14040072 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22560 KINST CT CONTRACTOR:XTERIA CONSTRUCTION PERMIT NO: 14040072
OWNER'S NAME: BERGAMO MICHAEL P AND YANG BIN PO BOX 5460 DATE ISSUED:04/11/2014
OWNER'S PHONE: 4082529708 SAN JOSE,CA 95150 PHONE NO:(408)289-5353
p' LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL
16 SQ'S-REMOVE ASPHALT SHINGLE& INSTALL NEW
License Class C' 3 Lic.# 7G z-7-0 C11 ASPHALT COMP CLASS A SYSTEM
Contractor
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:$6900
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:34251005 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 W WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS CE OR
to building construction,and hereby authorize representatives of this city to enter SPECTION.
upon the above mentioned property for inspection purposes. (We)agree tC indemnify and keep harmless the City of Cupertino against liabilities,ju costs,and expenses which may accrue against said City in consequence oDate:
granting of thi e it. Additionally,the applicant understands and will comply issued
with all non-po t rce gulations per the Cupertino Municipal Code,Section
9 18.
/� RE-ROOFS:
Signature V� Date —` �' All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed without first obtai inspection,I agree to remove all new materials for
inspection.
ElOWNER-BUILDERDECLARATION I/ //— /C
Signature of Applicant Date:
yr
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
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 u equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by thi ay rea Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with th u thio Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sectio 5, 533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this ! ^�� //C/Date:
Owner or authorized agent:
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 CONSTRUCTION LENDING AGENCY
Compensation laws of California. If,after making this certificate of exemption,I
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
RER90F PERMIT APPLICATION O 1
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPE TINO CA 95014-3255 `O
CUFERTINt? (408)77T-3228•FAX(408)777-3333•buildincl0cuoertino.orcl
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PROJECT ADDRESS ?J Kwosj,—
oc-t— 7APN
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— ac-r—
OWNER NAME « , / PHONE D S2,577o E-MAIL
STREET ADDRESS rN C y ITY,STATE,ZIe_1l".A 0 ew Q` (AX
CONTACT NAME � Gr PHOI� (� E-MAIL 7J
5 o 0 0 5f'37�6
STREET ADDRESS 1TY,STATE,ZIP FAX
-0 PtA A-516 e G L.0&.,}
❑OWNER ❑ OWNER-BUILDER ❑ O�mAGENT VC0ZACTO ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME C��,�p LICENSI
NUMBER LICENSE TYPE� BUS.LIC.r _5"
COMPANY NAME �^�n/Cr �N MAIL� � FAX syV/(/ref Q 7/,5 �J
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STREE ADDRESSITY,STATE,ZH SA,,, Esc 444ysIZG PHONE Z�V 7777
ARCHITECT/ENGINEER NAME LICENSI NUMBER BUS.LIC,
COMPANY NAME 1 -MAIL FAX
STREET ADDRESS ! ,STATE,ZIP PHONE
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USE OF SFD Or Duplex 1❑ Multi-Family R FAREA I J VALUATION:
STRUCTURE: ❑ Commercial a
EXISTING ROOF TYPE: ❑BUILT-UP ROOF ASPHALT SHINGLES 11 WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY)
REMOVE/REPLACE VeNES I IF NO. PLYWOOD ❑ h^ ❑ PLYWD ❑ OSB PITCH: ROOF
❑NO #LAYERS. THICKNESS: 115/8- TYPE: ❑CDX :12 CLASS: A
ICC-ES REPORT e
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF! SPHALT SHINGLES WOOD SHAKES ❑WOOD S19NGLES ❑OTHER
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DESCRIPTION OF WORK: TIP
By my signature below,I certify to each off owing: I am the proowner or authorized agent to act on the property owner's behalf. 1 have read this
application and the information I have pro 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 bui o I authorize ntatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date: �— b 7-1K
SUPPLEMENTAL INFbRMATION REQUIRED
! Q n t?1FIrJICG T, `�NL.Y �:
.If building is associated with a H�me Owner's Association,pi ovide letter ' xovrit st tP
of approval from HOA. BtItT]DII GP•L#I�REIVTEW
_Provide Planning approval to veru if there any restrictions.
Provide copy of Manufacturers stallation Specifications.
