OTCA,
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21861 MCCLELLAN RD
CONTRACTOR: NEIGHBORS ROOFING
PERMIT NO: 15070223
AND GUTTERS
OWNER'S NAME: LUCAS MICHAEL E AND SHERRY S
200 FORD RD STE 236
DATE ISSUED: 07/30/2015
OWNER'S PHONE: 4082558126
SAN JOSE, CA 95138
PHONE NO: (408) 472-3869
�— LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
REMOVE (E) SHAKES AND INSTALL (N) OSB,
License Class Lic. # C4_0 6
UNDERLAYMENT AND ASPHALT SHINGLES (33
Contractor 6L1bf- Cy, -S Op Date - ,3 Cir
SQUARES)
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: $11500
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
APN Number: 35714005.00
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 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
180S FROLAST CALLED INSPECTI N.
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
9.18.
Signature Date -, d 5
RE -ROOFS:
_
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
hereby affirm that I am exempt from the Contractor's License Law for one of
Signature of Applicant: ate:
- 3I
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 2 505, 25533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner
permit is issued.
or authorized agent: 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
Lender's Address
APPLICANT CERTIFICATION
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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
ARCHITECT'S DECLARATION
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
CUPERTINO
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(cDcupertino.org
PROJECT ADDRESS /
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E-MAIL
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CITY, STATES, ZIP
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CONTACT NAME
PHONE
E-MAIL
STREET ADDRESS
CITY, STATE, ZIP
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❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT � CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME��
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LICENSE TYPE
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COMPANY NAME E-MAIL
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FAX
STREET ADDRESS CITY, STATE, ZIP
PHONE
Z 196
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC. #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF SFD or Duplex ❑ Multi -Family
ROOF AREA:
VALUATION:
STRUCTURE: ❑ Commercial
-33
EXISTING ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES 0 WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER (SPECIFY)
REMOVE /REPLACE BYES
IF NO, L
PLYWOOD El w,ElPLYWD
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N` OSB 2a
PITCH:
ROOF
El NO
# LAYERS:
THICKNESS: 115/8"
TYPE: ElCDX
1
' 12
CLASS: A
PROPOSED ROOF TYPE: ❑ BUILT-UP ROOF q31ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER
ICC -ES REPORT #
DESCRIPTION OF WORK:
rre sh6, Ke S 116 S �-c, z r Y a
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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 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 building con truction. I a thorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature Date: '—
of Applicant/Agent:
SUPPLEMENTAL INFORMATION REQUIRED
If building is associated with a Home Owner's Association, provide letter
Y ' �PLaNcaEcxTYPE ` , n
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OVER�THE-COUNTER
_
of approval from HOA.
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Provide Planning approval to verify if there any restrictions.
y❑hBUILDI�VGPL�ANREVIEW
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Provide copy of Manufacturer's Installation Specifications.
❑`"sT�.riDAxD ` r '* ''
❑s FIREDEPT h
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Provide signed copy of Cupertino's Tear -Off Policy.NVO
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❑w`oTHER �� �;, r _- �A
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ReroofApp2011.doc revised 03/16/11
CITY OF CUPERTINO 1aD1_60`a3
FEE ESTIMATOR — BUILDING DIVISION
imADDRESS:
21861 MCCLELLAN RD.
DATE: 07/30/2015
REVIEWED BY: PAUL
Plant Cheek fiee:
APN: 35714 005
BP#:
*VALUATION: 1$11,500
*PERMIT TYPE: Minor Building Permit
PLAN CHECK TYPE: Re -roof
PRIMARY
USE: SFD or Duplex
_
PENTAMATION
PERMIT TYPE: 1SFDWLR00
WORK
Remove E shakes and Install N OSB underla ment and asphalt shingles 33 Squares)
SCOPE
Supp1. Insp Fee
FEE ID ROOF AREA
s.f.
1REROOFFRES 3,300
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc )_ These fees are hated on the nreliminary information availahle and are only an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 E . 7/11131
FEE
QTY/FEE
MISC ITEMS
Plant Cheek fiee:
Supp/. PC'Tee
Plunib./I lfeeh./Elec
Permit Fee:
$561.00
Supp1. Insp Fee
Plumb. MecAiElec°
Pt utn b. i,'�leelt. if'lec Per tta it Fee:
COnstruelion Tccx.
F-1
Actn?zni,St�atitic� 1%ee:
Work Without Permit? 0 Yes (j) No
$0.00
Aihcrnr.,et�.1'lcnn�zin Fees:
Travel.Documentaiion 1`ees:
Stronjz Motion Fee: IBSEISMICR
$1.50
Select an Administrative
Bldia Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$563.50
$0.00 TO AL'' FEE:
0
Revised: 07/02/2015
s
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-)cupertino.orq
PROJECT ADDRESS / /j4 C I� /�
APN Co
OWNER N^ t Clr e C�i� C U I LAY p �lJ
2 S� O I �
E-MAIL
STREET ADDRESS
CITY, STATE, ZIP
FAX
CON CTO NAME.
b. -b c, -J "�
LICE, M`ERBER
�`O iA
LICENSE TYPE
L
BUS. LIC. R
COMPANY NAM P
g 0 -f - 's
E-MAIL
FAX
STREET ADDRESS /
CITY, STATE, ZIP � ��
� � /-
d00
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 aln 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 Residentiale.
Siffriature of ADDIicant/Aeent: �, Date:
ReroofPolicy_2014.doc revised 01115114