13100065CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10430 PRUNE TREE LN
CONTRACTOR: EL CAMINO ROOFING PERMIT NO: 13100065
CO INC
OWNER'S NAME: MINDER RICHARD D AND VALERIE L
1650 S 7TH ST DATE ISSUED: 10/09/2013
OWNER'S PHONE: 4082063700
SAN JOSE, CA 95112 1 PHONE NO: (408)292-7644
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
❑ LICENSED CONTRACTOR'S DECLARATION
Lic. # 7.
(21 SQ'S) TEAR OFF (E) WOOD. SHAKE, INSTALL
License Class
OSB/RADIANT, 30LBS FELT & LIFETIME COMP
£t (Am M `
Contractor ° Date �7
I hereby affirm that I am liceused under t ovisions 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
Valuation: $10500
performance of the work for which this permit is issued.
Sq. Ft Floor Area:
ave 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: 31633120.00 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
WITIIIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction, and hereby authorize representatives of this city to enter
180 DAYS FROM L CALLED INSPECTION.
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
the
l�
costs, and expenses which may accrue against said City in consequence of
Issue Date:
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.
, Date (� _ 1
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
Signature
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
❑ OWNER -BUILDER DECLARATION
Signature of Applicant: Date: O l�
I hereby affirm that I am exempt from the Contractor's License Law for one of
-
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
the following two reasons:
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)
HAZARDOUS MATERIALS DISCLOSURE
I, as owner of the property, am exclusively contracting with licensed contractors to
the (Sec.7044, Business & Professions Code).
I have read the hazardous materials requirements under Chapter 6.95 of the
construct project
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
Code, Section 25532(a) should I store or handle hazardous
declarations:
I have and will maintain a Certificate of Consent to self -insure for Worker's
Health & Safety
material. Additionally, should I use equipment or devices which emit hazardous
defined by the Bay Area Air Quality Management District I
Compensation, as provided for by Section 3700 of the Labor Code, for the
air contaminants as
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
performance of the work for which this permit is issued.
the Health & Safety Code, Sections 25505, 25 , and 25534.
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
Owner or authorized agent: 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
I hereby affirm that there is a construction lending agency for the performance of
become subject to the Worker's Compensation provision's of the Labor Code, I must
work's for which this permit is issued (Sec. 3097, Civ C.)Lender's
forthwith comply with such provisions or this permit shall be deemed revoked.
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,
accrue against said City in consequence of the
I understand my plans shall be used as public records.
costs, and expenses which may
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
CUPERTINO.
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION O
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 �O
(408) 777-3228 • FAX (408) 777-3333 • buildingacuoertino.orq
PROJECT ADDRESS
APN #
a ` f
OWNER NAMEP
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ONE
EMAIL
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O�
STREET ADDRESS `
+`
CONTACT NAME
PHONE
E-MAIL
STREET ADDRESS
CITY, STATE, ZIP
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ -OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONrRA NAMrAW
LICENSE NUMBER
LICENTYP�
BUS. LIC. #
^,�
Q Z
COMPANY NAME t E-MAIL
F M0 0 1
ST ET ADDRESS CIT SATE, ZIP A ^ '
PONE
O .Z
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC. #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ SFD or Duplex ❑ Multi -Family
ROOF AREA:
VALUATION:
Commercial
Z��
I� 'J
STRUCTURE: ❑
EXISTING ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER (SPECIFY)
REMOVE /REPLACE #6 YES
IFNO,
PLYWOOD ❑ /,"
PLYWD SB
PITCH:
:12
ROOF
A
❑ NO
# LAYERS:
THICKNESS: ❑ 5/8'
TYPE: ❑ CDX
CLASS:
SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER
PROPOSED ROOF TYPE: ❑ BUILT-UP ROOF XPLT
ICC -ES REPORT #
D RIPTION OF WORK:
^ ' 1
v
J I
r ccei�-
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 Urrect. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relatin to building C04641ion. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: Date: 1 —
�oF�x�"
M._
SUPPLEMENTAL INFORMATION REQUIRED
If building is associated with a Home Owner's Association, provide letter
I%z�TE
a
_
of approval from HOA.
= >z -x b%T R®sIISLD
,rRE
Provide Planning approval to verify Ifthere any restrictions.
_ Provide copy of Manufacturer's Installation Specifications.
a
Provide signed copy of Cupertino's Tear -Off Policy.
HER:
/ , ReroofApp_2011.doc revised 03116111
CITY OF CUPERTINO
INLUM TTT71 TICITT1LAr A Tl11r) 1E)7T77 717N!'' niV1PC1(1N
1-' may. '.fi � 1 -am,S �r'Y� L1� x.. .. "-�c. �.� r+V ��4`-='Caay `c'3^•
Wch. Plan (.'heck Phimb. Plan Check Elec. Plan (.heck
Wech. Permit P'ee: Plumb. Permit Fee: I Elec. Permit Fee:
Fh_
rlleeh. Insp. Other Plumb Insp. Other Elee. Insp.
ED
We,
In p. Fee:Plumb. Insp. Fee:Elee. Insp. Fee.
�.•_ ri,__.__ c:_.. O...s..�.. Q,...,.,. Il:otr:rt .Cnhnnl
NOTE: This estimate does not include fees due to otner DepaTnments ttie. raunnuig, .... — n., ..• •.l - - ----- - ---
-a—i. !'nnmrt tha Dont far addn'l info.
