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13080183CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20875 VALLEY GREEN DR I CONTRACTOR: NEMMER ROOFING PERMIT NO: 13080183 OWNER'S NAME: KORET FOUNDATION OWNER'S PHONE: 6505923960 ❑ LICENSED CONTRACTOR'S DECLARATION License Class Lic. # % Yg a Contractor I hereby affirm that I am licensed under th4rovisions 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. 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 pessued. APPLICANT CERTIFICATION 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, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signatur e_LL 1-3 ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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 construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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 permit. is issued. I certify that in the performance of the work for which this permit is issued, I shall 5348 AUDUBON PARK CT DATE ISSUED: 08/23/2013 FREMONT, CA 94538 PHONE NO: (510) 919-2930 JOB DESCRIPTION: RESIDENTIAL[] COMMERCIAL0 BLDG 600-607- RE -ROOF TEAR OFF, INSTALL OSB AND REROOF WITH COMP CLASS A 109 SQ Sq. Ft Floor Area: I Valuation: $51454 APN Number: 32609064.00 1 Occupancy Type: PERMIT EXPII2ES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAY,rM LAST CALLED INSPE TION. Issued by: Date: RE -ROOFS: 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. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Owner or authorized agent �s� /Z.�Date: �'3^ not employ any person in any manner so as to become subject to the Worker's CONSTRUCTION LENDING AGENCY 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 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 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, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CUPSRI'INO. REROO'F PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 •FAX (408) 777-3333 • building acupertino.orq 4,00-607 ,9� R �3b�� PROJECT ADDRESS�� APN # OWNER NA -Cr -,-PHONE 0. C9 n bS0 E-MAIL STREET ADDRESS ( CTP C wrTE �� • /�� i FAX CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX ONER-BUILDER 13 OWNER AGENT 40NTRACTOR ❑ CONTRACTOR AGENT ❑ ARCMECT ❑ ENGR41MR ❑ DEVELOPER ❑ TENANT ❑ OWNER ElW CONTRACTOR ®� j �- �� LIC E ER 0 LICENSEE 3 BUS. LIC. # COMPANYI� e yJ _ JJ�`�� E-MAIL FAX STREET ADDRESS L / C TATE ZII �� • -S 3 � P b '315 `�. 6 ARCHITECT/ENGWEERNAME LIC ENSENUM 3ER BUS. LIC. # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFD or Duplex Multi -Family STRUCTURE: E]Commercial ROOF AREA: /090(3 VALUATION: 5/ V5 y EXISTING ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER (SPECIFY) REMOVE/REPLACE )kYES ❑ NO IFNO. 1 #LAYERS: PLYWOOD 1�(%" ❑ THICKNESS: ❑ 5/8" PLYWD IO OSB TYPE: ❑ CDX PITCH: L: 12 ROOF CLASS: A PROPOSED ROOF TYPE: ❑ BUILT-UP ROOF I -ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER ICC -ES REPORT # DESCRIPTION OF WORK J. /Y7 ` -i (QS By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the p perty 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 accura I a ee to comply with all applicable local ordinances and state laws relating building co n. I authorize representatives of Cupertino to enter the abiden fi� property for inspection purposes. Signature of Applicant/Agent: Date: (JX SUPPLEMENTAL INFORMATION REQUIRED _ If building is associated with a Home Owner's Association, provide letter of approval from HOA. Provide Planning approval to verify if there any restrictions. _ Provide copy of Manufacturer's Installation Specifications. Provide signed copy of Cupertino's Tear -Off Policy. ATE=- ovT v o*r®Bip>zv r PL w_. , -` T ReroofApp_2011.doc revised 03116111 CUPERTINO 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 (408) 777-3228- FAX (408) 777-3333 • building(cDcupertino.org PROJECT ADDRESSv / APN # OWNER NAME _ �y-- � e� �Q E-MAIL STREET ADDRES/®sz5 %S ��A !o C ST End . FAX CONTRACTOR LICENSENUMBERo� LISE BUS. LIC.# COMPANY NAME A f � � �f E-MAIL FAX STREET ?D3 S ® � � C STATE, ZIP i-� / f s � Q Q a SAO / l 7 � �� c✓ 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 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 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 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 Residential Co Signature of Applicant/Agent: Date: ReroofPo1icy_2012.doc revised 10/7/12