13120124 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10605 GASCOIGNE DR CONTRACTOR:CSR ROOFING INC PERMIT NO:13120124
OWNER'S NAME: WINNIE S LEE 164 MARIAN LN DATE ISSUED:12/17/2013
OWNER'S PHONE: 4087258868 SAN JOSE,CA 95127 PHONE NO:(408)5924596
❑ LICZENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL F]
License Class GJ Lic.# ��y �3 Z re-roof 20 sq-remove existing shingles,install plywood install 3016 underlayment
install
Contractor Date 6
I hereby affirm that I am licei.,ed 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:$10000
I 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:37528013.00 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 FROM LAST CALLED 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 /Z 1 CG ?
granting of this permit. Additionally,the applicant understands and will comply Issued by: Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
918.
"-ROOFS:
-ROOFS:
J
Signature Date b All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed without fust obtaining an inspection,I agree to remove all new materials for
inspection.
❑ OWNER-BUILDER DECLARATION t 3
Signature of Applicant: 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
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 2550 and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date:��l/Z6//J
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
918.
Signature Date
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 2
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (��
CUPERTINO. (408)777-3228• FAX(408)777-3333•building(aDcupertino.org
0
PROJECT ADDRESS 2S APN# O I
OWNER NAME PHO 40 'g o EMAIL
STREET ADDRESS S L CITY, STATE, UZIP"� �� �cb�/J FAX
u ( J �J
CONTACT NAME PHONE E-MAIL
STREET ADDRESS CITY,STATE,ZIP FAX
OWNER ❑ OwNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME /f C P LICENSE NUMBER LICENSE TYPE BUS.LIC.#
✓ (�J k
COMPANY NAME C^a E-MAIL 'r K
�_ C- '-ICJU LG ZJIJI'J
STREET ADDRESS CITY,STATE,ZIP M tjo I q
ARCHITECT/ENGINEERNAME LICENSENUMBER BUS.LIC.#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑ SFD or Duplex ❑ Multi-Family ROOF AREA: VALUATION:
STRUCTURE: EI Commercial
IQ tod
EXISTING ROOF TYPE: . ❑BUILT-UP ROOF ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD
SHINGLES ElOTHER(SPECIFY)
REMOVE/REPLACE P<YES IF NO, PLYWOOD " ❑ PLYWD l�L1`QS�B PITCH: ROOF
❑NO #LAYERS. THICKNESS: 115/8" TYPE: ElCDX 2 CLASS A
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF �SPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT#
DESCRIPTION OF WORK 10
�l
cil
t9 .e i rrt ti 5 -)�OLP 1
By my signature below,I certify to each of the ollowtng: I am the property owner or authorized agent to ac4n the property er'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 building construction. I lie representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: ( Date: 12` 4-01Imo_
SUPPLEMENTAL INFORMATION REQUIRED � �� gcExrsa3oN>3Yk �
If building is associated with a Home Owner's Association,provide letter T� o � xotrrlrrsof �
of approval from HOA. + � ® u>7v>zvcpAz�rw �
_Provide Planning approval to verify if there any restrictions. �, xis ��'1P �J'LAivi�Ev�R• �:
Provide copy of Manufacturer's Installation Specifications.
_Provide signed copy of Cupertino's Tear-Off Policy.
ReroofApp_2011.doc revised 0311.6111.
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 10605 gascoigne dr DATE: 12/17/2013 REVIEWED BY: Mendez
APN: BP#: *VALUATION: j$10,000
*PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD Or Duplex PENTAMATION 1SFDWLR00
USE: PERMIT TYPE:
WORK re-roof 20 sq-remove existing shingles, install plywood install 301b underla ment install
SCOPE
FEE ID ROOF AREA
s.f.
1REROOFFRES 2,000
01 11 � .
�
P LN
P e
1:PaR
X/ech.Plan Check Phaub.Plan Cheek Elec_flan Check
F11111,PernritFee:
Plumb.Permit Fee: Elec.Permit Fee:
Llfibc'h.
,Zech.Inst. Other Plumb Asp. Other Elec.Insp. Li Insp. Fee: Plumb. Ins/).1,1,e: I:lec.Insp,Fee:
NOTE:This estimate does not include fees due to other Departments(L a Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc. . Thesefees are based oxthe relimina information available and are only an estimate Contact the Dept for addn7 info,
FEE ITEMS(Fee Resolution 11-053 E . 711113) FEE QTY/FEE MISC ITEMS
Plein Check P'.ee:
4ul�l�l. PC'Fc-e
Plurnb.111ech.tl'lec
Permit Fee: $320.00
Suppl. Insp Fee
Plum h.,,Mech./Elec
Plumb./Mech.i"Elec PeWit P'ee:
Consfruction T'c'rx:
Adin inistrative ft'ee:
Work Without Permit? 0 Yes (E) No $0.00
A(Ivunc€d Planning frees:
7'ravel.Docrrrrterctatiorr Fees:.
Strong Motion Fee: IBSEISMICR $1.00 Select an Administrative Item
Bldg-Stds Commission Fee: IBCBSC $1.00
µ v
- $322.00 $0.00 $322.00
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
CUPERTI;NO
(408)77/7�-3228• FAX(408)777-3333•building a(D.cupertino.org
PROJECT ADDRESS / /,� APN#
lio a Y
OWNERNAME I k PHONE / E-MAM
lLee (�
STREET ADDRESSca O CITY, STATE,ZIP FAX
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC.#
COMPANY NAME CS EMAIL /S�YD O t�C f FAX r(/J/1 66
STREET ADDRESS (/ CITY,STATE,ZIP PHONE
3�
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 roofmg 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 detecto e 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