Loading...
14050123 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10406 MIRA VISTA AVE CONTRACTOR:PROUTY WILLIAM J PERMIT NO: 14050123 AND BARBARA J OWNER'S NAME: PROUTY WILLIAM J AND BARBARA J 10406 MIRA VISTA RD DATE ISSUED:05/20/2014 OWNER'S PHONE: 4082577549 CUPERTINO,CA 95014-2745 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL ❑ TEAR OFF(E)WOOD SHAKE,INSTALL(N)OSB,FELT&3 License Class Lic.# PLY ASPHALT SHINGLES,CLASS A ROOF SYSTEM(30 SQ'S) Contractor 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 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:$12000 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:35702016.00 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 WITFIIN 180 D ERM DANCE 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 LED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgme costs,and expenses which may accrue against said City in consequence of the ZU t. granting of this permit. Additionally,the applicant understands and will comply ed a with all non-point source regulations per the Cupertino Municipal Code, to 9 18. RE-ROOFS: Signature Date All roofs shall be inspected prior to any roofing material being installed.If a roof is installed without first obtaining Ainspei gree to remove all new materials for inspection. OWNER-BUILDER DECLARATION �Signature ofApplicant: Date: hereby affirm that I am exempt from the Contractor's License Law for one ofhe following two reasons: ALL ROOF COVERCLASS"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 perjur =self-insure 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 Consr Worker's material. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for b Section 3700 of the Labor Code,for the air contaminants as defined by the BayArea uality Management District I performance of the work which this it is issued. will maintain compliance with the Cuperti o M icipal Code,Chapter 9.12 and Emit ve and will ain Worker' ompensation Insurance,as provided for by the Health&Safety Code,Sections0 ,25525 3,and 25534. tion 3700 of the Labo Cade,for the performance of the work for which this —' Owner or authorized agent: '777Date: 2� 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.Addition e applicant understands and will comply with all non-point source regu io per the upertino Municipal Code,Section Licensed Professional 918. Signature Date REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE CUPERTINO, CA 95014-3255 NX J CUPRTIh10 (408)77773228 FAX(408)777-3333•building(a)cupertino.org PROJECT ADDRESS qb f� / A �/ FNJI •� O 2- -'ID o OWNERNAME/�j! ` Iii PH �� , ` E-MAIL V V v STREET (,f/ / CITY, TATE,ZIP ✓ q.� FAX ® FiQiD (moo CONTACT NAME PHONE E-MAIL STREET ADDRESS. CITY,STATE,ZIP FAX OWNER- ❑"OWNER-BUILDER - 3 OWNER AGENT ❑.CONTRACTOR ❑CONTRACTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME o V �//�_/ LICENSE NUMBER LICENSE TYPE BUS.LIC.# AN r i!�Y COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE ARCHITECTXNGINEER 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: STRUCTURE: ❑ Commercial /0 7-0 EXISTING ROOF TYPE:. ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES IRWOOD SHINGLES ❑OTHER(SPECIFY) REMOVE/REPLACE '<M IFNO, PLYWOOD '/" ❑ PLYWD ❑OSB PITCH: ROO ❑NO #LAYERS: THICKNESS. TYPE: ❑CDX �:12 CLASFS: A ICC-ES REPORT# PROPOSED ROOF TYPE: ElBUILT-UPROOF SPHALT SHINGLES ❑WOOD SHAKES 11WOOD SHINGLES ❑OTHER DESCRIPTION OF WORK: to gig By my signature below,I certify'to each ofthe following: 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'con t - hays read the Description of Workand verify it is accurate. I agree to comply with all applicable loc ordinances and state laws relating to building co do Iauthori representatives of Cupertino to enter the above-ids •tied property for inspection purpo Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQ RED If building is associated with a Home Owner's Association,provide letter --- ° -' - of approval from HOA. Provide Planning approval to verify if there any restrictions. P Provide copy of Manufacturer's Installation Specifications. Provide signed copy of Cupertino's Tear-Off Policy. ReroofApp_2011.doe revised 03/16/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10406 MIRA VISTA RD DATE: 05/20/2014 REVIEWED BY: MELISSA APN: 357 02 016 BP#: *VALUATION: 1$12,000 PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof PRIMARY SFD or Duplex PENTAMATION 1 SFDWLROO USE: PERMIT TYPE: WORK TEAR OFF E WOOD SHAKE INSTALL N OSB FELT& 3 PLY ASPHALT SHINGLES CLASS A SCOPE ROOF SYSTEM (30 SQ'S) FEE ID ROOF AREA s.f. 1REROOFFRES 3,000 ° , ,M'fec/?a Plum CheckIF I Pha77rh. Plan f.lh��c4 Ah"'c' P t n hecl, Lleeir_ Peivoit Fee: 1'lumr,. Pe:r nlr lc.. tn.sp. Orhef P?urs1�Iran El El lc�,h. ?;rsh. 1��e�: Phimb. hasp. lee: ?alar. Ilasr, t, NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc . Thesefees are based on the prelimina information available and are only an estimate. Contact the De t or addn'1 info, FEE ITEMS (Fee Resolution 11-053 Elf. 7/1113) FEE QTY/FEE MISC ITEMS I'lon Check Permit Fee: $480.00 1'I�•rrrh.:t<f`<�c°i1.iL'`le'c° !'er•razit fi'ee:_T_T ­ C117rsrr'iIC'Cir"i7t 4:11121jJi,S't7"7 1L'G:t`('c Work Without Permit? 0 Yes (E) No $0.00 lc1 �rruac(I'itiYtltr 7 Fees: liz ;,s f I)cr r reeattatic»J Fees: Stronp,Motion Fee: IBSEISMICR $1.20 Select an Administrative Item Bldp_Stds Commission Fee: IBCBSC $1.00 ` VR + T7, $482.20 $0.00 TOTAL FEE:; $482.20 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(d-)cupertino.org PROJECT ADDRESS APN# OWNERNeAffifZ1 7E- IL / J ST�tF, �ES CI , STATE, IP,,.^,J -IO/22 OL FAX CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC.# COMPANY NAME v E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE 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 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 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 c ly with the re-roof policy stated above. I also understand that smoke detectors and carbon monoxide detectors e req ed to be installed in accordance with Sections R314 and R315 of the 2013 California Residential Code. 1 Signature of Applicant/Agent: Date: / ReroojPolicy_2014.doc revised 01/15/14 OWNED-BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION r,x 10300 TORRE AVENUE• CUPERTINO,CA 55014-3255 CUPERTINO. (408)777-322B•FAX(406)777-3333.