15040188 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 11807 PINE BROOK CT CONTRACTOR:BUCK'S ROOFING PERMIT NO: 15040188
OWNER'S NAME: GLENN&LOUISE FISHLER 6853 W RIVERSIDE WAY DATE ISSUED:04/27/2015
OWNER'S PHONE: 4085944128 SAN JOSE,CA 95129 PHONE NO:(408)313-3429
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL E]
TEAR OFF(E)WOOD SHAKE,INSTALL 25 SQ'S CLASS A
License Class LA Lie,# 3 _ alb COMP OVER EXISTING PLY
Contractor ( '_ VfEl Dater -l& _�—
I hereby affirm that I am licensed unifer 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:$14000
�i a and will maintain Worker's Compensation Insurance,as provided for by
ection 3700 of the Labor Code,for the performance of the work for which this APN Number:36604060.00 Occupancy Type:
permi js 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 DAYS FROM LAST CALLED 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 " 5uw V,*j Date:
granting of this permit. Additionally,the applicant understands and will comply Issued by:
with all non-point source regulations per the Cupertino Municipal Code,Section
9 18.
s, E-ROOF5:
Signature Date / a � 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 Appli t: "y i Date: /
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: ALL ROO C ERINGS 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(See.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 25505,25533,and 25534. t�
Section 3700 of the Labor Code,for the performance of the work for which thisZ// -
permit is issued. Owner 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
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
,1
r
`REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERTINO (408)777-3228 • FAX (408)777-3333• buildina(a)cupertino.org
PROJECT ADDRESS1 �n A �i / APN / /1 L/_ Q 0/0
OWNER NAME f & 1 I�X ` PN l ! E-MAIL
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STREET ADDRESS CITY, STATE,ZIP FAX
CONTACT NA OE �( PHONE L� E-MAIL
TREET ADDRESS —J CITY STA ZIP FAX
�cU /Z
❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTORNAME / LICENSENUMBER. Li
CEN TYP BUS.LIC.
1C ov r/� 7
COMPANY NAMEj r E-MAIL FAX //
STREET ADDS S ,'.I�i V �,a� !� 1 C STA �7 / PHONE///O
ARCHITECT/ENGINEER NAME
II�C �, / LICENSE NUMBER \J C! BUS.LIIC.9
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF SFD or Duplex ❑ Multi-Family ROOF AREA: VALUATION:
STRUCTURE: Commercial Z / C/� 0 d U
EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES IJOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY)
REMOVE/REPLACE )<YES IFNO. PLYWOOD )&,w, ❑ PLYWD ❑ OSB PITCH: �ql
ROOF
❑NO #LAYERS: THICKNESS: El5/8" TYPE: CDX CLASS: APROPOSED ROOF TYPE: ❑BUILT-UPROOF ElASPHALT SHINGLES 1:1WOOD SHAKES ElWOOD SHINGLESOTHERICC-ES REPORT R
DESCRIPTION OF WORK: f� / � �C
yat tJtjs I L4 v
1 •
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 construction. I authorize representatives of Cupertino to enter the above-id feed property for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL IN ATION REQUIRED
_If building is associated with a me 0",npr's Association,provide letter ,touTuvGSLIP 'tE a �
of approval from HOA. N ' R THE COUItTER�Iu'r� $UILDII�GPL`ANREVIEPVt" r
R�3twl� akl
Provide Planning approval to verify if there any restrictions. )] EZPxEss K fl PLAl,1�II�GPLAI�nxE�EI � ,
x
Provide copy of Manufacturer's Installation Specifications. fl`sTANDA� }yl � YPIREDEPT
4 i <f
Provide signed copy of Cupertino's Tear-Off Policy.
iz:tf'-
ReroofApp_2011.doc revised 03/16/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 11807 PINE BROOK CT DATE: 04/27/2015 REVIEWED BY: PAUL
APN: 366 04 060 BP#: ''VALUATION: 1$14,000
PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY PENTAMATION
USE: SFD or Duplex PERMIT TYPE: 1 SFDWLROO
WORK TEAR OFF E WOOD SHAKE INSTALL 25 SQ'S CLASS A COMP OVER EXISTING PLY
SCOPE
FEE ID ROOF AREA
s.f.
1REROOFFRES 2,500
He ch. Plan Check Numb. Plan Check I7ec.Plan Check
:11ech. Permit Fee: Plumb. Permil Fee: Ilea Permit Fee:
Other Alech. Insp. Olher-Plumb Inset. Li Other Elec.Insp,
ED-L-
Mech.Insp.Hee: Plumb. Ir:sp. Fee: Elec.Insp.Fee:
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). These ees are based on the prelimina information available and are only an estimate Contact the De t or addn'1 info.
FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Suppl. X."'Fee
Plum b./Hech./Elee
Permit Fee: $425.00
Suppl. Insp Fee
Plumb.,,Mech./Flee
Plumb./1Vdech./Elec Pernril Fee:
Construction Tai:
Administrative Fee:
Work Without Permit? 0 Yes (j) No $0.00
,Advanced Planning Pees:
Travel Documentalion Fees: �
Strong Motion Fee: IBSEISMICR $1.82 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUSTOTALSi $427.82 $0.00 T7�7-821
TOTAL FEE
Revised: 04/01/2015
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
CUPERTINO
(408)777-3228• FAX(408)777-3333• build!ng(a,cupertino.org
PROJECT ADDRESS // (�O �J�C C ^APN 9 � / / � O
OWNERNAME ��� PHONE C/ (//Z� E-MAIL
STREET ADDRESS CITY,STATE,ZIP FAX
CONTRACTORNAME e� �\ ` f LICENP NU E -S-5i AYP 3 BUS.LIC.9
COMPANY NAME ��J / E-/MAIL FAX
12
STREET D RES CITY TATE ZIP r� r, �q PHONEujc� ka
V 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 7:30-3:30pin(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%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 e.
Signature of Applicant/Agent:% Date:
ReroofPolicy_2014.doc revised 01/15/14