14060058I CITY OF CUPERTINO BUILDING PERMIT
IBUILDING ADDRESS: 11756 PINE BROOK CT I ROOFING CO CONTRACTOR: DAN ELLIOTT'S I PERMIT NO: 14060058 I
OWNER'S NAME: LOW KELVIN B C AND LIEW BEE Y P O BOX 26878 DATE ISSUED: 06/10/2014 I
OWNER'S PHONE: 4083864800
is LICENSED CONTRACTOR'S DECLARATION
License Class - Lic. # 11!�l /
Contract r, — Date ! d /
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.
,I h e and will maintain Worker's Compensation Insurance, as provided for by
ction 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION
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
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
with all non -point source regulations per the Cupertino Municipal Code, Section
9 18.
Signatu r, ��V,� � Date
❑ OWNER- BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
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.
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
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
SAN JOSE, CA 95159 1 PHONE NO: (408)559 -7327
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL
RE -ROOF 25 SQ, REMOVE SHAKES AND FLASHING,
INSTALL
30LB FELT CLASS A
Sq. Ft Floor Area: I Valuation: $10410
APN Number: 36604072.00 1 Occupancy Type:
PERM IRES IF WORK IS NOT STARTED
WIT PERMIT ISSU CE OR
180 D S FROM LLED INSP CT N.
Issued by: Date: 0 t'
RE- ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, a ee to remove all new materials for
inspection. f/, r
Signature of Applica_4 — 2_6q / Datd —/ 0 —/ 7
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Sec.'ons 5,2553 , and 25534.
Owner or authorized agen Date: 7
CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code, I must I 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
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
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
with all non -point source regulations per the Cupertino Municipal Code, Section
918.
Signature
Date
Lender's
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
CUPERTINO
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014 -3255 1 �
(408) 777 -3228 - FAX (408) 777 -3333 - buildingOcuaertino.ora PO
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PROJECT ADDRESS 5 �r o C
APN # & o p 709 a
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❑ OWNER ❑ OwNER-BimDm ❑ owNERAGENT ® CONTRACTOR ❑coNTRACrORAGENt ❑ ARCHrrECr ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTORNAME
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LICENSE NUMBER
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ARCHITECTIENGINEER NAME
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COMPANY NAME
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USE OF ® SFD or Duplex ❑ Multi- Family
STRUCTURE: ❑ Commercial
ROOF AREA: N
•� 9 i•'
VALUATION:
\0 114\10p,
EXISTING ROOF TYPE: ❑ BUILT -UP ROOF ❑ ASPHALT SHINGLES V WOOD SHAKES ❑ WOOD SHINGLES ❑ OMEIR (SPECIFY)
REMOVE /REPLACE ®YES
13 NO
IF NO
!! YERS:
PLYWOOD E3 %- ❑
xi�ss: ❑ 5!8
PLYWD ❑OSB
E 13 X
PITCH:
' 12
ROOF
CLAS : A
PROPOSED ROOF TYPE: ❑ BUILT-UP RooF M ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ ono
ICC -ES REPORT #
DESCRIPTION OF WORK -
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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 accunue. I agree to comply with all applicable local
ordinances and state laws relating to I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of ApplicantlAgent: ` Date:
SUPPLEMENTAL INFORMATION QUIRED
_ 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.
Provide copy of Manufacturer's Installation Specifications.
Provide signed copy of Cupertino's Tear -Off Policy.
OMCE USYI ONLY
CHECK'"E
ROUTING SUP
OVER- Tff,00urrT R
❑ EXPRESS
❑ SrANnARU
❑ MMDWG PLAN REVIEW
❑ PI ANNTNG PLAN REVIEW
❑ FM DEPT
❑ OTHER:
ReroofApp_2011. doc revised 03116111
---� CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
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 vreliminary information available and are onlv an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11 -053 E . 711113)
ADDRESS: 11756 pinebrook ct
QTY/FEE
DATE: 06/10/2014
REVIEWED BY: Mendez
APN:
BP #:
*VALUATION:
1$10,410
*PERMIT TYPE: Minor Building Permit
PLAN CHECK TYPE: Re -roof
PRIMARY
USE: SFD Or Duplex
Permit Fee:
$400.00
PENTAMATION
PERMIT TYPE: 1 SFDWLROO
WORK
re -roof 25 sq, remove shakes and flashing,
install 301b felt class a
SCOPE
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 vreliminary information available and are onlv an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11 -053 E . 711113)
Z
QTY/FEE
MISC ITEMS
Plan Check Fee:
slq)pli PC Ft?t?
