14030031CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10123 AMADOR OAK CT
CONTRACTOR: IQV CONSTRUCTION
PERMIT NO: 14030031
INC
OWNER'S NAME: HOOD SARAH S AND WEST ROBERT 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 COMMERCIAL E]
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(4 SQ'S) TEAR OFF (E) BUR, INSTALL SECURE ROCK,
License Class/ Lic. # (
60MIL CARLISLE ROOF SYSTEM
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Contractor rQ 16 4
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
Sq. Ft Floor Area:
Valuation: $2715
performance of the work for which this permit is issued.
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
permit is issued.
APN Number: 34232023 00
Occupancy Type:
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
IT ISSUANCE OR
WITHIN 180 DAYS��ALLED
upon the above mentioned property for inspection purposes. (We) agree to save
180 DAY L 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
3
granting of this permit. Additionally, the applicant understands and will comply
ed by: /
with all non -point so a regulations per the Cupertino Municipal Code, Section
9 18.
Io
RE -ROOFS:
Signature Date J / /U
J
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining inspection, I agree to remove all new materials for
inspection.
❑ OWNER -BUILDER DECLARATION
Signature Date: /
I hereby affirm that I am exempt from the Contractor's License Law for one of
ofApplicOCOV
the following two reasons:
ALL ROERINGS TO BE CLASS "A" OR BETTER
1, 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. 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 Cupertino Municipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sections 5533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agen 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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
ARCHITECT'S DECLARATION
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 Cclicupertino.orcl
CUPERTINO
PROTECT ADDRESS
7APN # 3,q2- _32- x 23.0 0
OWNERNAMFE-M.AiL
STREET ADDRESS CITY, STATE, ZIP I FAX
CONTACT NAMEPHOt�
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E-MAIL
STREET ADDRESS
CITY, STATE, ZIP
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ .OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGB,'EER ❑ DEVELOPER ❑TF NANT
CONTRACTOR NAME
LICENSE NUMBER
LICENSE TYPE
BUS. LIC. k
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COMPANY NAME
E-MAIL
FAX
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STREET ADDRESS
CITY STATE, ZIP _
PHONE
ARCHITECT/ENGINEER NAME
LICENSE NU1.4BER
BUS. LIC. H
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ SFD or Duplex ❑ Multi -Family
ROOF AREA:
VALUATION:
Commercial
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STRUCTURE: ❑
�'>(')
EXISTING ROOF TYPE: , 'W BUILT-UP ROOF ❑ ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER (SPECIFY)
REMOVE /REPLACE MYES
IF NO,
1
PLYWOOD ❑ ''vv. ❑
PLYWD ❑OSS
PITCH:
12
ROOF
A
❑ NO
N LAYERS:
THICKNESS: ❑ 5/6"
TYPE: 13(
CLASS:
PROPOSED ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES OTHER
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 ovener's behalf. I have rea is
application and the information I have piov ed is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all app ab al
ordinances and state laws relatinjtVflg construction. I authorize representatives of Cupertino to enter the above- identified property inspecti pu s.
S ignature of Applicant/AgenC Date:
SUPPLEI\IEN AL WFORMATI0N REQUIREDt
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"0x�LAt` cl�e>cT�trEu��
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_ If building is associated with aHome Owner's -Association, provide letter
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t�gtarf•T h t fi sero:
❑ BUILDII\G2-LAl\'RE}�P'y?
of approval from HOA.'
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— Provide Planning approval to verify there any restrictions.
C���ExPIU ;r.
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_Provide copy of Manufacturer's Installation Specifications..Ipq
Provide signed copy of Cupertino's Tear -Off Policy.
sItn'r x tC1�TREDErG�
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ReroofApp_2011.doc revised 03/16/11
CUPr_0—r1 SIO
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 Qcupertino.org
PROJECT ADDRESS. / /f
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OWNERNAME
1s)V7 -i O / E-MAIL
STREET ADDRESS
CITY, STATE, ZIP I
FAX S
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CONTRACTORNANM
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LI SE NUMBER LIC�NSETYPE
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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.
- 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 Mll 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 det tors are required to be installed in accordance with Sections R314 and R315 of
the 2010 California Residential Code. _
Signature of Applicant/Agent: _ Date: /
Reroo,Tolicy_2012.doc revised 10/7/12