14010066 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10374 SAN FERNANDO AVE CONTRACTOR:BRIDGEMAN/MANCHA PERMIT NO:14010066
ROOFING
OWNER'S NAME: JACK AND MARILYN GOODMAN 13621 FERNCREST CT DATE ISSUED:01/09/2014
OWNER'S PHONE: 4085053413 SARATOGA,CA 95070 PHONE NO:(408)866-8170
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL E]
2 p 5630 �— RE-ROOF 27 SQUARES,COMP TO COMP
License Class C— 7 \ Lic.# t'
r
rn
AJJ Contractor
2JN�—: Date
I hereby affi tl am liceL 1 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:$12700
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:35712043.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT IBES IF WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WIT 1 0 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 DA F M 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 ! �!!�
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.
(' RE-ROOFS:
Signature Date 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.
❑ OWNER-BUILDER DECLARATION 1-2—Ig
Signature of Applicant: tom' Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: ALL ROO RING O 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 25505,25533,and 25534.
c
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 CONSTCTION LENDING AGENCY
RU
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
A
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION.
10300 TORRE AVENUE-CUPERTINO, CA 95014-3255
CURER'C'l[�EO. (408)777-3228• FAX(408)777-3333•building cDcuoertino.org �LO
PROJECT ADDRESS V e, APN# 7
OWNERNAME PHONNCfa/ S-3�►3 EMAIL
STREET ADDRESS IO��( �(_� CITY, STATE,ZIP u FAX
jC v f
CONTACT NAME PHONE E-MAIL
STREET ADDRESS CITY,STATE,ZIP FAX
❑ owNER ❑ OwNER-BUILDER ❑.owNERAGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME ag^
rp LICENSENUMB _,0(,,,,- LICENTTSETYPE n BUS.LIC.#Zq
COMPANY NAME E-MAIL FAX 21081 ya9 S I$3
c; erna,• '�1o�C�a
STREET ADDRESS t CITY,STATE,Zl �{ n SO-7D PHOI� O�/8�/�a 3o
ARCHITECT/ENGINEERNAME LICENSENUM 3FR (� `� BUS.LIC.# (�
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF 15 SFD or Duplex ❑ Multi-Family ROOF ARENlA: VA�,iJATION:
STRUCTURE: ❑ CommeIcial +�tU�l
EXISTING ROOF TYPE: ❑BUILT-UP ROOF 91 ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY)
REMOVE/REPLACE J1 YES IFNO, PLYWOOD 0 %" ❑ PLYWD ❑ OSB PITCH: j/., ROOF
❑NO 1 #LAYERS: THICKNESS: 115/8" TYPE: CDX :12 CLASS: A
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF AN ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT#
DESCRIPTION OF WORK
nom
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 lavas relating to building c nstruc i n. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date:
S UP P LEMEN TAij1WMA.TI W REQUIRED aic�vsrol.LX � �
_If building is associated with a Home Owners Association,provide letterMM
_ RO � '
of approval from HOA. ovEx-TG3TEt1B p 'cr
Provide Planning approval to verify ifthere any restrictions. �.. S
�s`PI, £GP.LAI�ItEVIE�i' -
_Provide copy of Manufacturer's Installation Specifications.
Provide signed copy of Cupertino's Tear-OffPolicy. _ T �
ReroofApp_2011.doc revised 03116111.
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 10374 San Fernando Ave DATE: 01/09/2014 REVIEWED BY: Mendez
APN: BP#: *VALUATION: 1$12,700
*PERMIT TYPE: Minor.Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD or Duplex PENTAMATION 1 SFDWLROOF
USE: PERMIT TYPE:
WORK re-roof 27 sq com to comp
SCOPE
FEE ID ROOF AREA
s.f.
IREROOFFRES 2,700
zm WE,
24
Xlech, Plan Check Plumb.Plurt C"hed I lec,flan Check
Wech.Permit Fee: Plumb.Permit Fee: Elec.Permit Fee:
Otho r,llech.Imp. Other Plumb Insp. Other Elec.Insp.
Meeh.Insp. Fee: Plumb. hush. Fee. Elec.Insp. Fee::
NOTE: This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). Theseees are based on the relimina information available and are onlyan estimate. Contact the Det or addn'l info.
FEE ITEMS(Fee Resolution 11-053 E . 7ff 11113) FEE QTY/FEE MISC ITEMS
Plan Check I*"ee:
Suppl. PC F'ee
Plumb./i1!lech./E'lec
Permit Fee: $432.00
SupY)l. I17sh Fee
Phan h./1[ech./Ef lec
Plumb./Wech.IFlec Per-mitF'ee:
Construction .Tax:
Adini"istrative Fee:
Work Without Permit? ® Yes (E) No $0.00
AdvaneedPlanning flees:
Travel Documentation Fees: �
Strony Motion Fee: IBSEIS1L11CR $1.27 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00
NOWN
:,z; i $434.27 0.00h � a r $434.27
Revised: 01/01/2014
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•buildinga(Dcupertino.ora
PROJECT ADDRESS �-y q So �n Q� APN#
OWNER NANIE �J` 'f G(3o�AQn 1` PHONEiqKy&S j 1 3 E-MAIL
STREET ADDRESS K v CITY,STATE,U� J�`1 1 FAX
zrc,� t ca.
CONTRACTORNAMEJ�AI LICENSENUMBl�63o�/� LICENS � BUS.LIC.#
COMPANY NAME \� E-MAIL �( FAXg0q_/qaq<8
Ct
STREET ADDRESS r A CITY,STATE,z!�_,,. (q' 956
-7 D PHONE) Cdd To x)
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 un 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 inspedtion.
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 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 8315 of
the 2010 California Residential
Signature of Applicant/Agent: Date: r 7
ReroojPolicy_2012.doc revised 10/7/12