14060099 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21361 MILFORD DR CONTRACTOR:CONRAD ROOFING PERMIT NO: 14060099
SERVICE
OWNER'S NAME: KATE FINN 332 PHELAN AVE DATE, ISSUED:06/16/2014
OWNER'S PHONE: SAN JOSE,CA 95112 PHONE NO:(408)294-7615
❑ LICENSED CONTRACTOR'S DECLARATION F
// BUILDING PERMIT INFO- BLDG ELECT PLUMB
License Class Lie.# FF
�� .-14—& MECH RESIDENTIAL COMMERCIAL
Contractor Date 6
1 hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION'TEAR OFF EXISTING SHAKE ROOFING&INS'FALI.7/16
(commencing with Section 7000)of Division 3 of the Business&Professions OSB
Code and that m license is in full force and effect. SHEATHING,30 LB FELT&CERTAINTEED PRESIDENTIAL
y COMPOSITION SHINGLES(2800 SQ FT)
I hereby affirm under penalty of perjury one of the following two declarations:
1 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.
X/ 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. Sq.Ft Floor Area: Valuation:$15300
APPLICANT CERTIFICATION
1 certify that I have read this application and state that the above information is APN Number:32641101 00 Occupancy Type:
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, PERMIT EXPIRES IF WORK IS NOT STARTED
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR
with all non-point source regulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION.
9 18. /
Signature Date �� Issued by: 2'i4/y Date:
❑ OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of RF,-ROOFS:
the following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is
1,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,1 agree to remove all new materials for
will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection.
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant. /i�l' ��G Date. /y
construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE
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 read the hazardous materials requirements under Chapter 6.95 of the
1 have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Section 3700 of the Labor Code,for the performance of the work For which this
Safety Code,Section 25532(a)should I store or handle hazardous material.
permit is issued. Additionally,should I use equipment or devices which emit hazardous air
I certify that in the performance of the work for which this permit is issued,l shall contaminants as defined by the Bay Area Air Quality Management District I will
not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Compensation laws of California. If,after making this certificate of exemption,I Health&Safety Code,Sections 25505,25533,and 25534.
become subject to the Worker's Compensation provisions of the Labor Code,I must
forthwith comply with such provisions or this permit shall be deemed revoked. Ow r autho-i/ed agent: pate:6_1(_( /
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is
correct.1 agree to comply with all city and county ordinances and state laws relating I hereby affirm that there is a construction lending agency for the performance of work's
to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.)
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the Lender's Address
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION
9 18.
I understand my plans shall be used as public records.
Signature Date
Licensed Professional
f I �
(DO�
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERTiNO (408)777-3228•FAX(408)777-3333•buildin4(@cupertino.org
PROJECT ADDRESS ?/ ) /l�)la� G-e l AC` APN#
OWNER NAME of PHO OS— 00 C- C LIS-11^' E-MAII
STREET ADDRESS Z 6 I. / `�G`^ �1 CITY,STATE,ZIP _ ,_I '. FAX
CONTACT NAME PHONE C/� E-MAIL
41,
STREET ADDRESS CITY,STATE,ZIP FAX
❑OWNER ❑ OWNER-BUIIAER ❑-:OWNERAGENT ❑,CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTORNAME LICENSENUMBER LICENSE TYPE BUS.LIC.#
I" 2.N G95 . G—7
COMPANYNAME�✓��A�. Ti!/l.J.;. i���L� E-MAIL
GOd1r�i FAX
STREET ADDRESS ? I� 1� yL, CITY,STATE,ZIP ,y- f /` G�S, Z PHONE 1 6
Y-7Z
JS-
ARCHInCT/ENOINEERNJAME I_ ( - LICENSE NUMBER BUS.LIC.C#./
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF _SFD or Duplex ❑ Multi-Family ROOF AREA: VALUATION:
STRUCTURE: ❑ Commercial t,s�t—t *1S73 or'
EXISTING ROOF TYPE:. ❑BUILT-UP ROOF ❑ASPHALT SHINGLES AWOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY)
REMOVE/REPLACE *YES IFNO, PLYWOOD ❑ w, 7 PLYWD OSB PITCH: ROOF
❑NO #LAYERS: THICKNESS: ❑5/8" TYPE: CDX 12 CLASS: A
ICC-ES REPORT#
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF p SPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER
DESCRIPTION OF WORK: C " C.X`��fl �Gl,a f , -Y✓��Tca 1' ��/F� '/ U��
f A-r.4
By my signature below,Lcertify 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 accurate. I agree to comply with all applicable local
ordinances and state laws relating to:bu' in coristruc ion I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature ofApplicandAgent Date: L--
SUPPLEMENTAL INFORMATION REQUIRED
If building is associated with a Home Owner's Association,provide letterof approval from HOA.