L� �ax� � II FtRB DEPT
_Provide signed copy of Cupertino p Tear-Off'Policy. ❑ oTx�x
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ReroofApp_2011.doc revised 031161'11
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CITY OF CUPERTINO
FEE ESTIMATOR— BUILDING DIVISION
ADDRESS: 22560 KINST CT DATE: 04/11/2014 REVIEWED BY: MELISSA
APN: 342 51 005 BP#: *VALUATION: 1$6,900
*PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD or Duplex PENTAMATION 1SFDWLR00F
USE: P PERMIT TYPE: A
WORK 16 SQ'S - REMOVE ASPHALT SHINGLE & INSTALL NEW ASPHALT COMP CLASS A SYSTEM
SCOPE
FEE ID ROOF AREA
s.f.
1 REROOFFRES 1,600
1 `
T�+
x �1i.
if'cl t'`crai t. °ac F; 11/wd), Plac t('hec n' 1,7(- . 1'i,a r C'hac'c
FIT, T r.P,<rir Foe: F h,,Tnb. P rma F"e:
FIT,7,
01/i c r T i n�a7>Iris>, Lj
Of/W,
Isci, /rs:rJ,f :e: 77r'tt�uh. T��.�z Pc'e:: ie'c. /tzs}�
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 prelimina information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
:S'lIppl. PC 1'e
Permit Fee: $256.00
Perntit Fee:
C.`onstnicr .ion Tcty.
Work Without Permit? ® Yes No $0.00
%fXl'Ct7J!'c'Cl Z�"}ttt71d7ri£j
Fees:
Strom Motion Fee: IBSEISMICR $0.69 Select an Administrative Item
Bldp Stds Commission Fee: IBCBSC $1.00
�SIN NB '�L` t $257.69 $0.00 . TOTAL FEE: $257.69
Revised: 04/01/2014
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RERO�F TEAR-OFF POLICY
COMMU( ITY DEVELOPMENT D PARTMENT-BUILDING DIVISION
ALBERTALVADOR,P.E.,G.B. .,BUILDING OFFICIAL
Ct PERTINO 10300 TORE AVENUE-CUPEF TINO,.CA 95014-3255
(408)777J3228-FAX(408)777-3333-WldinQCal_cuoertino.orn
PROJECT,ADDRESS / / APN N _ 0 5,
OWNER NAME ItAl C ke,_IG11 e- e�O PH 2�;Z E-MAIL
STREET ADDRESS i 8 a Cay,STATE. iP 1�7,Z Q PA}:
CONTRACTOR NAME LICENSE NU ER LICEN TYPEBUS.LIC k
�ZZDq �37/5
COMPANY NAME MAIL } !/5 `�Z
STREET ADDRESS C ,STATE,ZIP, (� j=/ PHONE
le c a ssi� oB. S7?7
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I UNDERSTAND AND AGREE TO THE FOLLOWING:
1. The re-roof project shall'Comply with all applicable provisions of the 2013 California Codes.
2. An inspection request cati be scheduled up lo one business day before the recluested inspection date.
Please schedule inspectigns online or call (4 8) 7.77-3228 from 7:30-3:30pm (Mon-Thurs) or 7:30-
2:30pm (Friday) to schedule inspection. Fo Tear-Off and Nailing Inspections, you must also call on the
day of the inspection onl� after that phase of the work is completed. The building inspector will be
available within one hour. The hours for this service are: 7:30-10:30am and 12:30-3:30 (Mon-Thurs)
and 7:30-10:30am and 12:30-2:30(Friday). Final Inspections will be given a two hour window.
3. Tear-Off Inspection is ieguired. Any and all dry-rotted wood shall be replaced prior to this inspection.
Unless new plywood roo�sheathing is proposed throughout, all the nails/fasteners shall be either
completely knocked-do l vn or removed prior to this inspection.
4. If plywood is installed, alplywood Naflin2 I s ection is required.
5. Roofing shall not be appiied 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.
b. A Final Inspection and hpProval shall be obtained from the building inspector when the re-roofing is
completed. To receive aEfinal sign-off, the fallowing items will be verified:
a. Flat roofs shall have a minimum of I/"ger foot of slope and demonstrate there is no ponding.
b. Listings from approved testing age ciesfor all pre-manufactured products used shall be
available on-sitq to review at the tinie of the inspection.
c. Proper spark arrestor installation, v nts 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 eaieh of the following is true: : I am the property owner or authorized agent to act on the
property owner's behalf. I under6an d gree to co ply with the re-roof policy stated above. I also understand that
smoke detectors and carbon monpxi ct rs are re uired to be installed iii accordance with Sections R314 and R315 of
the 2013 California Residential Cho
Signature of Applicant/Agent: Date:
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Ret-oofPolicy_2014.doe revised 01/15114
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