14100009 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7490 DUMAS DR CONTRACTOR:KEITH ROOFING CO INC PERMIT NO: 14100009
OWNER'S NAME_'*
SAN JOSE,CA 95126 PHONE NO:(408)295-8616
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL ❑
RE-ROOF 24 SQ'S-REMOVE SHAKE ROOF,INSTALL 7/16
License Class Lie.# �171%//� OSB CLASS A
Contra or Date �v
I here a firm 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
Zper rmance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$10500
ave 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 APN Number:35926010.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERM11EXMIRES F WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating W 80 DAYS OF PE IT 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 FR ST CALLED INSPEC ION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments, cf
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 regulations per the Cupertino Municipal Code,Section
9 18.
RE-ROOFS:
Signat Date v All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed without first obtainin nspection,I agree to remove all new materials for
inspection.
❑ OWNER-BUILDER DECLARATION 7j
Signature ofAZ
� t: Dat
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: ALOF 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. 2 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Secti 505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this ��
permit is issued. Owner or authorized age Date:
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
918.
Signature Date
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 h
curitkst`ka
,(408)777-3228• FAX(408)777-3333•buildino cDcuipertino.org \v
PROJECT ADDRESSG APN# 359
OWNER NAME l G CJ�
STREET ADDRESS 4 ' CITY.�, ip1FAX
CONTACT NAJ,SE�,i. � P E-MAIL
STREET ADDRESS, CITY,STATE,ZIP FAX
❑ OwNER ❑ OWNER--BUILDER ❑.OWNERAGENT -pJ01URACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACfORNAME LICENSE LICENSE BUS.
COMPANY NAME E-MAIL - FAX
STREET ADDRESS PHONE? rj`
ARCH[TECT/ENGINEER NAME LCENUMBER
BUS.LIC.9
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑ SFD or Duplex ❑ Multi-Family ROOF AREA.- VALUATION:
sTRucruxE: ❑ Commercial G� I
EXISTING ROOF TYPE:, ❑BUILT-UP ROOF ❑ASPHALT SHINGLES OD SHAKES ❑WOOD__��S,HrrNGLES ❑OTHER(SPECIFY)
REMOVE/REPLACE ❑YES IF NO, PLYWOOD ❑ W, ❑ PLYWD N�vst3 PITCH: ROOF
❑NO LAYERS: THICKNESS: ❑ 5/8" TYPE: ❑ CDX 12 CLASS- A
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF __; S T SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT#
DESCRIPTION OF WORK-
By
ORKBy my signature below,I certify,to a the following: I ain the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information v rovided is:correct I hgve:rea Description of Work.and verify it is accurate. I gree to compI with all applicable local
ordinances and state
' Date: <<%%U
SUPPLEMENTAL INFORMATION REQUIRED
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 Manufacturers Installation Specifications.
Provide signed copy of Cupertino's Tear-Off Policy. 4
IF 9MMEN
ReroofApp_2011.doc revised 03116/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 7490 dumas DATE: 10/02/2014 REVIEWED BY: mendez
APN: BP#: *VALUATION: 1$10,500
*PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD or Duplex PENTAMATION 1 SFDWLROO
USE: PERMIT TYPE:
WORK re-roof
SCOPE
FEE ID ROOF AREA
s.f.
1 REROOFFRES 2,400
4a �gr�
Check 1'1,1111+'h. Plan('heclr lilecr. Ph 1P Check
17h, 1e. il Fee' PlarinhPermit k7e� Pcrr if T�,t,-
0_L_
(fir/rc r-1 kc h, lrlsrr. (like"r Plvmb frup. U;her I le(, hFsf".
Phurth. Insp, Fee- r,/Cc.Imp,
NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc. . These fees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff. 711113) FEE QTY/FEE MISC ITEMS
Plan
r
Permit Fee: $408.00
1 C',rini1 Fee:
<S6�d�c`tZftPt"i7t,'l"L't�c,'L'.
Work Without Permit? 0 Yes (E) No $0.00
,!t °_ar7c°t cj Pletnning Fees:
1)o;'ltrr!eaz.taliorl Dees.,
Strom Motion Fee: IBSEISMICR $1.37 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
n
r
$410.37 $0.00 TOTALFEE: $410.37
Revised: 08/20/2014
T
REROOF TEAR-OFF POLICY
r COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION
ALBERT SALVADOR, P.E.,C.B.O., BUILDING OFFICIAL
C:UPERTINO 10300 TORRE AVENUE-CUPERTINO,CA 95014-3255
(408) 777-3228-FAX(408)777-3333-building(5cupertino.org
PROJECT ADDRESS a��UMA APN#
OWNER NAME ��)
STREET ADDRESS ^ J� � CTfY, TE, Q �� r}� FAX
CONTRACTOR NAME LIC UMBER G LICiEN�SFP BUS.LIC.#
44�
COMPANY NAME EMAIL FAX
STREETADDRESS `% ^�[ � CITY,-TA3 ZIP Z� PHGN ✓ (J'fl
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 monoxi ctors are required to be installed in accordance with Section R31 and R315 of
the 2013 California Residential oee. )/!
Signature of Applicant/Agent: Date`
ReroofPolicy_2014.doc remised 01/15114
CUPERTINO
Address
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
°. 40 .
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 ever level of a dwellingunit indudin 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: ha 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 in compliance with the California Building
and California Residential Codes. The alarms have been tested and are operational, as of the date signed
below.
�'p�f%jlo t have read and
(
the terms and conditions of this statement
�.................�. ....................Date:/.1/....4..1••••
..... Date: .....
f,/j....
Smoke and CO forin.doc revised 03118114