Provide Planning approval to verify if there any restrictions.
Provide copy of Manufacturer's Installation Specifications.
1,11611 1!1 1
Provide signed copy of Cupertino's Tear-Off Policy.
ReroofApp_201 1.doc revised 03/16/11
CITY OF CUPERTINO
FEE ESTIMATOR— BUILDING DIVISION
ADDRESS: 21361 Milford Dr DATE: 06/16/2014 REVIEWED BY: Sean
APN: I BP#: *VALUATION: 1$15,300
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY PENTAMATION
USE: SFD Or Duplex PERMIT TYPE: 1 SFDWLROO
WORK Tear off exi ting shake roofing and install 7/16 OSB sheathing, 30 Ib felt and certainteed presidential
SCOPE composition shingles (2800 sq ft).
;4kch. Now Cheek t'lur;h. Plop£_"her, t ec: Pa Y,("eco,
�tl tc,'i.P e r,wii Fee: t'lumb. /'unit I,cc. 1"i"( Perm;"
F7 h�<<
L
1,kuh.
. I,a;lz I t er: t'htmh. hiss. Fee
NOTE:This estimate does not include fees due to other Departments(i.e.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 Dept./or addn'l in o.
FEE ITEMS (Tee Resolution 11-053 E . 7/1/13,1 FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 2,800 s.£ Re-roof
Suppl. PC Fee: (j) Reg. ® OT O.p hrs $0.00 $448.00 1REROOFRES
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee:Q Reg. 0 OTO O hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: -FT $0.00
Co3.,4r,rvcii(on 1'la .
[;T12LPf14/t"c7tll'c'b'e't': 0
Work Without Permit? ® Yes (E) No $0.00
Advanced Planning Fee: $0.00 Select a Non-Residential
Building or Structure
II'tt%;>r .�)r)C r,lrra<'iFl(al7�erd Fees: �
Strong Motion Fee: IBSEISMICR $1.53 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00
. .�; $2.53 $448.00 _ TOTAL FEE: $450.53
Revised: 04/01/2014
RE ROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
ALBERT SALVADOR,P.E.,C.B.O.,BUILDING OFFICIAL
CVPERTINO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333-building(cDcuoertino.org
PROJECT ADDRESS � / � ,A n APN#
OWNER NAME ��� {-�` �n� PHONE
'tOo-P OL-18 ifr' E-MAIL
STREET ADDRESS r CITY,STATE,ZIP C� FAX
CONTRACTOR NAME ,J LICENSE NUMBER1� - LICENSE TYPE�r� BUS.LIC.#
COMPANY NAME EMAIL ( FAX
STREET ADDRESS3 J„ �a� p{' CITY,STATE,ZIPfi 7` A�// 2 PHONE
4 11
I UNDERSTAND AND AGREE TO THEE 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 monoxidee ctors are required to be installed in accordance with Sections R314 and R315 of
the 2013 California Residential Code.
Signature of Applicant/Agent: Date:
ReroofPolicy_2014.doc revised 01/15/14