13100111 CITY OF CUPERTINO BUILDING PERMIT
CONTRACTOR-Z s =e� PERMIT NO:13100111
BUILDING ADDRESS: 10133 BERKSHIItE CT � D
OWNER'S NAME: LEVALLEY JEFFREY K AND DIANA C T� L �Uti(o� DATE ISSUED:10/16/2013
PHONE NO:
OWNER'S PHONE: 4085093660
JOB DESCRIPTION: RESIDENTIAL U COMMERCIAL
II
❑ LICENSED CONTRACTOR'S DECLARATION
License ClassC31 - Lica# 9 7 7:g RE-ROOF 34 SQ-REMOVE SHAKES,INSTALL 7/16 OSB,
//�`y,��1�,/► �,�1 f 30LB FELT&CLASS A
Contracto4 Y�//^1( ) E S Date
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 Valuation:$13856
performance of the work for which this permit is issued. Sq.Ft Floor Area:
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the abor Code,for the performance of the work for which this APN Number:34212103.00 Occupancy Type:
permit is issued.
WAPPLICANTCERTIFICATION
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 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 DAY M LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments, ZI&
/3
costs,and expenses which may accrue against said City in consequence of the Issued by 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. A n �t RE-ROOFS:
Signature /,H ''� Date 1[//lAll 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 Signature of Applicant: r Date: AQW16/Z 3
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: ALL RO 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(Sec.7044,
Business&Professions Code) HAZARDOUS MATERIALS DISCLOSURE
1,as owner of the property,am exclusively contracting with licensed contractors to
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 Cupertino Municipal Code,Chapter 9.12 and
the Health&Safety Code,Sectio 25505,25533,and 25534.
I have and will maintain Worker's Compensation Insurance,as provided for by O
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent Dater
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
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
's
forthwith comply with such provisions or this permit shall be deemedworkfor which this permit is issued(Sec.3097,Civ C.)
_revoked. 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 cityand 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 O�
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 �\
CUPERTINO (408)777-3228•FAX(408)777-3333•buildin-gCa)-cupertino.org \
PROJECT ADDRESS O 3_9I a J APN# 24„'Z
OWNS '—D', I art�i• PHONE406 ( ,J E-MAIL
STREET ADDRESSCITY,STATE,ZIP b `/� FAX
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CONTACT NAME PHONE},6 E-MAI. I lde4- ®o d
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STREET ADDRESS CITY,STATE,ZIP FAX
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❑OWNER ❑ OWNER-BUILDER ❑OWNERACENT l�CONTRAcroR ❑CONIRACTADRAGENT ❑ ARcHrrECT ❑ENGwEER ❑ DEVELOPER ❑T NANT
CONTRACTOR NAM f r c a LICENSE R-7LICENSE E BUS.LIC �
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COMPANY NAME - E ml.��1 ® F -9 -779 F7
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STREET ADDRESS `O t.' � S6TATE,ZIP PHONE
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ARCHITECT/ENGINEER 'NAME LICENSE NUMBER BUS LIC.#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF IRI SFD or Duplex ❑ Multi-Family ROOF AREA: VALUATION:
STRUCTURE: ❑ Commercial
EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY)
REMOVE/REPLACE A- YES IF NO PLYWOOD )9 vp ❑ PLYWD XOSB PITCH: ROOF
❑NO 1 #LAYERS: THICKNESS: ❑4/g" TYPE: ❑CDx �:12 CLASS: A
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT#
DESCRIPTION OF WORK: ; •7 4' r /
r
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 hav 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 t on. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: - Date: IN 16113
SUPPLEMENTAL INFORMATION REQUIIZED 0MCE USE ONLY
_If building is associated with a Home Owner's Association,provide letter 9II?6;TYPE ROUTING SLIP
of approval from HOA. 45 OVER-THE-COUITER ❑ BUILDING PLAN REVIEW
Provide Planning approval to verify if there any restrictions. ❑ IwREss ❑ PLANNING PLAN REVIEW
Provide copy of Manufactwes JWallation Specification, ❑ STANDARD ❑ ME DEPT
Provide signed copy of Cupertino's Tear-Off Policy. ❑ OTHER:
ReroofApp_2011.doc revised 03/16!11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 10133 berkshire ct DATE: 10/16/2013 REVIEWED BY: Mendez
APN: BP#: *VALUATION: $13,856
*PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY PENTAMATION 1 SFDWLROOF
USE: SFD or Duplex PERMIT TYPE: i
WORK re-roof 34 s -remove shakes install 7/16 osb 301b felt&class a
SCOPE
FEE ID ROOF AREA
s.f.
1 REROOFFRES 3,400
Ivtech. Plan Check Plutrrb.Plant Check Elec.Plan Check
Tech.Permit Fee: Plumb.Permit Fee: l lec. Permit Fee:
Other ;�9uch.Ins��. Other Plumb Insp. Other IYec.Insp.
tleclz. Insp.Tee: Plumb. hrsp.Fee: Dec.Insp.Fee:
NOTE:This estimate does not include:fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,eta). These fees are based on%therelimina information available and are only an estimate. Contact the Dept for addh7 info.
FEE ITEMS (Fee Resolution 11-053 E . 7/1/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Suppl. PCFee
Plumb.lMechJLlee
Permit.Fee: $544.00
Su/apl. Insp Fee
Plumb.i'MechJEZee
PlumbJMech./Flee Permit Fee• _71
Construction :Tar:
Administrative Fee:
Work Without Permit? ®Yes Q No $0.00
Advanced Planning Fees:
Travel Documentation Fees: A
Strong Motion.Fee: 1BSEISMICR $1.39 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
!M"Ter , $546.39 $0.00 R $546.39
Revised: 10/01/2013
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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•building a(�.cuoertino.org
PROJECT ADDRESS APN#
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O RNAIEKEA P SIE D0 EMPII .-I
STREET ADDRESS �. CITY,ST ,ZIP D FAX
CO CTORN ,w' he i LICENSENUMBER,14b LI ENSJ2 BUS.LIC.#
07 T
COMPC.ANY `AME•IltV/ & FAX
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STRE ADD29
RE19 -4
SS 0j,41 ��' C��TE ZIP `L 950
' U1 12 PHONE _ O
V I UNDERSTAND AND AGREE TO T/HE 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 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 CA. -
Signature of Applicant/Agent: Date: /0//4//3
ReroofPo1icy_2012.doc revised 10/7/12