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14030017 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22588 LAZY OAK CT CONTRACTOR:IQV CONSTRUCTION PERMIT NO: 14030017 INC OWNER'S NAME: YOUNG RICHARD A 820 CHARCOT AVE DATE ISSUED:03/10/2014 OWNER'S PHONE: 4084483080 SAN JOSE,CA 95131 PHONE NO:(408)582-9200 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL F] �� 2/t REMOVE EXISTING BUILT UP ROOF AND INSTALL License Class C-3 5 Lie.# SECURE ,_ ROCK AND 60 MIL CARLISLE ROOFING SYSTEM(560 SQ Contractor Date FT). 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 performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$3800 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:34232004 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 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 DAYS FRO LLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply Issu te: with all non-point so ce regulations per the Cupertino Municipal Code,Section 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 ins ction,I agree to remove all new materials for inspection. ❑ OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of XV the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER L 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) 1,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. 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 Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cuperti Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 2 0 2 533,and 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 Compensation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY 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 REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION. 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTlNO. (408)777-3228• FAX(408)777-3333-building aDcupertino.orq J4103 b6�� PROJECT ADDRESS 22_S93 t �� N* 2 2 00J OV.'NERNAMF I �I� �OU nPHO � '�70.3E MAII.STREET ADDRESS CITY,STATE,ZIP I FAX CONTACT NAME E-MAIL Z i 45 - S 7 Z. 7' STREET ADDRESS CITY,STATE,ZIP FAX ❑ OWNER ❑ OWNER-BUILDER ❑.OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAMEr5 ) LICENSE NUMBER90!/ LICENSE TYPE BUS.LIC. mle // COMPANY NAME E-MAIL FAX CITY,STATE,ZI A _/ PHONE STREET ADDRESS t;� � S.C'-�(!L! -°I::i C: !`I //C� ARCHTTECT/ENGAIEER NAME LICENSE NUMBER BUS.LIC.# COMPANY NAME EMAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑ SFD or Duplex ❑ Multi-Family ROOF AREA: VALUATION: Z-_�-c)C3 STRUCTURE: El Commercial EXISTING ROOF TYPE: ,1?3-BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES, ❑WOOD SHINGLES ❑OTHER(SPECIFY) REMOVE/REPLACE ®YES IF NO, PLYWOOD ❑ '-A" ❑ PLYR'D ❑ OSB PITCH: ROOF ❑NO X LAYERS: THICKNESS: ❑ 5/6" TYPE: ❑ CDX '12 CLASS: A PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES OTHER ICC-ES REPORT S DESCRIPTION OF WORK / 60 it i 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 haveprovi d 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 b onstruction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEAlEN AL 12�rFORA4ATI0N REQUIRED la s � -OFFICEIJSEQn` 4 If building is associated with a Home Owner's Association,provide letter � YLAI�CHECK�YP. ovr�.c st> of approval from HOA. q R cO� �rER t Y6EB vl��PL�RF � J Provide Planning approval to verify if there any restrictions. ExPltEss ��PIs >s;P REVIEW " _: —Provide copy of Manufacturer's Installation Specifications.. , _Provide signed copy of Cupertino sTear-Off Policy. [ _•� �r� �.f y Reroofilpp_2011.doc revised 0311.6111. 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 ancupertino.org PROTECT ADDRESSe) I APN (,� `� 00 OWNER NAMVo 0 E L/ M� 6 I PHONE E-MAIL STREETADDRESS V�/1rI 11/R� CITY,STATE,ZIP I FAXJ PE CONTRACTORNAME P� LI NS_EIJ ER LICNSE I BUS.LIC.m COMPANY N ' �E-J,MATT FAX tf TREET ADDRESS CITY STATE,ZSP PHONE S TCkes �-� St s�v sc- cA 5illo I UNDERSTAND ANT 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 inspedtiori. 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. 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-roofuig 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 Daid 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 deterltors are required to be installed in accordance with Sections R314 and R315 of the 2010 California Residential Code. Signature of Applicant/Agent: Date: ReroofPolicy_2012.doc revised 10/7/12