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131001600 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20776 HANFORD DR CONTRACTOR: EXECUTIVE ROOFING PERMIT NO: 13100160 OWNER'S NAME: PETER &TINA WANG 313 INGRAM CT DATE ISSUED: 10/24/2013 OWNER'S PHONE: 4082182183 SAN JOSE, CA 95139 PHONE NO: (408)158-6044 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL License ClassCom- Lic. # 95 RE -ROOF 18 SQ - REMOVE SHAKES INSTALL OSB, 30YR �, n i 2 Y Dnp � ltc COMP CLASS A Contractor 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 erformance of the work for which this permit is issued. Sq. Ft Floor Area: Valuation: $6400 ave and will maintain Worker's Compensation Insurance, as provided for by APN Number: 32630066.00 Occupancy Type: ection 3700 of the Labor Code, for the performance of the work for which this 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 to building construction, and hereby authorize representatives of this city to enter/ WITHIN 00 DAYS OF PERMIT ISSUANCE OR upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, 180 DAY F LAST CALLED INSPECTION. / i" 1f l costs, and expenses which may accrue against said City in consequence of the Issued b Date: j y' granting of this permit. Additionally, the applicant understands and will comply with all non-po per the Cupertino Municipal Code, SectionRE-ROOFS: 9.18. Uouclations Signature Date y I 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 remo4aflneaterials for inspection. OWNER -BUILDER DECLARATIONSignature of Applicant: fir, v Date:I hereby affirm that I am exempt from the Contractor's License Law for one ofthe following two reasons: ALL ROOF COVERINGS TO BE CLASS "A"ER 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(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 deices 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. I have and will maintain Worker's Compensation Insurance, as provided for by will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &Safety Code, Sections 2 505, 25533, and 25534. Section 3700 of the Labor Code, for theerformance of the work for which this p Owner or authorized agent: � Date: 2� 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 CUPERTINO. REROOF PERMIT APPLICATION e COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildinga(kupertino.orq 7kj PROJECT ADDRESS ) �^ L f a A -D�`� j •1,4 APN # 132,V3 g0(0(0 ✓Z OWNERNAME q �j� '6, PHONE � 0"1 ) 15, q � ] 5 E-MAIL STREET ADDRESS 2 �l Al ,� 1 ILl! J N road CITY, STATE, ZIP nV / L 9 �0I 1.rt©` /E-MAIL FAX CONTACT NAME _bm i� PHONE vVl� ?✓ STREET ADDRESS / 1 T I w 1� /1. CITY, STATE, ZIP CA ( FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT V CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME e i� 11J LICENSE NUMBER Z C �'7ti1 ' J / JV U LICENSE TYPV BUS. LIC. # ,/-y'Tll COMPANY NAME �^ E-MAIL i/ - , 1 �p FAX/ STREET ADDRESS - ` ( `I t " CITY, STATE, ZIP �'� d �f !l PHONE a l✓ ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC. 4 COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF SFD or Duplex ❑ Multi -Family ROOF AREA: VALUATION: q0t STRUCTURE: ❑ Commercial EXISTING ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES )f WOOD SHAKES 11 WOOD SHINGLES El OTHER (SPECIFY) REMOVE /REPLACE LSYES IF NO, PLYWOOD 19 %/ ❑ PLYWD iii OSBPITCH: ROOF El NO 4 LAYERS: THICKNESS: 115/8" TYPE: ❑ CDX ' 12 CLASS: A PROPOSED ROOF TYPE: ❑ BUIILT-UP ROOF 11ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ElOTHER ICC -ES REPORT # DESCRIPTION OF WORK: 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 rrect. 