. WITH 46SQ LIFETIME COMPOSITION 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. 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 Sq.Ft Floor Area: Valuation:$21000 permit is issued. APPLICANT CERTIFICATION APN Number:32628054.00 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and Will comply 180 DAYS FR ST CALLED INSPECTION. with non- int sou gulations per the Cupertino Municial C"de,Section 9.1 - �12.�1 / Sig ture Date 113 ❑ OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All ro S�iat e inspected prior to any roofing material being installed.If a roof is the following two reasons: inst led with first obtai ing an inspection I agree to remove all new materials for I,as owner of the property,or my employees with wages as their sole compensation, ins ection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Signa of Applica ate: I,as owner of the property,am exclusively contracting with licensed contractors toI construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE 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 I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534. Compensation laws of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must Owner or authorized agent: forthwith comply with such provisions or this permit shall be deemed revoked. Date: APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address costs,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION Aignat on-point source regulatio a Cupertino Municipal Code,Section I understand my plans shall be used as public records. ate Licensed Professional • REROOF PERMIT APPLICATION -02 C-> " COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228•FAX(408)777-3333•building(@cupertino.org �� 6O PROJECT ADDRESS ,11 y I H-',,-L- Ro o K APN# OWNER NAME PHONE U y _ 2_/l�/� "GL� E-MAIL STREET ADDRESS lj ( , lei1 �(l I� CITY,STATE,ZIP o/� I C� FAX CONTACT NAME ,L_t o l� C/ PHONE v`/y, E-MAIL STREET ADDRESS CITY,STATE,ZIP FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME-'V,, LICE NSENIB R LICENTE!,� _6 BUS.LIC.# Z 0 J COMPANY NAME / E-MAIL re f o O 1 I (1 � C`1^' o f` CUY FAX ICI 1 STREET ADDRESS qby F�� �� 1^-'1 I f I CITY,STATE,ZIP �� (�I n v�� PHONE _6 26 -1 D ARCHITECT/ENGINEER NAME 'J�,l/l/l: LICENSE NUMBER l (/ BUS.LIC.# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF SF or Duplex ❑ Multi-Family ROOF AREA: ( VALUATION: STRUCTURE: ❑ Commercial q6 t;4 EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES AOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY) REMOVE/REPLACE_ S IF NO. PLYWOOD ❑%d' 11PLYwD ElOSB PITCH: ROOF ❑ NO #LAYERS: THICKNESS: 115/8" TYPE: 13CDX '12 CLASS: A PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT# DESCRIPTION OF WORK: LAM&-- N—, `n By mysignature ertify to ea a following: I am the prope owner or authorized agent to act on the property owner's behalf. I have read this application an a inform I h. a pro a Is corre,moi)iave d the' cription of Work and verify it is accurate. I agree to comply with all applicable local ordinances a d state laws Tela build`s n. I a r entatives of Cupertino to enter the ab*e-idqntifie for inspection purposes. Signature of licant/A ent: Date: 2 1 SUPPL T IOM REQUIRED OFFICE USE ONLY _If building is associated with a Home Owners Association,provide letter PLIN CHECK TYPE ROUTING SLIP of approval from HOA. OVER-THE-COUNTER BUILDING PLAN REVIEW Provide Planning approval to verify if there any restrictions. ❑ EXPRESS ❑ PLANNING PLAN REVIEW Provide copy of Manufacturer's Installation Specifications. ❑ STANDARD ❑ FUZE DEPT Provide signed copy of Cupertino's Tear-Off Policy. ❑ OTHER: ReroofApp_2011.doc revised 03/16/11 eoqoo t ( CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 21181 Hazel Brook Dr DATE: 07/02/2013 REVIEWED BY: Sean APN: Z��Q BP#: *VALUATION: 1$21,000 %PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof PRIMARY PENTAMATION USE: SFD or Duplex PERMIT TYPE: 1 SFDWLROO WORK Remove shake roofing and install new 30#felt paper with lifetime composition. SCOPE FEE ID ROOF AREA S.L 1REROOFFRES 4,600 ra ,m _ham<_ Mech. Plan Check Plumb. Plan Check Elec:..Plan(.;heck .L1e; Permit Fee: Plumb. Permit Pee: Elec. Permit fee: Other.Wech.Irup, Other Plumb Insp, Other Elec.Insp. _1lech. Inv% Sze: 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). These ees are based on the prelimina 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 Fee: Suppl. PC:Fee 4-id I f'Zumb.il�Ieclz.;lllec, Permit Fee: $69 . 0 T-77 I Suppl.Ins/ Fee f lumb./jV1ec:h.1Elec Plumb./Mech.iElec Permit Fee: Construction?ax: F71 Administrative.Fee: Work Without Permit? ® Yes (F) No $0.00 Aclvancecl Planning Fees: Travel Documentation Fees: Strong Motion Fee: IBSEISMICR $2.10 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 j ONE �� � x _3,, r.. $693.101 $ �1 ©TCL N'EE 10 .00 0 Revised: 67/01/2013 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•buildino(acuaertino.org PROJECT ADDRESS 2- AAS Zoo ( APN# OWNERNAME " �v L{ � PHONE(lA\y �06 — E-MAIL IlJ(1 2 STREET ADDRESS ZZ;5Ji m IE CITY,STATE,ZIP e i . C FAX CONTRACTOR NAME {i I -Ro r 1�/jf h/ LICENSE NUMBER 7 2_1�� ��LI/CENSE TYP 5� BUS.LIC.# COMPANY NAME lJ I b' E-MAIL ( FAX V b! J STREET ADDRESS (�2� \ CITY,STATE,ZIP �j�� (I 1 1 L- I PHONE I�t 1 U_b L G —q-2,q / \/ I UNDERSTAND AND AGREE TO THE FOLLOWING: lJ 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 ce of the following is true: I am the property owner or authorized agent to act on the property owner's beha . I understan and a pl Ith the e-roof policy stated above. I also understand that smoke detectors and c bon monoxide ct s are re ed to ins lle 'n accordance with Sections R314 and R315 of the 2010 California Rtsilnt: ential Codej ( I ( ^ i , Signature of Applicai Date: !� ReroofPolicy_2012.doe revised 10/7/12