.
Permit Fee:
$400.00
sul.. )1. Inn " /) Fee
Permit 1'ee:
C.f1(i:
(.7on,yiPuction TUX
Adniini4'i"t` tine z'L :
'
: 3('C'SI. 2 "FC'itTZ f Fee:
Work Without Permit? Yes (E) No
P ivnb, Pe fii i Fee :
Ae,1 aI!£.'f' 1 Plannii q .hef,s:
Ff:'f:':
01017 r rW£;L'l:. fnsl).
Travellac :c r)i�sr�t<r /rc��t.I'ccS:
Strong Motion Fee: IBSEISMICR
$1.04
€ ik r l'dd {mb Irisji,
Bldg Stds Commission Fee: IBCBSC
$1.00
G
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$4
�OTA L F02.04 EE
.
$402.04
" PO". fiP.i,XP. i�ee:
.�'3jid nb8 lrur3. /"�ee:
Dec. l Slp. /"e£::
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 vreliminary information available and are onlv an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11 -053 E . 711113)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
slq)pli PC Ft?t?
.
Permit Fee:
$400.00
sul.. )1. Inn " /) Fee
Permit 1'ee:
(.7on,yiPuction TUX
Adniini4'i"t` tine z'L :
Work Without Permit? Yes (E) No
$0.00
Ae,1 aI!£.'f' 1 Plannii q .hef,s:
�
Travellac :c r)i�sr�t<r /rc��t.I'ccS:
Strong Motion Fee: IBSEISMICR
$1.04
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
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$4
�OTA L F02.04 EE
.
$402.04
Revised: 04/01/2014
CUPERTINO
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
(408) 777 -3228 • FAX (408) 777 -3333 • building(a)cupertino.org
PROJECT ADDRESS
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APN # '
OWN *{ -eME 1`
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STREET ADDRESS
CITY, STATE, ZIP
FAX
CONTRACTOkM4WE
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LICENSE NUMBER
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LICEN 411!1
BUS. LIC. #
COMPANY NAME A
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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 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 Residen ' Co .
Signature of Applicant/Agen Date4'/'o
ReroofPolicy_2014.doc revised 01115114
Address
%� is%
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
(408) 777 -3228 FAX (408) 777 -3333 • buildinc(a.cupertino.ora
PURPOSE
This affidavit is a self - certification for the installation of all required Smoke and Carbon Monoxide Alarms for
compliance with 2013 CRC Section R314,2013 CBC Sections 420.6 and 907.2.11.2 where no interior access for
inspections are required.
(GENERAL INFORM-A-TION
Existing single - family and multi- family dwellings shall be provided with Smoke Alarms and Carbon
Monoxide alarms. When the valuation of additions, alterations, or repairs to existing dwelling units exceeds
$1000.00, CRC Section R314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and /or Carbon
Monoxide Alarms be installed in the following locations:
AREA
SMOKE ALARM
CO ALARM
Outside of each separate sleeping area in the immediate vicinity of the
bedroom(s)
X
X
On every level of a dwelling unit including basements
X
X
Within each sleeping room
X
Carbon Monoxide alarms are not required in dwellings which do not contain fuel- burning appliances and that
do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with
CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal.
Power Supply: In dwelling units with no commercial power supply, alarm(s) may be solely battery operated.
In existing dwelling units, alarms are permitted to be solely battery operated here repairs or alterations do
not result in the removal of wall and ceiling finishes or there is no access by ans of attic, basement or crawl
space. Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2. el al pe uil r
alarms which must be connected to the building wiring.
gctric r"-1
As owner of the above- referenced property, I hereby certify that the alarms ref er4 I above has/have been
installed in accordance with#he manufacturer's instructions and in compliance with e California Building
and California Residential Codes. The alarms have been tested and are operational, as of the date signed
below.
I have read and agree to complv with the terms and conditions of this statement
Owner (or Owner Agent's) Name:
Signature ...................... .. ..... ............... ............................... .......................... Date: b i
C ntractor Nine,.
i nature... �! !� k1C 3. !
........... ............................... Lic.# . ............................... Date: ..................
Smoke and CO form.doc revised 03118114
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