• build!no�cuoertino.oro Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: SFEADDRESS K7D I Ar^N S} 01'df< hAtdE OWNS DR' S I D O� c DESCRIPTION OF WORK: We are providing you W!Lh an Owner-Builder Acknowledgment and information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner-Builder. VVe will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our o flicial address indicated. An agent of the owner cannot execute this notice unless You,the property owner, obtain the prior approval of the permit-Ling authority. OWNER'S ACKNOWLEDGIViENT AND VERIFICATION OF iNFORMATION (DIREC ONS:Please read and initial each statement below to signiy you understand or vera, l this information.) 1. 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner- ilder'building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner-Builder,may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. l am willfully acting as an Owner-Builder and am aware of the limits of my ins nce coverage for injuries to workers on my property. 2. 1 understand building permits are not required to be signed by property.owners unless they are responsible for construction and are not hiring a licensed Contractor to assume this responsibility. 3. 1 understand as an"Owner-Builder" I am the responsible part'of record on the permit. I understand that I may rotect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her na instead of my own. 4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license u ers on permits and contracts. 5. (.understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the tai value of my construction is at least five hundred dollars ($500), including labor and materials, I may be ;16dera Bred an "employer"under state and 'federal law. 6. I understand if I am considered an "employer' under state and federal law, i must register with the state and l government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." i also understand my failure to abide by(nese laws may subject ;M,sid�en eriousfinancial risk.1 understand under California Contractors' State License Law, an Owner-Builder who builds single-family tial structures cannot legally build them with the intent to o�mer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work ;n��yfinarnneciaor 'od under contract with a licensed general building Contractor. . 1uderstand asan Owner-Builder iII sell the'property for which this Permit is issued, I may be held liable for personal injuries sustained by any subsequent owner(s)that result from any latent construction defects in the workmanship or materials. O a;»erBuilde;Forrn 2010.doc revised 01/11110 1F Yl 6,; 1 understand I may o.btain nore information regarding my obligations as an "employer" from the Internal venue Service,the United States Small Business Administration, the California Department of Benefit Payments, and the Califomia Division of Industrial Accidents. I also understand I may contact the Califomia Contractors' State License Board(CSLB) at 1-B00-321-CSLB (2752)or vaww.eslb.ca.gov for more information about licensed ;Mhe ctors. 0. 1 am aware of and consent to an Owner-Builder building.permit applied for in my name, and understand that l party legally and financially responsible for proposed construction activity at the site address lis-1- 111. isted above. i 1. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide yp plicable laws and requirements that govern Owner-Builders as well as employers. 1 agree to notify!tie issuer of this form immediately of any additions, deletions, or changes to any of the iion I have provided on this torn. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license,the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint.Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner-Builder and wish io hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status Of their workers' Compensation insurance coverage. CONSTRUCTION LENDINGAGENCY (DIRECTIONS:Please complete the following construction lending agency information.) I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) Lender Name: Lender Address: Before a building permit can be issued,this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note:A copy of the property ov✓ner's driver's license, form notarization, or other verification acceptable to the '19W be required to be presented v✓hen the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: Irl --------------------------------------------------------------------------------------------------------------------------------------------- (NOTE: The rollowing Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner-Builder). AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER, BEHALF Excluding the Notice to Property Owner,the execution of which I understand is my personal responsibility, I hereby authorize the following person(s)to act as my agents)to apply for, sign, and file the documents necessary to obtain an Owner-Builder Permit for my project. Scope of Construction Project(or Description of Work): Project Location or Address: Name of Authorized Agent: Tel No I^-,ddress of Authorized Agent: I declare under penalty of perjury that i am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note:A copy of the property owner's driver's license, form notarization, or other venfrcation acceptable to the city may be required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: 0r:i7erBu1_1aA7F077n 2010.docre-vised04,11!/10 Building Department City Of Cupertino 10300 Torre Avenue Cupertino,CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/SUBCONTRACTOR LIST. JOB ADDRESSIOV 6 PERMIT# U I Z3 OWNER'S NAME: Wz ! O V PHONE# d$. S GENERAL CONTRACTOR: BUSINESS'LICENSE# ADDRESS: CITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY IN CTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL :SUBCONT C RS HAVE OBTAINED A 'CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: � �- Signature Date Please check applicable subcontractors and complete the following information: V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring/Carpeting Linoleum/Wood Glass/Glazing Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Cont ctor Signature Date