15080068D
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 3 RESULTS WAY
CONTRACTOR: STATEWIDE ROOFING
PERMIT NO: 15080068
INC
OWNER'S NAME: BVK PERIMETER SQUARE RETAIL LLC ET
5542 MONTEREY RD
DATE ISSUED: 08/07/2015
O ER'S PHONE: 4089749575
SAN JOSE, CA 95138
PHONE NO: (408)288-8680
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL
License Class � Laic. # 2)Q3q 2b
OVERLAY 1 (E) B.U.R. WITH (N) VERSICO 80 MIL TPO
ROOF OVER 1/2 INCH FAN -FOLD INSULFOAM (148 SQ'S)
\�
``
Contractor S"t7��ceW�U� 110<'Rq Date �
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: $77840
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: 35720042.3
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 D 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 OM LAS LED INSPEC ION
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
with all non -point source regulations per a 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 ate:
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, 25533, d 534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner /
permit is issued.
or authorized agent ate:
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
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
CITY OF CUPERTINO
Fm -N FEE ESTIMATOR — BUILDING DIVISION
lalADDRESS:
3 RESULTS WAY
DATE: 08/07/2015
REVIEWED BY: MELISSA
.At1eeh. Permit Fire'
APN: 357 20 042
BP#:
"VALUATION: 1$77,840
*PERMIT TYPE: Minor Building Permit
PLAN CHECK TYPE: Re -roof
PRIMARY Commercial Building
USE:
Plumb 11fech.!Elec
PENTAMATION 1COMMLROOF
PERMIT TYPE:
WORK
OVERLAY 1 E B.U.R. WITH N VERSICO 80 MIL TPO ROOF OVER 1/2 INCH FAN -FOLD
SCOPE
INSULFOAM (148 SQ'S)
FEE ID ROOF AREA
s.f.
1REROOFCOM 14,800
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 preliminary information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eft' 7/1!13)
ifech. Plan Check
Numb. Plan Check
Elec. flan Check FT
.At1eeh. Permit Fire'
Plumb, Permit Fee:
1 lec. Permit Fire
Other Alech. /nslr- I —
Other Plumb 7*rsr=
Ll
Other Elec. Insp.
Plumb 11fech.!Elec
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 preliminary information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eft' 7/1!13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
Suppl. PC Fee
Plumb 11fech.!Elec
Permit Fee:
$1,110.00
SuppL Insp Fee
P1umh.1jVech.; E'lec
Plunzh.41ech.%E'lec Permit
Construction Tax. -FT
Administrative Fee:
Work Without Permit? 0 Yes (2) No
$0.00
Advanced Planning Fees:
Travel Documentation Fees:
Strong Motion Fee: IBSEISMICO
$21.80
Select an Administrative Item
1
Bldg, Stds Commission Fee: IBCBSC
$4.001
SUBTOTALS:
$1,135.80
$0.00 TOTAL FEE:
1 $1,135.80
Revised: 07/02/2015
CUPERTINO
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(Qcupertino.org �O O
PROJECT ADDRESS Results Way 3, Cupertino, CA
APN # 35+-- : O � Z
OWNER NAME Apple, InC. V r
PHONE
408-974-9575
E-MAIL
STREET ADDRESS
1 Infinite Loop
CITY, STATE, ZIP
Cupertino, CA 95014
FAX
408-255-2337
CONTACT NAME Mike Courtney or Kathy Robertson
PHONE 408-286-7828 TE
-MAIL mcourtney@swroof.net
STREET ADDRESS 5542 Monterey Rd., #201
CITY, STATE, ZIP San Jose, CA 95138
FAX 408-286-7828
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT IX CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
Kathy Robertson
LICENSE NUMBER
803926
LICENSE TYPE C-39
BUS. LIC. # 23509
COMPANY NAME
Statewide Roofing, Inc.
E-MAIL
krobertson@swroof.net
FAX 408-286-7820
STREET ADDRESS
5542 Monterey Rd., #201
CITY, STATE, ZIP
San Jose, CA 95138
PHONE 408-286-7828
ARCHITECT/ENGINEER NAME
N/A
LICENSE NUMBER
BUS. LIC. #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ SFD or Duplex ❑ Multi -Family
STRUCTURE: IR Commercial
ROOF AREA:
14,800 square feet
VALUATION:
$77,840.00
EXISTING ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES EXOTHER (SPECIFY) Versico 80 mil.
REMOVE /REPLACE ❑ YES
O
IF NO.
#LAYERS:
PLYWOOD ❑ w, ❑ _TPLPE
THICKNESS: ❑ 5/8"
YWD ❑ OSB
: ❑ CDX
PITCH: �
:12
ROOF
CLASS: `�
PROPOSED ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES 160THE - ICC -ES REPORT #
DESCRIPTION OF WORK:
We are overlaying one (1) existing built-up roof with a Versico 80 mil TPO roof over 1/2" of Fan -Fold insulfoam
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the propK owne . I have read this
application and the information I have provided is c ct. 1 ave read t 'cri on of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to buildi tructi I author' res atives upertino to enter the above-identifie rope or inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFOR ON 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.
OFF CE USE ONLY
PLAN CHECK TYPE
ROUTING SLIP
❑ OVER-THE-COUNTER
❑ EXPRESS
❑ STANDARD
❑ BUILDING PLAN REVIEW
❑ PLANNING PLAN REVIEW
❑ FIRE DEPT
❑ OTHER:
ReroofApp_201 Ldoe revised 03/16/11
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 aO.cupertino.org
PROJECT ADDRESS Results Way 3, Cupertino CA 95014
APN # 1
(�/
OWNER NAME Apple, Inc.
PHONE 408-974-9575
E-MAIL
STREET ADDRESS 1 Infinite Loop
CITY, STATE, ZIP Cupertino, CA 95014
FAX 408-255-2337
CONTRACTOR NAME Kathy Robertson
LICENSE NUMBER 803926
LICE SEE TYPE
BUS. LIC. # 23509
COMPANY NAME Statewide Roofing, Inc.
E-MAIL krobertson@swroof.net
FAX 408-286-7828
STREET ADDRESS 5542 Monterey Rd., #201
CITY, STATE, ZIP San Jose, CA 95138
PHONE 408-286-7828
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-
2:34pm (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 '/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 re ' ed to be ' alle , n acco ance with Sections R314 and R315 of
the 2013 California Residential Code.
Signature of Applicant/Agent: Date: August 7, 2015
ReroofPo1icy_2014.doc revised 01115/14