14100151 CITY OF CUPtRTINO BUILDING PERMIT
BUILDING ADDRESS: 1036 WEST HILL CT rnw'rD"`'TOR. PERMIT NQ: 14100151
�. �t �P/'ovr�e7e.✓l S�'i G iS� /�✓C
OWNER'S NAME:
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL
TEAR OFF(E)WOOD SHAKE,INSTALL(N)OSB,CLASS A
License Class C 3 Lic.# �97`�o�fio LANDMARK 50 YR COMP(27 SQ'S)
qq ' %r
Contractor 1,4 Nw �af�t. Lrn e JL
/ /v1sk/y
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:$12800
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 APN Number:36227045 00 Occupancy Type:
permit is issued.
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 coilnty 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 F M LAS D 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 Issu a e: O y
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.
RE-ROOFS:
Signature Date C K 7 N All roofs�bcanyroofing 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
Signature of Applicant: a e:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: ALL ROOF NGS TO BE CLASS ,, 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)
HAZARDOUS MATERIALS DISCLOSURE
I,as owner of the property,am exclusively contracting with licensed contractors to
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,Sections 2550 533,a 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Date:W1.9t4
Owner or authorized agent:
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
n
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9 18.
Signature Date
REROOF PERMIT. APPLICATION
�O
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 l k
CUPERTINO (408)777-3228•FAX(408)777-3333•building(d,cupertino.org
PROJECT ADDRESS 103&
Q3I'_ V-` ''• LL 1 CA• APN# 2
OWNER NAME _ /
STREET ADDRESS �r I Ci • CITY, STATE,ZIP rv'v/ FAX
CONTACT NAME • PHONE E-MAIL
STREET ADDRESS CITY,STATE,ZIP FAX .
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAMELICENSE NUMBER FLICE;NsEYPE BUS.LIC.#
.3
COMPANY NAME -MAIL FAX
I
STREET ADDRESS CITY,STATE, IP PHONE
U64714) c.. f�;s . I , cAVo C', c e S
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC.#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF �FD or Duplex ❑ Multi-Family ROOF AREA: VALUATION:
STRUCTURE: `❑ Commercial V `2 000
EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY)
REMOVE/REPLACE ES IF NO. PLYWOOD / ` ❑ PLYWD XOSB PITCH: ROOF
❑NO #LAYERS: THICKNESS: 5/8" TYPE: ❑ CDX 4:0 '12 CLASS: A
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF' )! SPHALT SHINGLES El WOOD SHAKES 11 WOOD SHINGLES 1:1 OTHER ICC-ES REPORT#
:::-7
DESCRIPTION OF WORK:
By my signature below,I certify 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 provi 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 buil 'ng construction. esentatives of Cupertino to enter the above-identifie prope for inspection purposes.
Signature of Applicant/Agent: V Date: LL
SUPPLEMENTAL INFORMATION REQUIRED
If building is associated with a Home Owner's Association,provide letter nN TYPE
Of approval from HOA. ❑�� "`
a'i{ jTJiLDINGPLANREVIEW
_Provide Planning approval to verify if there any restrictions. ] s DLANNINc PLAN REviEw
�
Provide copy of Manufacturer's Installation Specifications. sTAlvn`pRn h ❑ D
_Provide signed copy of Cupertino's Tear-Off Policy. ❑ TI3ER
ReroofApp_2011.doc revised 03/16/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 1036 WEST HILL CT DATE: 10/24/2014 REVIEWED BY: MELISSA
APN: 362 27 045 BP#: *VALUATION: 1$12,800
*PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD or Duplex PENTAMATION 1SFDWLROOF
USE: P PERMIT TYPE:
WORK TEAR OFF E WOOD SHAKE INSTALL N OSB CLASS A LANDMARK 50 YR COMP 26 SQ'S
SCOPE
FEE ID ROOF AREA
s.f.
1 REROOFFRES 2,600
Fere; 1,ee.
Other Plumb 1nsp- ( i?e?�I t<r:�. ?rslo
Plumb. r1up. Fee:
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 Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 E f 711/13) FEE QTY/FEE MISC ITEMS
Plan Chil,,E:
REROOF TEAR-OFF POLICY
its COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
CUPERTINO 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228•FAX(408)777-3333-building okupertino.org
PROJECT ADDRESS . t/r C�: 7APN It -3 f __ t v y
OWNER NAME v I v
h r ��D FAX
fr J �
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC.#
O a0
COMPANY NAME E-MAOI. AX
STREET ADDRESS CITY STA E,ZIP PHONE
i 3 61' c¢ Fob- s� s*"c
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 un 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/4"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 and R315 of
the 2013 California Residential Code.
Signature of Applicant/Agent: Date: Id 2 v A
ReroofPolicy_2014.doc revised 01/15/14