14040062 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7930 OCTOBER WAY CONTRACTOR:CUPERTINO ROOF,INC PERMIT NO: 14040062
OWNER'S NAME: CHOI HA S AND HUI C 1052 KELLY DR DATE ISSUED:04/10/2014
OWNER'S PHONE: 4088289642 SAN JOSE,CA 95129 PHONE NO:(408)973-9427
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL ❑
q (27 SQ'S)TEAR OFF WOOD SHAKE,INSTALL(N)OSB,
License Class C l Lic.# p L S_� ) 15LB FELT,CLASS A COMP
Contractor U C +1-,:3 c C{�<,4 Date 7—!
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:$11000
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:36213033.00 Occupancy Type:
permit is issued.
APPLICANT CE16IFICATION
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 WITIHN 180 DAYS SSUANCE 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 VI LAS D 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 sued by: Date:
with-a"ITnonT-Pmgt source regulations per the Cupertino Municipal Code,Section
9 18. �
�� —�(� — L any
roofing material being installed.If a roof is
installed without fir ' 'ng an inspection,I agree to remove all new materials for
inspection. /
❑ OWNER-BUILDER DECLARATION 4-113 --� f
I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date:
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(See.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 Cod , — 25505,25533,and 25534.Section 3700 ofthe Labor Code,for the performance ofthe 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
W
O
REROOF PERMIT APPLICATION O
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE-CUPERTINO, CA 95014-3255 V
CUPERTINO (408)777-3228•FAX(408)777-3333•buildingOmpertino.org
PROJECT ADDRESS - p� 0 D G�D �gAPN#
OWNER NAME I •z PHONE q d R E-MAIL
STREET ADDRESS CITY, STATE,ZIP C FAX
CONTACT NAMEt_ q"� PHONE E-MAIL
1 Cl
STREET ADDRESS, CITY,STATE,ZIP FAX
❑OWNER ❑ OWNER-BUILDER .OWNER AGENT ❑;CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER [3 TENANT
CONTRACTOR NAMEU LICENSE N[J v�IBEI; LIC TYPE BUS.LIC.#
! o J (�
COMPANY NAME v^ E-MAIL FAX
STREET ADDRESS STATE,ZIP _ 9 T' 2 PHONE ��—�
ARCHITECT/ENGINEER NAME G' LICENSE NUMBER BUS.LIC.#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF _--W SFD or Duplex ❑ Multi-Family ROOF AREA: VALUATION: -
sTRucnJxE: E] Commercial _
EXISTING ROORTYPE:. ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER{SPECIFY)
REMOVE/REPL�YES IF NO, PLYWOOD ❑ %--to tJ. PL OSB PITCH: ROOF
❑NO 1 #LAYERS: THICKNESS: ❑5/8" TYPE: 11CDX '12 CLASS:
PROPOSED ROOF TYPE: ❑BUILT-UP ROOD ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT#
DESCRIPTION OF WORK:
C �Y� l� •y
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
applicationand the information royided is porrect. 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 o:buil co frac`n. I authorize representatives of Cupertino to enter theabo identified property for inspection purposes.
Signature of Applicant/Agent: '. Date:
SUPPLEMENTAL INFORMATION REQUIRED
If building is associated with a Home Owner's Association,provide letter
of approval from HOA.
a
Provide Planning approval to verify if there any restrictions.
Provide copy of Manufacturers Installation Specifications.
Provide signed copy of Cupertino's Tear-Off Policy.
ReroofApp_2011.doc revised 03/16111
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 7930 OCTOBER WAY DATE: 04/10/2014 REVIEWED BY: MELISSA
APN: 362 13 033 BP#: "VALUATION: Isi1,000
xPERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY PENTAMATION
USE: SFD or Duplex PERMIT TYPE: 1SFDWLR00
WORK TEAR OFF WOOD SHAKE INSTALL N OSB 15LB FELT CLASS A COMP
SCOPE
FEE ID ROOF AREA
s.L
1REROOFFRES 2,700
Plan€.'h�cn 1'Lrtt;f�. I'%art C'he�ch ' ec,
, "fJ). P_ nr%tFee: Pfrtmb, T'trmil Fee,
0111 Wech. lrasP. Other Plumb lrup. F-1 I
NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,eta). These ees are based on the prelimina information available and are only an estimate. Contact the De t or addn'1 in o.
FEE ITEMS (Fee Resolution 11-053 E f..' 7/1/131 FEE QTY/FEE MISC ITEMS
Mom (J`ze .r,-I {,
Permit Fee: $432.00
.Srt�l�11,
r
Permit Fec":
F-1
C'r P:stt'tu`ti(1� !'t7:t:
Work Without Permit? 0 Yes (F) No $0.00
l't'E's A
Strong:Motion Fee: IBSEISMICR $1.10 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00
� uUA $434.10 $0.00 434.10
n fi . .� TOTAL FEE:
Revised: 04/01/2014
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION
ALBERT SALVADOR,P.E.,C.B.O., BUILDING OFFICIAL
CUPERTINO 10300 TORRE AVENUE-CUPERTINO,CA 95014-3255
(408)777-3228-FAX(408)777-3333-building(a)cupertino.ora
PROJECT ADDRESS --711.13 7 APN# o
CIKOWNERNAME PHONE (7 E-MAIL
STREET ADDRESS CITY,STATE,ZIP FAX
CONTRACTOR NAME� LICENSE NUMBER �/ /� LICENSE YP BUS.LIC.#
COMPANY NAME i � ) U `JG` E-MAIL J l7 I `, FAX
STREET ADDRESS �?V ._ ' / I CITY,STATE,ZIP �- / U PHONE/.
V I UNDERSTAND AND AGREE TO THE FOLLOWING: i
1. The re-roof project shall comply with all applicable provisions of the 2013 California Codes.
2. An inspection request can be scheduled up to one business day before the requested inspection date.
Please schedule inspections online or 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. 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 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 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/"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 bebefore 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 R315 of
the 2013 California Residential � \r
Signature of Applicant/Agent: Date:
ReroofPolicy_2014.doc revised 01115/14