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13080213 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10500 SAN FELIPE RD CONTRACTOR:LIGHTHOUSE PERMIT NO: 13080213 CONSTRUCTION OWNER'S NAME: KLEDZIK NICK AND JUDITH F 1110 HACIENDA DATE ISSUED:08/28/2013 OWNER'S PHONE: 4088915312 CAMPBELL,CA 95008 PHONE NO:(408)891-5312 ❑ LICENSED CONTRACTOR'S DECLARATION F_ C �A S.C} �j BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class C Lie # �'S l 7-1 r— f"" " Ck t'Ca /�,� n MECH RESIDENTIAL COMMERCIAL Contractor �► . "Ic.{r D'at )"'� G � I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REMOVE 12 SQ COMPOSITION,REPLACE WITH 40YR (commencing with Section 7000)of Division 3 of the Business&Professions DIMENSIONAL SHINGLES BACK HALF OF ROOF ONLY 12SQ Code and that my license is in full force and effect. 1 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 Sq.Ft Floor Area: Valuation:$2000 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:34244017.00 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the 180 DA S FROM L T CALLED INSPECTION. 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. �j �e Issued by: Date: Signature "� �, - Date ( �•l►� ')3 ❑ OWNER-BUILDER DECLARATION RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is 1 hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for the following two reasons: inspection. 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, Signature of Applicant: Q a Q Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to VV \ construct the project(See.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 1 hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air contaminants as defin'6d by the Bay Area Air Quality Management District I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shallalth 4Safe Code,Sections 25505,25533,and 25534. 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 ez a become subject to the Worker's Compensation provisions of the Labor Code,I must te: U 0r forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.) correct. I agree to comply with all city and county ordinances and state laws relating Lender's Name to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address__ indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. Licensed Professional Signature Date t LoREROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUf�>trRT'lINO (408)777-3228•FAX(408)777-3333•buildinga-cupertino.org PROJECT ADDRESS Q a o o7 n, APN# OWNER NAME (+�J It \ ' C y' HONE ` S��_ Q STREET ADDRESS I C ® �r ^L•° STATE,ZIP No 2,S 014 FAX CONTACT NAM J ©• vU �/ PH Cj C11 I E-MAIL STREET ADDRESS _T/J/.y^ C T Z P 1 n (�� F � ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER TENANT CONTRACTOR CONTRACTOR NAME 2r v LICENSE NUMBER [' ,1 LI SE TCE BBU�S-.hLIC.# COMPANY NAME �OUEMAIL STREET ADDRESS O l ac ` (�Q C V I!�(' 2 _ ONE , v �' :R q I 2 ARCHITECT/ENGINEERNAME LICENSENUMBER vi ' BUS.LIC.# v a V COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑ SFD or Duplex ❑ Multi-Family ROOF AREA: VALUATION: STRUCTURE: ❑ Commercial O©C• o o EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY) REMOVE/REPLACE YES IFNO, PLYWOOD V2" PL SB PITCH: ROOF ❑NO #LAYERS: THIC 5/8 -rvl: DX 12 CLASS: A PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ASPHALT SHINGLES ❑WOOD SHAKES 11WOOD SHINGLES OTHER ICC-ES REPORT# DESCRIPTION OF WORK: , < t 0 t r ^ /►J�ogy 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 rovided is correct I ave read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws re to bu /strruction I u rite re resent ves of Cupertino to enter the ab ve-i tified rope for in ection purposes. Signature of Applicant/Agent: w Date: SUPPLEMENTAL INFORMATION REQUIREDo$�FIZ ITSE ONL MA _If building is associated with a Home Owner's Association,provide letter xUT of approval from HOA. I k PP Provide Planning approval to verify if there any restrictions. xP , w. Provide copy of Manufacturer's Installation Specifications. I Provide signed copy of Cupertino's Tear-Off Policy. o ,. ReroofApp_201 1.doc revised 0311.6111. CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10500 San Felipe Road DATE: 08/28/2013 REVIEWED BY: larrys APN: BP#: "VALUATION: 1$2,000 *PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof PRIMARY SFD or Duplex PENTAMATION 1SFDWLR00F USE: PERMIT TYPE: WORK remove 12 squares composition, replace with 40 year dimensional shingles. Back half of roof only SCOPE FEE ID ROOF AREA s.f. 1REROOFFRES 1,200 .b PIRM A,fe,,k. Plan Check Phunb.Plan Check Elec.Plan Check L1e1,11.Permit Fee: Plumb.Permit Fee: Elec. Permil Fee: Chher,tlech.Insp. Other Plumb Insp. Li Other Dec.Insp, Lj 1lcech. Inch,Fee: Plutnh.Insp.Fee: Elec.Insp.Fee: NOTE:This estimate does not includefees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,eta). These ees are based on the relimina information available and are only an estimate. Contact the Dept or addn'1 in o. FEE ITEMS (Fee Resolution 11-053 E . 7111121 FEE QTY/FEE MISC ITEMS Plan Check l(?e: ,SuPI)l. PC Fee Plurnh.Alfech./Elec Permit Fee: $192.00 Suppl. Insp Flee Plum f�.,='tleclz.;llc�c Plurnlr.i1111ech./Elec Permit Fee: Construction.Tax: ,l dintnistratl ve.l`ee: Work Without Permit? ®Yes (j) No $0.00 Advanced Planning/ices: 7'"Ivel Documentation Fees Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 $193.50 $0.00 $193.50 Revised: 07/01/2013 1 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•buildinaCa.cupertino.ora PROJECT ADDRESS 00 ISM �-yP�( &L APN# OWNER NAME N1 � �t ' t Pg 1) PHONE E'MAII STREET ADDRESS ,�y� VCA_� CITY&029�1 /� FAX CONTRACTOR NAMECx)��'1✓` C B LI SE ( BUS.LIC.# COMPANY NAME U.& E MAIL i1� iC �,^ / STREET ADDRESS l CITY,S Ola Q V I UNDERSTAND AND AGREE TO THE FOLLOWING: r 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 mo aide ete t rs are re uired to be installed in accordance with Sections R314 and R315 of the 2010 California Residentia o Signature of Applicant/Agent: ` Date: ReroojPolicy_2012.doc revised 10/7/12