13100206 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 18911 PENDERGAST AVE CONTRACTOR:DANEL ROOFING PERMIT NO: 13100206
OWNER'S NAME: MAGOLA SHIFFER TRUSTEE 900 HENDERSON AVE APT 48 DATE ISSUED: 10/30/2013
OWNER'S PHONE: 4082529325 SUNNYVALE,CA 94086 PHONE NO:(408)241-3104
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
License Class ��P\ Lic.# '�? I�_ Q (17 SQ'S)TEAR OFF(E)T&G,INSTALL GAF CLASS A
�p COMP ROOF
Contractor ► 1(1`�P 1-t`'tit Date F100—
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:$8280
performance of the work for which this permit is issued. Sq.Ft Floor Area:
�1 1 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:37533031.00 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 DAY PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter LLED INSPECTION.
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the ISS Date: �/ 3
granting of this p it. Addition ly,the applicant understands and will comply
with all no of s urce regul ions per the Cupertino Municipal Code,Section
9.18.
O_ any
r ROOFS:
Signature Date All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed without first obtaini"anZeclon, o remoinspection.
❑ OWNER-BUILDER DECLARATION Date:
Signature of Applicant:
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(Sec.7044,
Business&Professions Code) HAZARDOUS MATERIALS DISCLOSURE
I,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. 1 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 Ba Area Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance wit he e&
p tino Muni 'pal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by
the Health&Safety Code, t� ns 55 5,25533, nd 25534.
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
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
c
REROOF PERMIT APPLICATION ��/
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION O
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 ��
CUPERTlNO (408)777-3228• FAX(408)777-3333•building(a)cupertino.org \
PROJECT ADDRESS ( " 1 1 J. APN# 1C�, 53 — 031
OV,NERNAME Q �1� \ �e\ PHOZ )
Io 2S2_ Z 151 E-MAIL
STREET 4DRESS FAX
CONTA T NAME PHONE(YM 252—q32_51
SZ—q3Z5 E-MAIL
STREET ADDRESS � CITY,STATE, ZIP FAX
XJ
OWNER ❑ OWNER-BUILDER ❑.OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHn'ECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAM \�^ ` V L ENS NUMBER J O LIC9 I ENSE TYPFC, BUS.LIC.#� D
COMPANY N �t FAX
AS ' E AIL p�
ST$E�ETADDRESS CITY TATE ZIP
JCti\ vrS ONE
9,{O DG Mon 2_L-0)\ L1
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- r VALUATION: UU
STRUCTURE. ❑ Commercial as S O 2-p
O
EXISTING ROOF TYPE: _ ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES UkOTHER(SPECIFY) /
REMOVE/REPLACE 51ES IF NO, PLYWOOD ❑ %" ❑ PLYwD ❑ OSB PITCH: _ ROOF
El
ElNO 1 #LAYERS THICKNESS: 115/8" TYPE: ElCDX '12 CLASS: A
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ASPHALT SHINGLES 13 WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT#
,C-ES
DESCRIPTION OF WORK:
V C , \� C�
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 ,e o ided is corn I. have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state]aws relati t bui di g construc on. I authorize representatives of Cupertino to enter thetya ve-identified prope for inspection purposes.
Signature of Applicant/Agent:
J Date: 1
SUPPLEMENTAL INFORMATION REQUIRED „r'oFFTCE vsr oNLY 'i
If building is associated with a Home Owner's Association,provide letter PLANCHECKTYPE, ROUTINc3LIP
of approval from HOA. ❑ OVERTICOUNTER ❑;BUILDING PLANREVLEw
Provide Planning approval to verify if there any restrictions. Q Esfr � ❑ PinrilvnvG'PLANIt>'vJEw 4
Provide copy of Manufacturer's Installation Specifications. l]sTnRv ;i £❑FIRE DEPT h #" ' ysry
,R. .ice yAiq Y yd
Provide signed copy of Cupertino's Tear-Off Policy. Is4 C7oTxER� 7,
ReroofApp_2011.doc revised 03116111
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 18911 PENDERGAST AVE DATE: 10/30/2013 REVIEWED BY: MELISSA
APN: 375 33 031 BP#: *VALUATION: 1$8,280
xPERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY PENTAMATION 1 SFDWLROOF
USE: SFD or Duplex PERMIT TYPE:
WORK � 17 SQ'S TEAR OFF E T&G INSTALL GAF CLASS A COMP ROOF
SCOPE
FEE ID ROOF AREA
s.f.
1 REROOFFRES 1,700
af'ch t'/u�,C7rcck ulrl> 1'lurt C b5,c t7�;�. t'l�1n t"�z�'ck
a �1utr.h_ ('crtrzit I� e: 1;'1,c Palttrit lwe
E3__L_
3(cxa, 112qoii?ea f'.'urnl, Ur/tc�; /�k��.Cnstz.
1"h ch. 111"p. kco /'blot?�. b),jp, t c", l;lcc lnsp. t �e:
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 the prelimina information available and are only an estimate. Contact the Dept for addn 7 info.
FEE ITEMS (Fee Resolution 11-053 a.' 7/1!13) FEE QTY/FEE MISC ITEMS
111ar2 C'hcc%Fce:
Slippl, PC Fee
P/zlznlr.i_11ecJz.:'Ilec
Permit Fee: $272.00
Szzhlrl. Irrsp I'c'e
f'hrrnlr.;s11c cJr.:"Laec
Pllrrrrh.i;1•t�rc•Ir.;'lslec /'c�rtztrP/�'ce�:
C`ons>+zrctior� KIN.
Work Without Permit? 0 Yes Q No $0.00
f c/vuzrcerl P/croor'm,I'ce:s:
Travel 0oczizrtcrrtution Fccb. �
Stronp,Motion Fee: 1BSEISMICR $0.83 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00
SUBTOTALS: $273.83 $0.00 TOTAL FEE: $273.83
Revised: 10/01/2013
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERTINQ
(408)777-3228 FAX(408)777-3333•building aC�cupertino.org
PROJECT ADDRESS g G I l2t ^C APN# 39
3 1
OWNERN �\ J Y \� �-( v�J P O� L J Z^g3ZS E-MAIL
STREET ADDRESS _ \ _\ n n CIT S�,STATE, P � / A S O` FAX
CO Ce ME �C/r`C)J� (� LICENS`NUTvAt LICENSE TEE) BUS.LIC.#2 L4(-7 O
CO NAME �\ �OV T �� E �tyL�C(� u FAX K7
y.N r\ Gl,,�OG• I..CJ�\
ST T ADDRES$ , a*� A �y Q CITY,STATE,ZIP ` `��` pry i -3 I O(f
f� �1C3�SG'(� n C� "l 10 1.ll�� -1
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 understa d and agree to comply with the re-roof policy stated above. I also understand that
smoke detectors and carbon m ox dd detectors are required to be installed in accordance with Sections R314 and R315 of
the 2010 California Residenti 1 o I L
\
Signature of Applicant/Agent: k` Date: I
RerooJPolicy_2012.doc revised 10/7/12