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 to but I—ng�con ction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. '' 2 Signature of Applicant/Agent: Date: F SUPPLEMENTAL INF0 ATION REQUIRED o1FlcEusi orzy " zcxTYPE r . " RouTmlGSLrn "`' ' x If building is associated with a"I*Iome Owner's Association, provide letter ❑' of approval from HOA.�OVERTH7<COUNTER BUiLDINGPLANREVIEW Provide Planning approval to verify ifthere any restrictions. `Q ExPREss PLANNINCPLANREVIEw Provide copy of Manufacturer's Installation Specifications. $T,tRD ❑FIREDErT tl z.r _ Provide signed copy of Cu ertino's Tear -Off Policy. oTM.���."' � ReroofApp_2011.doe revised 03116111 CITY OF CUPERTINO 1VV tV W cmnvr s TnR - RI TIT .DTNC. DIVISION FEE ID ROOF AREA s.f. 1 REROOFFRES 1,800 1'JJL' JL,,Jl X I T ---- Ch,ck Alec it. 1' -unit f t r, ADDRESS: DATE: 10/24/2013 REVIEWED BY: mendez 121 LnSU.it BP#: 'VALUATION: 1$6,400 APN: $288.00 Slpp/. Insp Fee *PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re -roof PRIMARY SFD or Duplex Plumb. "M ch.,' lec PENTAMATION 1SFDWLR00F PERMIT TYPE: USE: WORK re -roof 18 sq- remove shakes install osb and 30yr comp class a SCOPE $0.00 FEE ID ROOF AREA s.f. 1 REROOFFRES 1,800 NOTE: This estimate does not include fees due to other Departments (Le. rtunrttng, ru,.,rL r, w ... , -• ----- ---. - - .. .. ___ •__�______.:_� ._....:,,.L,,...»d...., n»hr n„ ocN,nnln_ Cnntaet the Dent for addn'l info. District, etr-). These fees are based on the preamunur FEE ITEMS (Fee Resolution 11-053 Ef. 711,113) lf'tar T'f� n t'l,r'cR Plrrnrh. Plcfrr C'.rt�cr,ULL Ch,ck Alec it. 1' -unit f t r, Plnmh. 1;7� cPc'r mifr V(,'L lrr.,h. O!flat Pbonh. LnSU.it w' l','C,. _ Plumb, hLy" l'£, _ .. »._____:___ l`c'('. NOTE: This estimate does not include fees due to other Departments (Le. rtunrttng, ru,.,rL r, w ... , -• ----- ---. - - .. .. ___ •__�______.:_� ._....:,,.L,,...»d...., n»hr n„ ocN,nnln_ Cnntaet the Dent for addn'l info. District, etr-). These fees are based on the preamunur FEE ITEMS (Fee Resolution 11-053 Ef. 711,113) to urntuuvr, u—clubrc FEE »+•„ »• � QTY/FEE �... r MISC ITEMS Plan C'hcrc`lc FCC.' S'uppl. PC Fce Pl t/Cl tl7,i:� 1Nt'h.il;lPC Permit Fee: $288.00 Slpp/. Insp Fee Plumb. "M ch.,' lec Plttfnb.:';i•tcclt.;`La<'c 1'crrfztit T'ce�: Construction Tax: �ILln1U"n.cttYXtlL'i? bee': Work Without Permit? 0 Yes (E) No $0.00 -1clti'u11c.cd Plurfnin , Fees: I'l—a el 0oclulwatutiori b`eef's: Strong Motion Fee: IBSEISMICR $0.64 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $289.64 $0.00 TOTAL FEE. $289.64 Revised: 10/01/2013 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 - buildin-gacupertino.org PROJECT ADDRESS 7-7 APN 9 OWNERNAME C-�Ur✓l/ }�},�y--� /iI-(� PHONE O� f ` E-MAIL STREET ADDRESS5^I/V�j�/`J �J l -J IL`I-CENSE CITY, STATE, ZIP ^� / u %� Jj FAX CONTRACTOR NAME A ; rLZN NUMBER LICENSE LICENSE TYPEC 2 G BUS. LIC. # COMPANY NAME6y L(_ l 1�, I l"C �D 61. , �C STREET ADDRESS 3 ( 3 r N� Aw- 1- CITY, STATE, ZIP Cly 3 PHONE (�nR �-<y/ L 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 appliedwithout 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 Co e.2 N Si¢nature of Applicant/Agent: ;;t Date: �y RerooJPolicy_2012.doe revised 10/7/12