13090216 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 1515 S DE ANZA BLVD CONTRACTOR: f�/�}C f%/G PERMIT NO:13090216
Gv 4 t LSf�C�Lp //tk
OWNER'S NAME: TEGLIA IRENE M TRUSTEE DATE ISSUED:09/27/2013
OWNER'S PHONE: PHONE NO:
2 G� LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIAL
Lice Clas Lie.# C� �. �-- (64SQ'S)OVER(E)CAPSHEET,LAY(1)FIRESHIELD FR
�qq 2--22--2_�3 50,VERSICO 60 MIL TPO
Contractor�a.0 i-//'�L `N�C/-1'1�'iJ.Date Ci r
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:$21000
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:36610127.00 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
upon the above mentioned property for inspection purposes. (We)agree to save 180 D3T CALLED INSPECTION.
Inde ' and keep harmless the City of Cupertino against liabilities,judgments,
costs, expenses which may accrue against said City in consequence of the —Ofite, 2 "]
gr!Ttik o is permit. Additionally,the applicant understands and will comply
wi a int so rce regulations per the Cupertino MuJci4,Code,Section
9.
RE-ROOFS:
Signature _ Date All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed without f st n g inspectionrgreeoremove all ew materials for
inspection.
❑ OWNER-BUILDER DECLARATION 2'Z � ( 3
Signature of Applic Date:
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
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(See.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 it Cupertino Municipal Code,ChaU12I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code Se o M 5,2 533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this �
permit is issued. Owner or authorized agen Date:
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 (I/
COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION 0 O
10300 TORRE AVENUE-CUPERTINO, CA 95014-3255 �O
(408)777-3228- FAX(408)777-3333•building a,cupertino.org
CUPIERTIINIO.
PROJECT ADDRESS i J` APN#
OWNER NAME el 1 t (Y-0
7 PH ZZC� �b E-MAIL,
� /
STREET ADDRES' / CITY, 5 ZIP FAX
CONTACT NAME1 / v PHO E MA
STREET ADDRESS CITY,STATE,ZIP FAX
❑ OWNER ❑ OWNER-BUILDER ❑.OWNERAGENr CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME , '1 LICENSE NUMBER 6 Lt 5� LICENGTYP� BUS.LIC.#
( v4(,
�,G�r �
9-61 ^\E., W EG r irk 141 b l
COMPANY NAME S
E-MAIL FAX
STREET ADDRESS / , ` 1 CITY,STATE,ZIP �^ PHO ��
to Vr1 (� d
ARCHIT'ECT/ENGINEERNAME LICENSENUMBER BUS.LIC.#
COMPANY NAME E-MAIL. FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑ SFD or Duplex ❑ Multi-Family ROOF AREA: VALUATION:
STRUCTURE: Commercial I GLA00 f= (3� 0
EXISTING ROOF TYPE: BUILT-?AM 13ASPHALT SHINGLES 11WOOD SHAKES ❑WOOD SHINGLES 11OTHER(SPECIFY)
__T
REMOVE/REPLACE El YES IFNO, f PLYWOOD ❑ ❑ PLYWD 11 OSB PITCH: �/ ROOF
O #LAYERS: ! THICKNESS: 5/8" TYPE: ❑ CDX 12 CLASS: A
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES AOTHER- Fy ICC-ES REPORT#
DESCRIPTION OF WORK:
By my signature below,taLigd e Ilo g: I am the property owner or authorized agent to act on the pro erty owner's ehalf. I have read this
application and the infored co ct. I have read the D cription of Work and verify it is accurate I agree to co ply with all applicable local
ordinances and state lawco t n. I authorize r'pr a tatives of Cupertino to enter the above-i entified prop riy for inspection purposes.
Signature ofApplicant/ADate:
SUPPLE NTAL TION RE UIRED
_If building is associated with a Home Owner's Association,provide letter �TEI I NINE WN
Ro[Irnv�st I>'
ofa rovalfromHOA. u £®"s DmcriIvEw
PP Lt-ar .iJT �` t
Provide Planning approval to verify if there any restrictions. ExP Ss � Ir' a nN: w
_Provide copy of Manufacturer's Installation Specifications. '-
Provide signed copy of Cupertino's Tear-Off Policy.
yr,.
ReroofApp_2011.doc revised 03116111.
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 1515 S DE ANZA BLVD DATE: 09/27/2013 REVIEWED BY: MELISSA
APN: 36610,127 IBP#: *VALUATION: 1$21,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building PENTAMATION 1COMMLROOF
USE: PERMIT TYPE:
WORK [&4SQ'S)OVER E CAPSHEET LAY N FIRESHIELD FR 50 VERSICO 60 MIL TPO
SCOPE
,L1ech. Phan Check Phwib.Plan Check Elec..Plan Check'
iblc>-ch.Permit Fee: Plumb.Permit Fee: Elec. Permit fee:
L
M!ch.Insp. Other Plumb Insp. Li
Other Elec.Insp.
aij
.Insp.Pee: Plumb. Irish.Fee: Elee.Insp.Fee:
NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). These ees are based on the prefiWina information available and are only an estimate Contact the De t or addn'l info.
FEE ITEMS(Fee Resolution 11-053 E . 7/1/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00F6_,45001 s.f. Re-roof
Suppl.PC Fee: (E) Reg. ® OT 0.0 1 hrs $0.00 $557.00 IREROOFCOM
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp.Fee-0 Reg. ®OT 0 0 his $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
(;onsiruction .Tax:
F-1-
Administrative Fee: 0
Work Without Permit? ®Yes ie) No $0.00 0
Advanced Planning Fee. $0.00 Select a Non-Residential E)
Tic vel Documentation Fees: I
Building or Structure
Strong Motion.Fee: IBSEISMICO $4.41 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00
:x .
$5.41 $557.00 ,OTT4 $562.41
Revised: 08/01/2013
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
GUPERT[h[Q 10300TORRE AVENUE•CUPERTINO, CA 95014-3255
(4r0-8)777-3228• FAX(408)777-3333•building(a.cupertino.org
PROJECT ADD SS
OWNER N J PHONE E-MAIL
STREET ADD fi ox ro 4106 6 FAX
CONTRACTOR NAME ICENsF NUMBt 4 (32 LICENSE TYPES � BUS.LIC.#
COMPANY NAME E-MAIL 1` FAX
STREET ADDRESS O C `, CtITY,STATE,Z `1 PHONE
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 inspectionVthewo
eduled un to one business day before the requested inspection date.
Please call (47:30-3:30pm(Mon-Thurs) or 7:30-2:30pm(Friday)to schedule
inspection. F 'ling Inspections,you must also call on the day of the inspection only
after that phcompleted. The building inspector will be available within one hour.
Final Inspecttwo hour window.
3. Tear-Off Inspection is required. Any and all dry-rotted wood shall be replaced prior to this inspedtiori.
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_. RDofing 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 erstand and agree to comply with the re-roof policy stated above. I also understand that
smoke detectors and carbo mo xid et e tors e required to be installed in accordance with Sectio s R314 d R315 of
the 2010 California Reside tial ode
Signature of Applicant/Agent. Date:
ReroofPolicy_2012.doc revised 10/7/12