14080181CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 1343 PRIMROSE WAY
CONTRACTOR: MILLERS ROOFING
PERMIT NO: 14080181
OWNER'S NAME: YING YEESHUN S AND SUSAN S
2246 LOS GATOS ALMADEN RD
DATE ISSUED: 08/18/2014
OWNER'S PHONE: 4083187187
SAN JOSE, CA 95124
PHONE NO: (408) 356 -6211
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL
�1 C(�
��J'�(1
RE -ROOF 25SQ- REMOVE ROOF, INSTALL OSB CLASS A
License Class J Lic. # j}
f��
Contractor �� �p t [ "�� 1/ Date b
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
Sq. Ft Floor Area:
Valuation: $8000
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..6, %E1(
APN Number: 36617045 00
Occupancy Type:
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 DAYS FITMIW CALLED 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 by: Date .
with all non -point source regulations per the Cupertino Municipal Code, Section
RE- ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
9 18.
Signature/�.� ---- Date m /y
installed without first obtaining an inspection, I agree to remove all new materials for
inspection. /
❑ OWNER- BUILDER DECLARATION
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 (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 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 Code, Sections 25505, 25533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent:, -C�— 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
REROOF PERMIT APPLICATION g
COMMUNITY DEVELOPMENT DEPARTMENT •BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (i V
(408) 777 -3228 • FAX (408) 777 -3333 • building aacupertino.org
CtJ'�Ft'i"yN0 I
PROJECT ADDRESS %
% 7 •
CITY, STATE, ZIP ^.
• _ f A A
APN # f' I 0
0 G/L,
OWNER NAME P
LICENSE NUMBER
PHONE E
COMPANY NAME
E-MAIL
STREET ADDRESS
r A
A C
CITY, STATE, ZIP F
CITY, STATE, ZIP
FAX
CONTACT NAME C
C r
r �
ROOF AREA
PHONE•, r
r E
P-
E-MAIL
ASPHALT SHINGLES ❑ WOOD SHAKES
STREET ADDRESS . C
❑ OTHER (SPECIFY)
REMOVE /REPLACE XYFS
❑ NO
IFNO,
I # LAYERS:
CITY, STATE, ZIP F
PLYWOOD 11 %" ❑
THICKNESS: ❑ 5/8"
PLYWD 0OSB
TYPE: ❑ CDX
FAX
El ❑' OWNER - BUILDER ❑
❑ .OWNER AGENT .
.CONTRACTOR ❑ CONTRACTOR��� AGENT ❑
❑ ARCHITECT ❑ ENGINEER E3 DEVELOPER ❑ TENANT
CONTRACTORNAME L
inji
ICC -ES REPORT #
LICENSENUMBER �
�(� I L
LICENSE TYPE B
BUS.LIC
COMPANY NAME [
[✓(r E
E-MAIL F
FAX
T REST ADDR
J.
CITY, STATE, ZIP ^.
l L /�
7 /
PHONE
ARCHTTECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC. #
COMPANY NAME
E -MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF SFD or Duplex
sTRUCrIJIZE: ❑` Commercial
❑ Multi-Family
ROOF AREA
VALUATION:
P-
EXISTING ROOF'TYPE: , ❑BUILT -UP ROOF
ASPHALT SHINGLES ❑ WOOD SHAKES
❑ WOOD SHINGLES
❑ OTHER (SPECIFY)
REMOVE /REPLACE XYFS
❑ NO
IFNO,
I # LAYERS:
PLYWOOD 11 %" ❑
THICKNESS: ❑ 5/8"
PLYWD 0OSB
TYPE: ❑ CDX
PITCH:
12
ROOF
CLASS: A
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF
� ASPHALT SH N GLES 11 WOOD SHAKES
11 WOOD SHINGLES
❑ OTHER
ICC -ES REPORT #
DESCRIPTION OF WORK /o M I /P
R (ArA
I m�c ) 0Ls191 '64 i nQ
ski' n
ReroofApp_2011.doc revised 03116111
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
1343 primrose way
DATE: 08/1812014
REVIEWED BY: Mendez
JimADDRESS:
APN:
BP#:
*VALUATION: 1$8,000
PERMIT TYPE: Minor Building Permit
PLAN CHECK TYPE: Re-roof
PRIMARY SFD or Duplex
USE:
PENTAMATION 1SFDWLR00F
I PERMIT TYPE:
WORK
f 25s q- remove roof, install osb class a_
SCOPE
Permit Fee:
5 _S11
rZ
nom
�1' Fee: T-Ve":
LJ I Lj
Ic"t insp, 1'�,c'
NUIE: 1his estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
Divtrit-t- Pt!'_ Thpvp foov arp havad n" the nrpfiminnn/ ;"fnrmn6.. .—H.hl, ..d — h, — iL.- n--i f— -,4,4- 11 ;-.1-
FEE ITEMS (Fee Resolution 11-053 Eff 711113)
FEE
QTY /FEE_
7 MISC ITEMS
Plan Chc("Al-
suppl,
Permit Fee:
$425.00
Insp tr
T
C"I'M17.1 Fee:
Work Without Permit? 0 Yes (j) No
$0.00
A
Fees:
Strong Motion Fee: IBSEISMICR
$1.04
Select an Administrative Item
Bldg Stds Commission Fee:, IBCBSC
$1.00
N X .0E3
$427.04
$0.001 T OTA L FEE:
$427.041
Revised: 07/10/2014
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(Wcupertino.org
PROJECT ADDRESS j
"
APN #
OWNERNAME
V4
PHONE I,(f1
w
v
E-MAIL
STREET ADDRESS j
1 d
10\V
CITY, STATE, ZIP
FAX
CONTRACTOR NAME
q _/y
LICENSE NUMBER
�/
LICENSE TYPEC_
BUS. LIC. #
COMPANY NAME { h' A
E -MAIL
FAX
STREET ADDRESS r
CITY, STATE, ZIP
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 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 a d R315 of
the 2013 California Residential Code.
Signature of Applicant/Agent: Date:
ReroofPolicy_2014.doc revised 01115114
SMOKE / CARBON MONOXIDE ALARMS F, L E
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
CUPERTiNO 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
(408) 777 -3228 - FAX (408) 777 -3333 - building a()cupertino.org
n Permit No. �1 d0�
Address
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 INFORMATION
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 where repairs or alterations do
not result in the removal of wall and ceiling finishes or there is no access by means of attic, basement or crawl
space. Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2. An electrical permit is required for
alarms which must be connected to the building wiring.
As owner of the above - referenced property, I hereby certify that the alarm(s) referenced above has/have been
installed in accordance with the manufacturer's instructions and incompliance with the 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 comply with the terms and conditions of this statement
Owner (or Owner Agent's) Name:
t��, i ,
Sign ature
............:............... .............................. ............................... Date: ........
/
1 �. ...
Contractor Name: V (�) {�
Si nature.
.......... Lic.# .V.1 ............. Date:.....l,f
Smoke and CO form.doc revised 03118114