13090193CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22129 RAE IN
CONTRACTOR: A. QUINTERO ROOFING
PERMIT NO: 13090193
OWNER'S NAME: MIN XING
3939 QUIMBY RD
DATE ISSUED: 09/24/2013
OWNER'S PHONE: 6507998888
SAN JOSE, CA 95148
PHONE NO: (408) 531-1961
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL El COMMERCIAL
License Class C— M Lic. # 51/.3333
(27 SQ'S) TEAR OFF (E) WOOD SHAKE, INSTALL (N) OSB
Contractor 9 t1, ✓! ArO A&-44— Date 2 3
PRESIDENTIAL COMP SHINGLE
I hereby affirm that I am licensed under the provisions of C apter 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
Sq. Ft Floor Area:
Valuation: $18000
,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
APN Number: 35607068.00
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 DAYS F CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
9 2 K 113
granting of this permit. Additionally, the applicant understands and will comply
Issu Date:
with all non-point source regulations per the Cupertino Municipal Code, Section
9.18.
RE-ROOFS:
Signature Date A?
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.
❑
OWNER-BUILDER DECLARATION
S 2
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
ALL ROOF CO RINGS 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 (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(x) 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 25505, 25533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
,, ,�
Owner or authorized agent: c Date: -?/.Z
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
t
CUPER'T INO.
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333 • building(aDcupertino.org
PROJECT ADDRESS ^
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APN # 2 / ^ 07-— p} 0,
OWNERNAME
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CONTACT NAME E-MAIL
STREET ADDRESS CITY, STATE, ZIP FAX
❑ OWNER ❑ OWNER -BUILDER ❑ .OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER IF ANT
CONTRACTORNAME
LICENSENUMB R
LIWNSE
BUS. LIC. #
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COMPANY NAME w
E-MAIL
FAX
STREET ADDRESS
CITY�TATE, ZIP
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ARCHITECT/BNGINEERNAME
LICENSENUMBER
BUS. LIC. #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
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USE OF ❑ SFD or Duplex ❑ Multi-FamilyROOF AREA:
VALUATION:
two
STRUCTURE: E] Commercial
EXISTING ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES WOOD SHAKES ❑ WOOD SHINGLES ' ❑ OTHER (SPECIFY)
REMOVE/REPLACE 11 YES
IF NO,
I
PLYWOOD 13%', ❑
PLYWD ❑ OSB
PITCH:
1 :12
ROOF
A
❑ NO
# LAYERS:
THICKNESS: ❑ 5/8"
TYPE: ❑ CDX
CLASS:
PROPOSED ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER
ICC -ES REPORT #
DESCRIPTION OF WORK
Y r` r
all -
6r
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 relating building c e resentatives of Cupertino to enter the above -identified roperty for inspection purposes.
Signature of Applicant/Agent: Date: '1
SUPPLEMENTALi14FORMATION REQUIRED
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If building is associated with a Home Owner's Association, provide letter
t. R -T c3 -
®�IJILD>1�e Pz tyy
of approval from HOA.
—Provide Planning approval to verify If there any restrictions.
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Provide copy of Manufacturer's Installation Specifications.
Provide signed copy of Cupertino's Tear -Off Policy.
ReroofApp_2011. doc revised 03116111
CITY OF CUPERTINO
ffim FEE ESTIMATOR - BUILDING DIVISION
imlADDRESS:
22129 RAE LN
QTY/FEE
DATE: 09/24/2013
REVIEWED BY: MELISSA
APN: 356 07 068
BP#:
"VALUATION:
1$18,000
*PERMIT TYPE: Minor Building Permit
PLAN CHECK TYPE: Re -roof
PRIMARY SFD or Duplex
P
Permit Fee:
$432.00
PENTAMATION 1SFDWLR00F
USE:
PERMIT TYPE:
WORK
27 SQ'S TEAR OFF E WOOD SHAKE
INSTALL N OSB PRESIDENTIAL COMP SHINGLE
SCOPE
Construction Tela:
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public worKs, etre, sanitary sewer District, scnoot
Ai.ctriet vrc )_ Those fov_c are haced an the areliminary information available and are only an estimate. Contact the Deptfor addn'1 info.
FEE ITEMS (Fee Resolution 11-053 E . 7/1/13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
Suppl. PC Fee
Pluinb.111ech./Elec
Permit Fee:
$432.00
Suppl. Insp Fee
Plumb.; .'%tech.1 lec
Plumb. 1ech.lElec Permit Fee:
Construction Tela:
Administrative .Fee:
Work Without Permit? ® Yes 0 No
$0.00
Advanced Planning Fees:
�
Travel Documentation Fees:
Strong Motion Fee: 1BSEISMICR
$1.80
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
1 $1.00
$434.80
$0.00 .' - _ ,.. . `
$434.80
Revised: 08/01/2013
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 Ca.cupertino.org
PROJECT ADDRESS
APN # 3-5-6 - b -�' -0 6 B
OWNER NAME
J
E-MAIL
STREET ADDRESS
C STATE, ZIP
FAX
CONTRACTORNAME
J
LICENSE NUMBER
LICENSE TYPE
C�
BUS. LIC. 9
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS S�-7� f.
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CITY, STA ZIP
G..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 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.
)lied without first obtaining all pri
)ection 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.
of A
Date:
ReroofPo1icy_2012.doc revised 10/7/12