150800374
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19778 LA MAR DR
CONTRACTOR: STONERIDGE ROOFING
PERMIT NO: 15080037
OWNER'S NAME: FU HORNG-SEN AND ROSA CHANG TRUSTEE
1672 RIDGETREE WAY
DATE ISSUED: 08/05/2015
OWNER'S PHONE: 4087370110
SAN JOSE, CA 95132
PHONE NO: (408)729-5101
C� LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL E]
REMOVE (E) WOOD SHAKE ROOF, INSTALL (N) OSB
License Clas Lic. # �� ��
PLYWOOD, 30 LBS UNDERLAYMENT AND LAND MARK
TL
Contracto.<�� �� --+/� Date
ASPHALT SHINGLES (23 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: $12700
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: 36912030.00
Occupancy "i'ypc:
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
180 D S FROM LAST CALLED INSPE T ON.
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 11 /
J�,�// �4N
C�Vw
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.
RE -ROOFS:
Signature Date
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
Signature of Applicant: 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. 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 2550%%5, 25533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent:. Y G �� \c'7�3 CQ CEL 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
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
9.18.
Signature Date
CUPERTINO
REROOF PERMIT APPLICATION 1.9MMR
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building a(_.cupertino.orq
PROJECT ADDRESS \(3�'J_j\
t
APN#(J
69 '�_J
�
PHONE –7 E-MAIL
'yj
OWNER NAMEMA-k
STREET ADDRESS
CI �', STATE ZAP �FACONTACT
NAME
PHONE E-MAIL
STREET ADDRESS
CITY, STATE, ZIP FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OIAWERAGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
A\ 66� k2
LICENSE NUMBS
I Azlslo
LICENSE TYP
BUS. LIC. #
COMPANY NAM
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZI11k
PHONE qo�C
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC. #
COMPANY NAME E-MAIL
I
FAX
STREET ADDRESS CITY, STATE, ZIP
PHONE
USE OF ❑ SFD or Duplex ❑ Multi -Family
STRUCTURE: ❑ Commercial
ROOF AREA:
VALUATION: /
/
EXISTING ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES KOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER (SPECIFY)
EMOV /REPLACE t2YES
❑ NO
IF NO,
I # LAYERS: 1
PLYWOOD V26, ElPLYWD
THICKNESS: ❑ 5/8'.
OSB
TYPE: ❑ CDX
PITCH:
:12
ROOF
CLASS: A
PROPOSED ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER
ICC -ES REPORT #
DESCRIPTION OF WORK: � y
1
1{ lhJ
r l 1
By my signature below, I certify to each of the following: I am the property o Amer or authorized agent to act on the property oAAmer'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 Qbuilng construction. I authorize representatives of Cupertino to enter the ve-Identified property for inspection purposes.
SignatureofApplicant/Agent: Date: L.1---- —
SUPPLEMENTAL INFOKMATION 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 Manufacturer's Installation Specifications.
Provide signed copy of Cupertino's Tear Off Policy.
OFFICE
USEONLY
1 LAN CHECK TYPr
R0111 ENG SLIP
XIVER-IIIE-COTINTYR
C L%PRLSS
❑T
❑ ULILDING PLAN RLA Icw
PLANTING PLAN RP_AIEw'
❑ rII I I;err
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ReroofApp_2011.doc revised 03/16/11
CITY OF CUPERTINO 150800-34.
go, FEE ESTIMATOR - BUILDING DIVISION
61'
ADDRESS: 19778 LA MAR DR.
DATE: 08/05/2015
REVIEWED BY: PAUL
Atechf erwit Feer.
APN: 369 12 030
BP#:
`VALUATION: 1$12,700
*PERMIT TYPE: Minor Building Permit
PLAN CHECK TYPE: Re -roof
PRIMARY SFD or Duplex
USE:
P1umb./,11ech.,1E1ec
PENTAMATION 1SFDWLR00F
PERMIT TYPE:
WORK
Remove E wood shake roof, Install N OSB plywood, 30 lbs underla ment and land mark TL asphalt
SCOPE
shingles (23 Squares)
FEE ID ROOF AREA
s.f.
1REROOFFRES 2,300
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 nreliminary information available and are onlv an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff 711.113)
alech. Plan Check
Phunh. Ilan Check
Elec..Plan Check
Atechf erwit Feer.
Plumh, Permit Fee:
Flec. Permir Fee-
ei:-Other
Otherilec•h. Insp
Ph mh
Other Islet. Insp.
E17 --
I h 1171v,
P1umb./,11ech.,1E1ec
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 nreliminary information available and are onlv an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff 711.113)
FEE
QTY/FEE
MISC ITEMS
Plan ('heck hee:
Suppl. PC Fee
P1umb./,11ech.,1E1ec
Permit Fee:
$391.00
Suppl. Insp Fee
Plumb.il ,tech./Elec
Plumb.I.Mech.!Elec Permit Pepe:
Construction Tax:
Administrative Fee:
Work Without Permit? 0 Yes No
$0.00
Advanced Planning Pees.
Travel Docurnenlalion Fees:
Strong Motion Fee. IBSEISMICR
$1.65
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$393.65
$0.00 TOTAL FEE:
1 $393.65
Revised: 07/02/2015
REROOF TEAR -OFF POLICY i50500,q�_,
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 • buildina aacupertino.ora
PROJECT ADDRESS
u71.3bg
,PHONE
ROWOWNER
NAME
t
E-MAIL
STREET ADDRESS
CITY, STATE, ZIP
FAX
CONTRACTOR NAME6,.J
LICENSE NUMBS1�0
LICENSE rYPE
BUS. LIC. k
COMPANY NAME
n J '
/SCJ
E-MAIL
FAX
STREET ADDRESS
1,01CITY,
STATE, ZIP
dJ
PHONE 0 '-
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 Nailin-a 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 Cod .
Signature of Applicant/Agent: Date:
RerooJPolicy_2014.doc revised 01/15/14