140900940
v
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20875 VALLEY GREEN DR
CONTRACTOR: NEMMER ROOFING
PERMIT NO: 14090094
OWNER'S NAME: KORET FOUNDATION
5348 AUDUBON PARK CT
DATE ISSUED: 09/15/2014
OWNER'S PHONE: 6505923960
FREMONT, CA 94538
PHONE NO: (510) 919-2930
E)k LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL E]
BLDG 14-17 TEAR OFF (E) ROOF & INSTALL OSB (IF
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License Class (,-' Lic. #2 / % 3® �
NEEDED), GAF LIFETIME COMP ROOF SYSTEM (96 SQ'S)
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15
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
Sq. Ft Floor Area:
Valuation: $37053
performance of the work for which this permit is issued.
ave and will maintain Worker's Compensation Insurance, as provided for by
S ction 3700 of the Labor Code, for the performance of the work for which this
APN Number: 32609064.00
Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
PERMIT E S IF IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating
WITHIN 80 DAYS OF PF,RMIT 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 OM LAST C LLED 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
Issued by: Date:
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.
�/
Signat Date
RE -ROOFS:
All be inspected to any material being installed. If a roof is
a /
roofs shall prior roofing
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
❑ OWNER -BUILDER DECLARATION
Signature of Applic Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
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. 1 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, Sectio s 25505, 2553& and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent 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
CONSTRUCTION LENDING AGENCY
Compensation laws of California. If, after making this certificate of exemption, I
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
C' REROOF PERMIT APPLICATION
COMMUNITYDEVELOPMENT DEPARTMENT • BUILDING DIVISION (�_w
1.0300 TORRE AVENUE • CUPERTINO, CA 95014-3255 �(� 1
'(408j 777-3228 • FAX (408) 777-3333 • buildin4CcDcupertho.or4
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PROJECT A5Xg L9/Yi/�J '/l� 0 APN #
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STREET ADDRESS 7 /� ® �// • ST ZIP - FAX
—'Mr'�Z'
CONTACT NAME PHONE - E-MAIL
STREETADD CrrY,STATE. ZIP' �3 FAX
❑ OWNER'❑ OwNER-BUILDER ❑' OWNERAGENr ONMACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT 11mgw-mm 13DEVELAPER ❑ TENANT
CONTRACroRNAME UCENSENUMB LICEN BUS. LIC. #
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COMPANY NAME-
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STREET ADD CTFY, STATE� ZIP
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ARCHrrECT/ENGWEER NAME LICENSE NUMBER j! BUS. LIC. # J
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY, STATE, ZIP PHONE
053
USE OF ❑ SFD or Duplex ult-Family RooF AREA: VALUATION:
sTRvcruRE: ❑ Commercial
EXISTING ROOFTYPE: • ❑ BUI T -UP ROOF ❑ ASPHALT SHINGLES )400D SHAKES ❑ WOOD SHINGLES ❑ OTHER{SPECLFy)
REMOVE/REPLACE '9 -YM IFNO, T
LYWOOD *', ❑ PLYWD •I OSB Prrc ROOF
❑ NO w LAYERS: HI ❑ 5/8" TYPE: ❑ DX :12 CLASS: A
PROPOSED ROOF TYPE: ❑ BUILT -LIP ROOF ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER ICC -ES REPORT #
DESCRIPTION OF WORK-
By
ORKSy my signature below, I cert*'ta each 6f fallowing; I ain the property owneror 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 ding cotisttu ' I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of ApplicantlAgent: ' Date:
SUPPLEMENTAL INFORMATION REQUi13ED
If building is associated with a Horne Owner's Association, provide letter - -- q
of approval from HOA.
Provide Planning approval to verify ifthereany restrictions::
Provide copy of Manufactures s installation' Specifications.
Provide signed copy of Cupertino's Tear -Off Policy.
ReroofApp_2011.doc revised 03/16/11
ReroofPohcy_2014.d6c revised 01/15114
CUPERTINO
REROOF TEAR -OFF POLICY
COMMUNITY DEVELOPMENT` DEPARTMENT BUILDING DIVISION
ALBERT SALVADOR, P.E., C:B.O., BUILDING OFFICIAL
10300 T.ORRE AVENUE CUPERTINO, CA 95014-3255
(408) 777-3228 FAX (408) 777-3333 - building(cDcupertino.ora
PROJECT ADDRESS
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APN #
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STREET ADDRESS
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CONTRACTOR NAME
LICENSE NUMBER
LICENSE
BUS. LIC. #
COMPANY NAME A
E-MAIL
FAX
STREET ADDRESS—
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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/a" 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 un.derstand.and agree to comply with the re -roof policy stated above. T also understand that
smoke detectors and carbon monoxide detectors are re uire-d to be installed in accordance with Sections R314 and R315 of
the 2013 California Residential Code.
'All Y
Signature of Applicant/Agent: Date: f j — j
ReroofPo1icy_2014.doc remised 01/15114