13090135 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7984 FOLKESTONE DR CONTRACTOR:QUALITY ROOFING CO PERMIT NO:13090135
OWNER'S NAME: BONNIE LIBBY 10415 NEW AVE DATE ISSUED:09/18/2013
OWNER'S PHONE: 4084999475 GILROY,CA 95020 PHONE NO:(408)461-0484
M LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
License Class C `3 `� Lic.# 'AX"6 F1 (35 SQ'S)-TEAR OFF(E)WOOD SHAKE,INSTALL(N)
1/2"OSB,30 LBS FELT&LIFETIME COMP
Contractor `� toO��Date Q`�8�`3
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 foilowing 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:$15500
JC 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:36211002.00 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 WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter ED INSPECTION.
li
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS
indemnify and keep harmless the City of Cupertino against abilities,judgments, q
costs,and expenses which may accrue against said City in consequence of the Date: / 3
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.
�� �� t RE-ROOFS:
Signature \ r m,- Date 9— [— All roofs shall be inspected prior to any roofing material being installed.If a roof is
NJ installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
❑ OWNER-BUILDER DECLARATION
Signature of Applican+• �wa�.�_ ll� ate:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1,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 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,Sections 25
255005',25533,and
,25534.
1�ems+.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: (; 14d� 1�'`` -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 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 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 inconsequence 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 `
ELI COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 'CA
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 v
(408)'777-3228•FAX(408)777-3333•building a.cupertino.org
CUPERTINO. \,
PROJECT ADDRESS APN# 162, I I O Z
OWNERNAME \ PHONE _ E-MAIL
V
STREET ADDRESS r CITY, STATE,ZI FAX
72,
WA
CONTACT NAME PHO E-MAIL
STREET ADDRESS CITY,STATE,ZIP FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT 13 CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CO CT R AME LICENSE NUMBER LICENSE TYPE BUS.LIC.#
COMPANY NAME &MAIL FAX
STREET ADDRESS V CITY,STATE,ZIP S S6 q / PHO E 6
IN
ARCHITECT/ENGEER NAME LICENSE NUMBER b BUS.LIG#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑ SFD or Duplex Multi-Family ROOF AREA: VALUATION:
STRUCTURE: ❑ Commercial b b
EXISTING ROOF TYPE: ❑BUILT-UP ROOF PHALT SHINGLES WOOD HAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY)
REMOVE/REPLACE KYES IF NO, PLYWOOD ffl%" ❑ PLYWD OSB PITCH: ROOF
C1 NO #LAYERS: I THICKNESS: 115/8" TYPE: ❑CDX '12 CLASS: L1
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT#
DESCRIPTION OF WORK: \
t - O SLko 5e}F � Y66 1 ws � 8 S
6 tl. 4
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 relatigto building co c' n. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of ApplicanUAgen vim— �\ Date: ` U
MI
SUPPLEMENTAL INFORMATION REQUIRED ousEovr
_If building is associated with a Home Owner's Association,provide letter AA
of approval from HOA. a`} vER ��Buunnvc r> r�
_Provide Planning approval to verify if there any restrictions. - LAIvw
Provide copy of Manufacturer's Installation Specifications.
_Provide signed copy of Cupertino's Tear-Off Policy.
ReroofApp_201 1.doc revised 03116111
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 7984 FOLKESTONE DR DATE: 09/18/2013 REVIEWED BY: MELISSA
APN: 36211002 BP#: *VALUATION: 1$15,500
*PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD or Du lex PENTAMATION 1SFDWLR00F
USE: P PERMIT TYPE: i
WORK 35 SQ'S -TEAR OFF E WOOD SHAKE INSTALL N 1/2" OSB 30 LBS FELT& LIFETIME COMP
SCOPE
FEE H) ROOF AREA
s.f.
1REROOFFRES 3,500
t1"
' P
�G55t'tl�. -'.� _ - I i •i�m��n F� V:r�i ..,,,'a
Llech. Plan Check Phimb.Plan Cheek Elec..Plan Check
FTPermit Feet: Plumb.Permit Fee: Elec. Permit Fee:
Flheh
Akc.h.Insp. Other Plumb Insp. L1 Other Elec.Insp. ED-L--
I Insp. Fzze: Plumb. Insp.Fee: Elec.Insp.Fee:
NOTE:This estimate does not include fees due to other Departments('tie.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). These ees are based on the relimina information available and are onlyan estimate. Contact the Dept
or addn'1 info.
FEE ITEMS (Fee Resolution 11-053 E . 7/1113) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
.Stppl. PCFee
Plumb.ijtlech./Flee
Permit Fee: $560.00
Supp/, Insp Fee
Plumh.ilhech./Flee
Plumb.111ech.,'Flee Permit Fee:
C:onstrzaction Ta:v: F71
Administrative Fee:
Work Without Permit? ® Yes (j) No $0.00
Advanced Planning Fees:
"Travel Uoctimentation Fees:
Strom Motion Fee: IBSEISMICR $1.55 Select an Administrative Item
Bldy,Stds Commission Fee: 1BCBSC $1.00
w� = 00 m 25 5
A► Revised: 08/01/2013
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
CUPER`I'IN0
(408)777-3228 FAX(408)777-3333•buildinaCa.cuoertino.ora
PROJECT
ADDRESS 7APN# (o Z - r - 00'L
p, C, v-,S 7 .
O NAME y ` PHONE 8 \1 EMAIL
bt,V\� Q. b
STREET ADDRESSCTrY,STATE, P FAX
�� Qr� ��:
CO CTOR NA LICENSE NUMBER LICENSE T E BUS.LIC.#
_ t�-
COMP NA C E-MAIL FAX
t
STREET ADDRESS C STATE,ZIP2LL k C0.' H " /
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 Code. (�' A : 1
Signature of Applicant/Agent: �3�-�'� �" ��`" Date:
ReroofPolicy_2012.doc revised 10/7/12