13080210 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10090 HILLCREST RD CONTRACTOR--i"D—TCM PERMIT NO:13080210
OWNER'S NAME:NAME: WESTWOOD DONALD C AND T ANN � DATE ISSUED:08/28/2013
OWNER'S PHONE: 6507143994 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIAL[]
License Class Lic.# �y ZZ-1 RE-ROOF 40 SQ-TO INCLUDE DETACHED GARAGE-
CLASS
Contractor ti / Date �D'dv r ( A
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 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:$60785
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:32616081.00 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 WIT�IIN 0 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:rM LAST CALLED INSP TON,
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 Issued by: Date:Wt
with all non-point sourc gul pe the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signatu Date �r All roofs shall be inspected prior to y roofing material being installed.If a roof is
installed without first obtainin pection,I agree to remove all new materials for
inspection.
❑ OWNER-BUILDER DECLARATION 'G
Signature of A11c
I hereby affirm that I am exempt from the Contractor's License Law for one ofthe following two reasons: ALCOVERINGS 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 Cqperprm Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sectio 533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
Owner or authorized a _ 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
CUPERTIN4 (408)777-3228•FAX(408)777-3333•building(a�cupertino.org
PROJECT ADDRESS a APN# ) ' Dx
U ccs� V
OWNERNAME ip PHONE E-MAIL
TAoAe too
STREET ADDRESSCTFY,STATE, P FAX
ioogo �1� c�
CONTACT NAME PHONE EMAIL
STREET ADDRESS CITY,STATE,ZIP FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME ' LICENSE NUMBER LICENSE TYPE BUS.LIC.#
F2
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
ARCHITECT/ENGINEERNAME LICENSENUMBER BUS.LIC.#
COMPANY NAME EMAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF 2`9171)or Duplex ❑ Multi-Family ROOF AREA: VALUATION:
STRUCTURE: El Commercial 14o0o -W � 607915-
EXISTING ROOF TYPES, ❑BUILT-UP ROOF �PHALT SHINGLES 11 WOOD SHAKES ❑WOOD SHINGLES 11 OTHER(SPECIFY)
REMOVE/REPLACE�YES IF NO, I PLYWOOD �i" ❑ PLYWD ❑OSB PITCH: '9IiZ ROOF
❑NO I #LAYERS: THICKNESS: ❑ 5/8" TYPE: 0`CDX 1,61L Z_.12 CLASS: A
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF P�SPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER �7ICC-ES REPORT#
DESCRIPTION OF WORK: Y t
-eot
v d
l�
By my signatilke 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 co t. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to b ' co I authorize re resentatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/ Date:
SUPP TAL INFORMATION REQUIRED
If building is associated with a Home Owner's Association,provide letter Cry rYSE � a�Irirh - `
of approval from HOA. yT o.M s ® B pini REVI>
Provide Planning approval to verify if there any restrictions.
Provide copy of Manufacturer's Installation Specifications. ea
Provide signed copy of Cupertino's Tear-Off Policy.
e ..
ReroofApp_201 1.doc revised 03116111
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
{ ADDRESS: 10090 HILLCREST RD DATE: 08/28/2013 REVIEWED BY: MENDEZ
APN: BP#: *VALUATION: 1$60,785
*PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD or Duplex PENTAMATION 1SFDWLR00F
USE: PERMIT TYPE:
WORK RE- ROOF 40 SQ-TO INCLUDE DETACHED GARAGE-CLASS A
SCOPE
FEE ID ROOF AREA
s.f.
1REROOFFRES 4,000
p
L1ech. Plan Check Plumb, Plan Check Islec.Plan Check
Fech.Permit fi-e..• Plumb.Permit Fee: Elec. Permit Pee:
Other Mech.Insp. Other Plumb Insp. Other Elec.Insp. Li
Wech.Cnsp.l'e I. E2�j Plumb. Insp.Fee: Elec.Imp.Fite:
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc.). Theseees are based on the relimina information available and are on l an estimate. Contact the De t or addn'1 in o.
FEE ITEMS (Fee Resolution 11-053 E . 7/1/12) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Supj)l. PC Fee
Plumb.11fec;h.Elec
Permit Fee: $640.00
Supp/. Ins[)F ee
Plumb.i.Vle c;h./Elee
Plumh.lAlech./Elee Permit Fee:
Consta-uction Tax:
Administrative.Fee:
Work Without Permit? ® Yes (E) No $0.00
Advanced Planning Fees:
!ravel Documentation Fees: A
Strong Motion Fee: 1BSEISMICR $6.08 Select an Administrative Item
Bldy,Stds Commission Fee: 1BCBSC $3.00
gp : $649.08 $0.00 OTAL°T' $649.08
Revised: 07/01/2013
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
Its
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUP RTINO
(408)777-3228• FAX(408)777-3333•building
(a)cupertino.org
PROJECT ADDRESS ` !I , 7APN# ,gyp
OWNERNAME (� V PHO
STREET ADDRESSCITY, STATE,ZIP F®�
CONTRACTOR NAME ICE SE R ICENSETYPE
COMPANY NAME E FAX Yo$
Q. OVZ> 'a2-
STREET ADp1�S STATF�FIt' n PH
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S// O-�c d 2 <b -LZZ-opt
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 1/4"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 anVagree comply with the re-roof policy stated above. I also understand that
smoke detectors and carbon monoxide drequired to be installed in accordance with Sections R314 and R315 of
the 2010 California Residential Cod
Signature of Applicant/Agent: Date:
ReroofPolicy_2012.doc revised 10/7/12