14090076CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20875 VALLEY GREEN DR
CONTRACTOR: NEMMER ROOFING
PERMIT NO: 14090076
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
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
BLDG 672 - 679 - TEAR OFF (E) ROOF & INSTALL OSB
p
l
Licens Class 6— J77Q / Lic. it 7 �d
(IF NEEDED), GAF LIFETIME COMP ROOF SYSTEM (57
�Date /
SQ'S)
Contractor
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: $17526
I have and will maintain Worker's Compensation Insurance, as provided for by
APN Number: 32609064 00
Occupancy Type:
Section 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
PERMITEXPI RK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating
WITHIN AYS OF P 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 DA F=ASTALLED 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 regi tions per the Cupertino Municipal Code, Section
9 18.
y
RE-ROOFS:
Signatur Date 1 s _l /
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection I agree to remove all new materials for
inspection.
❑ OWNER-BUILDER DECLARATION
Date: _lir _ fy
Signature of Applic
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. 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, 25 3, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent* Date !`5
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
REROOF PERMIT APPLICATION 1�"1
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION O� V
9.0300 TORRE AVENUE • CUPERTINO, CA 95014-3255 , `O
GUp.>` tTlt�iQ '(408) 777-3228 • FAX (408) 777-3333 + buildinga)cupertino.org \ V�
PROJECT ADD !� . 9 N /Si'/ ► (p / �d 679 APN # 0
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ER
D'X.LLi�O`v!/! zO'�)l - Pli j�a Sh' 9F�® & /MAII" JCS
STREET ADDRESS (�S,T� ZIP FAX
CONTACT NAME PHONE EMAIL
STREET ADD CITY, STATE, ZIP FAX
OWNER' ❑ OWNER-BU=ER ❑ OWNERAGENT 1S1RelCTOR ❑ CONTRACTOR AGENT ❑ ARCMTECr ❑ ENM<EER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME LICENSE LICEN BUS. LIC. #
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COMPANY NAMEE-MAIL FAX-
CITY,
AX-CITY, STATE ZA' PHO
ARCHrIECT/ENGINEER NAME LICENSE NUMBER BUS. LIC. #
!COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY, STATE, ZIP PHONE
USE OF ❑ SFD Or Duplex- ulti-Family ROOFARE°A� � VALUATION: "
sTRvcnniE: ❑ Commercial
-msTwc; Rooii YPE: • ❑ BuiLT-UP ROOF- ❑ ASPHALT smNGLES ROOD SHAKES ❑WOOD SHINGLES ❑ OTHER (SPECIFY)
REMOVEIREPLACE AYES IFNO, PLYWOOD g_w ❑ PLYWD V OSB PITCH ROOF
❑ NO # PERS: I S: 5/8 TYPE- ❑ CDX • 12 CLASS: A'
PROPOSED ROOF TYPE: ❑ BuILT-uP ROOF ASPHALT SH.NGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER ICC -ES REPORT #
DESCRIP77ONOF WORK:
By my -signature Below, I certify"to each ofthe 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, r` ad the Description of Work:and verify it is accurate. I agree to comply with all applicable Iocal
ordinances and state laws relating to, b4Aing col, I authorize representatives of Cupertino to enter the above-identified
property for inspection purposes.
Signature of Applicant/Agent: ' Date:
SUPPLEMENTAL. INFORMATION REQUIRED
If building is associated vrx a Iloiila Owncr's Association, provide letter of approval from HOA.
Provide Planning approval to verify if there any restrictions.
Provide copy of Manufacture'r`s Installation Specifications.
— Provide signed copy of Cupertino's Tear -.Off Policy.
Reroof.4pp_2011.doc revised 03116111
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
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P irnib, .Plaii Clie,:,k
Other Plar�-ib 1rsp. FT
MTi1:nb, bisr- /`tet',:
NOTE. This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.). 1 Hese_ fees are vasea on the pretiminary information available and are only an estimate. Contact the Dept for addn 7 into.
FEE ITEMS (Fee Resolution 11-053 E . 711113Z
20875 VALLEY GREEN DR
DATE: 08/15/2014
REVIEWED BY: MELISSA
lialADDRESS:
APN: 326 30 064
BP#:
*VALUATION: $17,526
*PERMIT TYPE: Minor Building Permit
PLAN CHECK TYPE: Re -roof
PRIMARY Multi -Family Dwelling
USE:
Building is
3 Stories 0 Yes (F)No
PENTAMATION 1 R2ROOF
PERMIT TYPE:
WORK
BLDG 672 - 679 - TEAR OFF E ROOF & INSTALL OSB IF NEEDED),GAF LIFETIME COMP ROOF
SCOPE
SYSTEM (57 SQ'S)
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P irnib, .Plaii Clie,:,k
Other Plar�-ib 1rsp. FT
MTi1:nb, bisr- /`tet',:
NOTE. This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.). 1 Hese_ fees are vasea on the pretiminary information available and are only an estimate. Contact the Dept for addn 7 into.
FEE ITEMS (Fee Resolution 11-053 E . 711113Z
FEE
QTY/FEE
MISC ITEMS
flan Check F'e(,=,
{
ee
Permit Fee:
$969.00
Strppl..Insp Free;
Mum b,/' vk'ch� "' ae e Permit 1 ee:
("Onstri"vion Tax:
F7
Ahimini,m-afzve pec'::
Work Without Permit? ® Yes (E) No
$0.00
dS°F.Zi7ced . ''ILdI'Lnin Fees:
7M,vel I.s£3C'Zt?ddi.'ntation F'eeF s,,-
':Strong
StrongMotion Fee: 1BSEISMICR
$2.28
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
kit '` $972.28
$0.00 v TOTAL,'FEE:
$972.28
Revised: 08/20/2014
REROOF TEAR -OFF POLIGY
COMMUNITY DEVELOPMENTDEPARTMENT 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 • buildinc0a)cupert1no.orq
I4a`loa�-6
PROJECT ADDRESSS//�)
APN #
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OWNER N
PHO
E-MAIL
STREET ADDRESS
/
CITYy�TA� f' ZIP
CX
t�eGr7 / �V6
FAX
CONTRACTOR NAMEA
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LICENSE NUIVM9 a LICENSE T `�
BUS. LIC. #
COMPANY NAME
C
E-MAIL
FAX
STREET ADDRES
/1 / ` (
CITY ATE, Z�
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 canbe 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::30-10:3`0am 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 -dawn 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 demonstratethereis no ponding.
b. Listings froze 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. There -inspection fee shall' be paid before another inspection can be
scheduled.
By my signing below, I certify each of tba 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 uired to be installed in accordance with Sections R314 and R315 of
the 2013 California Residential Code.
Signature of Applicant/Agent: Date: f
RerootPolicy_2014.doe remised 01115114
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