13120069 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19866$AYWOOD DR CONTRACTOR:A.QUINTERO ROOFING PERMIT NO:13120069
OWNER'S NAME: JUN WEN LIU 3939 QUIMBY RD DATE ISSUED:12/09/2013
OWNER'S PHONE: 5105746828 SAN JOSE,CA 95148 PHONE NO:(408)531-1961
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL ❑
(23 SQ'S)TEAR OFF(E)SHAKE,INSTALL LIFETIME CLASS A COMP
License Class Lie.#� T�,� — ROOF SYSTEM
Contractor �, �» ,%� Date 4 .
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 consentto self insure for Worker's
Compensation,as provided for by Section 3700`of the Labor Code,for the
performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$10000
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:31630011.00 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 cityand county ordinances and state laws relating WITHIN 180 DAY RMIT ISSUANCOR
to building construction,and hereby authorize representatives of this city to enter LEE D INSPECTION.
upon the above mentioned property for inspection purposes. (We)agree to save 180 DA
indemnify and keep harmless the City of Cupertino.against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the sued Date 2
granting of this permit. Additionally,the applicant understands and will com
with all non-point source regulations per;the Cupertino Municipal Code;SetTibn
9.18.
RE-ROOFS:
Signature Date-/Z 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.
0 OWNER-BUILDER DECLARATION
Signature of Applic Date:
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)
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 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
will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
performance of the work for which this permifis issued.
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sec ions 25505,25533,and 25534.
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 tobecome*subject to the Worker's CONSTRUCTION LENDING AGENCY
Compensation laws of California. If after making tlis certificate of:exemption,I
become subject to the Worker's Compensation,provisions.of the Labor Code,Lmust 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.)
Lenders 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
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION.
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228• FAX(408)777-3333•building(Dcupertino.org ` ✓/
CUPERTINO \
PROJECT ADDRESS APN# l {, r 3 O D 1
OWNER NAME l
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STREET ADDRESS CITY,STATE,ZIP FAX
CONTACT NAME PHONE E-MAIL
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STREET ADDRESS CITY,STATE,ZIP FAX
❑ OWNER ❑ OWNER-BUILDER ❑.OWNER AGENT ZICONIRACTOP ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME LICENS NUMBER LICENSE TYPE BUS.LIC.#
4" sea
COMPANY NAE
ME -MA1L FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
. .+ O SO
ARCHTTECT/ENGINEERNAME LICENSENUMBER BUS.LIC.#
COMPANY NAME �_ &MAIL -_ FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE of ❑ SFD or Duplex ❑ Multi-Family ROOF AREA- VALUATION:
STRUCTURE: ❑ Commercial
EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES XOODSHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY)
REMOVE/REPLAC IF NO, PLYWOOD ❑ 'w PLYWD \ OSB PITCH: ROOF
❑NO I #LAYERS: THICKNESS: 115/8" TYPE: ❑ CDX :12 C SS: A
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT#
DESCRIPTION OF WORK
L,• a
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 to uilding constructi �rensentatives of Cupertino to enter the above-identified property for inspection purposes.
S ignature of Applicant/Agent: Date:
SUPPLEMENTAL INFOR1vIATION REQUIRED _ a? sE IL" 0
EN=
_
_If building is associated with a Home Owner's Association,provide letter ? 1 1- -.N VI A110rII`GSI1z��
of approval from HOA.
PP �OSrEIt=T OUJV'TEIZ:. �� UII.D "G PIyAl\R?♦K��IE -j�,
Provide Planning approval to verify if there any restrictions.
-'- EXPRESS P�, v1E
Provide copy of Manufacturer's Installation Specifications._ zFIRiD�xT r
_Provide signed copy of Cupertino's Tear-Off Policy.
Reroof54pp_2011.doc revised 03/16111.
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 1986E BAYWOOD DR DATE: 12/09/2013 REVIEWED BY: MELISSA
APN: 316 30*011 I.BP#: "VALUATION: 1$10,000
*PERMIT TYPE:. Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD or.Duplex PENTAMATION 1 SFDWLROOF
USE: P PERMIT TYPE:
WORK 23 SQ'S TEAR OFF E SHAKE INSTALL LIFETIME CLASS A COMP ROOF SYSTEM
SCOPE
FEE IDROOF AREA
s.f.
- 1REROOFFRES 2,300
N
L9kch. Plan Check Plumb.Plan Check Dec.Plan Check
L1.c:h. Permit Fee: Plumb.Permit Fee: Elec. Permit Fee:
Other Alech.Insp. Other Plumb Insp, ED__L_ Other Elec.Insp. Lj
.11ech.Insp.Fee: Plumb. Insp. Fee., Elec.Insp.Fee:
NOTE:This estimate does not include fees due to other Departments(La Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). Theseees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 11-053 E . 7/1/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Suppl. PC Fee
Plumlec.
Permit Fee: $368.00
. .Suppl. Insp Fee
Plumb./i!lech./Mec
Plumb./Meeh./Elee Permit Fee:
Construction Tax.
Administrative Fee..
Work Without Permit? 0 Yes '(j) No $0.00
Advanced Planning. Fees:
Travel Documentation Fees:
StrongMotion.Fee: IBSEISMICR $1.00 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00
��,a_ $370.00 $0.00 . $370.00
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
(408)777-3228• FAX(408)777-3333•building a(�.cuoertino.ora
PROJECT ADDRESS APN 4 3 6 1 , 3 d /
OWNERNAIvIE l�`V Jvh vim'' PHONE ll V E-MAIL
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STREET ADDRESS CrrY,STATE,ZIP FAX
ei{J
COINTRACTORNAME LICENSENUMBER LICENSE TYPE BUS.LIC.#
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COMPANY NAME E-MAIL FAX
J'
STREET ADDRESS CITY, TATE,ZIP PHONE
/ p8
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._ oofing 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 Maid 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 Vade.. .
Signature of Applicant/Agent: Date: 14/4 ZZ3
ReroojTo1icy_2012.doc revised 10/7/12