District, era). Lnese Lees are uuam vis use .c.ns..as.
FEE ITEMS LFee Resolution 11-053 E . 7/1113)
-WL•L` JL", JL
ROOF AREA
s.f.
---
Plan Check Fee:
ADDRESS: 10430 PRUNE TREE LANE
ippl. PC Fee
DATE: 10/09/2013
REVIEWED BY: MELISSA
APN: 316 33 120
1 BP#:
"VALUATION:
1$10,500
*PERMIT TYPE: Minor Building Permit
PLAN CHECK TYPE: Re -roof
PRIMARY
SFD or Duplex
PENTAMATION 1SFDWLROOF
PERMIT TYPE:
USE:
P1umh.A,,V1eeh.1E1ec Permit Fee:
Construction Tire:
WORK
21 SQ'S TEAR OFF E WOOD SHAKE
INSTALL OSB/RADIANT 30LBS FELT & LIFETIME COMP
Administrative Fee:
SCOPE
$0.00
,Advanced Planning Fees:
1-' may. '.fi � 1 -am,S �r'Y� L1� x.. .. "-�c. �.� r+V ��4`-='Caay `c'3^•
Wch. Plan (.'heck Phimb. Plan Check Elec. Plan (.heck
Wech. Permit P'ee: Plumb. Permit Fee: I Elec. Permit Fee:
Fh_
rlleeh. Insp. Other Plumb Insp. Other Elee. Insp.
ED
We,
In p. Fee:Plumb. Insp. Fee:Elee. Insp. Fee.
�.•_ ri,__.__ c:_.. O...s..�.. Q,...,.,. Il:otr:rt .Cnhnnl
NOTE: This estimate does not include fees due to otner DepaTnments ttie. raunnuig, .... — n., ..• •.l - - ----- - ---
-a—i. !'nnmrt tha Dont far addn'l info.
District, era). Lnese Lees are uuam vis use .c.ns..as.
FEE ITEMS LFee Resolution 11-053 E . 7/1113)
FEE ID
ROOF AREA
s.f.
____ _ -
MISC ITEMS
Plan Check Fee:
ippl. PC Fee
1 REROOFFRES
2,100
Pharn7 Al,fech./Elec
Permit Fee:
$336.00
Supp/. Insp Fee
Plumh.4fech./Elec
P1umh.A,,V1eeh.1E1ec Permit Fee:
Construction Tire:
Administrative Fee:
Work Without Permit? ® Yes No
$0.00
,Advanced Planning Fees:
�
1'ruiel1)Ocumentation Fce.s:
Strong Motion Fee: 1BSEISMICR
1-' may. '.fi � 1 -am,S �r'Y� L1� x.. .. "-�c. �.� r+V ��4`-='Caay `c'3^•
Wch. Plan (.'heck Phimb. Plan Check Elec. Plan (.heck
Wech. Permit P'ee: Plumb. Permit Fee: I Elec. Permit Fee:
Fh_
rlleeh. Insp. Other Plumb Insp. Other Elee. Insp.
ED
We,
In p. Fee:Plumb. Insp. Fee:Elee. Insp. Fee.
�.•_ ri,__.__ c:_.. O...s..�.. Q,...,.,. Il:otr:rt .Cnhnnl
NOTE: This estimate does not include fees due to otner DepaTnments ttie. raunnuig, .... — n., ..• •.l - - ----- - ---
-a—i. !'nnmrt tha Dont far addn'l info.
District, era). Lnese Lees are uuam vis use .c.ns..as.
FEE ITEMS LFee Resolution 11-053 E . 7/1113)
...-.••...•• •- »•»--»-__
FEE
__._ __ _
QTY/FEE
____ _ -
MISC ITEMS
Plan Check Fee:
ippl. PC Fee
Pharn7 Al,fech./Elec
Permit Fee:
$336.00
Supp/. Insp Fee
Plumh.4fech./Elec
P1umh.A,,V1eeh.1E1ec Permit Fee:
Construction Tire:
Administrative Fee:
Work Without Permit? ® Yes No
$0.00
,Advanced Planning Fees:
�
1'ruiel1)Ocumentation Fce.s:
Strong Motion Fee: 1BSEISMICR
$1.05
Select an Administrative Item
w, i 338.05
$0.00T a $
Bldg, Std s Commission Fee: 1BCBSC
ft -
$1.00
$338.05
Revised: 10/01/2013
CUPIERTINO
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(a cupertino.og
PROJECT ADDRESS
I
APN #
3 16 3 /
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k 6
V A ✓�
OWNERNAMBC
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m 14 C -41A
PHONE
E-MAIL
STREET ADDRESS
\
CITY, STATE, ZIP
FAX
CONTRACTOR AMEJM(LIC
BER
LICENS TYPE
BUS. LIC. #
`
-
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP,
P NE `0
I UNDERSTAND AND AGREE TO THE FOLLOWING:
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 woofing 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 VkoTpquired to be installed in accordance with Sections R314 and R315 of
the 2010 California Residential Code. I a _
Signature of Applicant/Agent: Date: l 1 �j .
ReroofPolicy_2012.doc revised 10/7/12