14050081 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10516 N FOOTHILL BLVD CONTRACTOR:C&C CONSTRUCTION PERMIT NO: 14050081
OWNER'S NAME: CASA MILAGRO LLC 210 GREENDALE WAY STE 2 DATE ISSUED:05/13/2014
OWNER'S PHONE: 4083955100 SAN JOSE,CA 95129 PHONE NO:(408)687-6945
E5.1 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL
UNITS A&B-TEAR OFF(E)ASPHALT SHINGLE,
License Class i3 Lic.# INSTALL(N)COMP ROOF SYSTEM(50 SQ'S)
Contractor-C-4 Com, f"�G OV► 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
U 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:$17500
(/ 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:32613067 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 DAY LAST C LED 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 Date:
2di
with all non-point source regulations per the Cupertino Municipal Code,Section
9 18.
:
Signature DateFroofing All roofs shall be inspectedmaterial being installed.If a roof is
installed without first obtaining Inspection,I agree to remove all new materials for
inspection.
❑ OWNER-BUILDER DECLARATION
Signature of Applicant: Date: J "-'
I hereby of rm that I am exempt from the Contractor's License Law for one of
the following two reasons: ALL ROO RINGS 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 sate(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 Ar ea Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the Cope ino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25 5,2 33,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: ` Dater
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 CONST CTION 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
RE'ROOF PERMIT APPLICATION
O
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION \ �.
10300 TORRE AVENUE CUPERTINO, CA 95014-3255 \ ,O
CUPRT11NI0 (408)77773228-FAX(408)777-3333•buildingcupertino.org
PROJECT ADDRESS 1 0 I- � • � IVAPN# � Z.� _ ' 3 — O�
OWNER NAME C. PHONE Q r ,, Q v E-MAIL
STREE ADD S TTY, STATE ZI o FAX
fj CONTACT NAME `rPCVj PHONE E MAIL
STREET AD SJ I 5 CITY,STATE,ZIP �S v
FAX y1-1(::,S /
❑OWNER ❑,OWNER--BUILDER ❑.OWNERAGENT ❑:CONTRACTOR 13 CONTRACTOR AGENT C.11 ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTR.A&� R NAME v �G LICENSE B � LICENSE TYPE BUS.LIC.#
COMPN E-MAIL FAX
CC�,rt csi f�CI�1i.
STREET ADDRESS CITY,STATE,Z PHONE
l Off. 4
ARCHPPECT/ENGINEER NAME LICENSE NUMBER BUS.LIC.#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑ SFD or Duplex ❑ Multi-Family ROOF AREA: VALUATION: -0 /V)1
STRUCTURE: C] Commercial
EXISTING ROOF:TYPE:.//❑BUILT-UP ROOF ❑ASPHALT SHINGLES 11 WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY)
REMOVE/REPLACE 2YES IF NO, PLYWOOD El %/ ❑ PLYWD ❑OSB PITCH: ROOF
❑NO I #LAYERS' THICKNESS: 1:15/8', TYPE: ❑COX :12 CLASS: A
ICC-ES REPORT#
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF _ El ASPHALT SHINGLES 11WOOD SHAKES 11WOOD SHINGLES ❑OTHER
DESC ON OF WORK: C yf l
A i � a C e 4
J —t
By my signature below,I certify'to each of the followi 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.co 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 c I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date: r
SUPPLEMENTAL XTION REQUIRED
If building is associated with a Ho Owner's Association,provide letter °
of approval from HOA.
Provide Planning approval to Vex if there any restrictions.
Provide copy of Manufacturer's Installation Specifications.
Provide signed copy of Cupertino's Tear-Off Policy.
ReroofApp_201 1.doe revised 03/16111
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 10516 FOOTHILL BLVD DATE: 05/13/2014 REVIEWED BY: MELISSA
APN: 326 13 067 BP#: *VALUATION: 1$17,500
*PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD or Du lex PENTAMATION 1SFDWLR00F
USE: P PERMIT TYPE:
WORK UNITS A& B -TEAR OFF E ASPHALT SHINGLE INSTALL N COMP ROOF SYSTEM 50 SQ'S
SCOPE
FEE ID ROOF AREA
s.f.
1REROOFFRES 5,000
77i ,
L1�c;t. F'lara f.?acrk t'lzrrrth. P(rrrt Clicin t ler'.f'r err(.;he:ctt
L1z:If_Permrt Fee: Plat xlr. Permit J�e~er: I 'r.. Pt;r r r t
0thcr,W(;chi Inst- Other Plumb Insp. 0/,,t&r 11t'er_Imp,
Mcok fnslr. /',v Ti`urnb. M,N'p. Fee. Elec.Inst), trx':
NOTE: This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc.). These fees are based on the prelinddna information available and are only an estimate Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/131 FEE QTY/FEE MISC ITEMS
Plan 1'`c:ep:
Permit Fee: $800.00
Permit 17(lc:
Consiriwiion TJX. F
r
Work Without Permit? ® Yes (F) No $0.00
rlGt'L'Ut7ced Plar in£,f Fees:
li�f c�l J)oc:rt,neera.Won Fees:
Strom Motion Fee: 1BSEISMICR $1.75 Select an Administrative Item
Bldg Stds Commission.Fee: IBCBSC $1.00
W� s $802.75 $0.00 TOTAL FEE: $802.75
i=Mham.
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-buildingfilcupertino.org
PROJECT ADDRESS
l� �.1\ J C4 APN#
OWNERNAME n PH XE-MAIL
►`� lc`c e U_C `?I IS S' I a
STREET ADD SS C TY, STATE,ZIP FAX
C+ J
C09 NTRA�C1T tR N C C,O ,G UhIB LICENSF� I LICENSE TYPE BUS.LIC.#
COMPANY NAME � 1 E-MAIL FAX
[CS'T�REET7ADIDRESS C STATE,ZIP PH��.�E _� 'l e✓1 &e. crJ a 2 - � `L (�xs �R'-i S
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 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 1/"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 an agree to comply with the re-roof policy stated above. I also understand that
smoke detectors and carbon monoxide ectors are required to be installed in accordance with Sections R314 and R315 of
the 2013 California Residential Cod
Signature of Applicant/Agent: Date,,gr
ReroofPolicy_2014.doc revised 01115114