15050052 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21771 STEVENS CREEK BLVD C_ONTRACTOR: PERMIT NO: 15050052
i°Ullt 14r C0hJ-S
OWNER'S NAME: CUPERTINO GA YA TRI LLC DATE ISSUED:05/11/2015
OWNER'S PHONE: 4152544582 PHONE NO:
r�-
x LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL
_ TEAR OFF(E)COMP,INSTALL(N) 15#FELT WITH
License Class ' Lic.# _rel~ SHEET METAL EDGE&(N)CLASS A COMP ROOF
Contractor mix-C IPFP (066 Date ,�1, ,lb( " SYSTEM
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
Pperformance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$9000
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:32620049.00 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 WIT AYS ERMIT 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 AYS LLED 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
granting of this permit. Additionally,the applicant understands and will compl ssued Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9 18. n
.� I �- RE-ROOFS:
Signature 's 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 i
Signature of Applicant: g.�E�'/ 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. 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 255 5533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Owner or authorized agent: _ Date:'l —P(—
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
,n
............................. ..
REROOF PERMIT APPLICATION
�®
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERTINO (408)777-3228• FAX(408)777-3333• building(cr cupertino.org \�
PROJECT ADDRESS , 1-771 /GOZ6�ffk APN 4
OWNER NAME PHONE p E-MAIL —(
STREET A fROS 6 y, r� CITY, STATE,ZIP FAp �Dh21
aej
CONTACT NAME PHO ` '
16( Z
ZE-MAIL
STREET ADDRESS CITY,STATE, ZIP FAX
❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME , h� LICENSE NUMBER /L' `, LICENSE TYPE `i(� BUS.LIC.m
COMPANY NAME 11 E-MAIL r C7 J I FAX
d7A1 Lo
STREET ADDRESS 7 s_3b P-r CITY,STATE,ZIP ,F PHONE--IS 22-d sr-
ARCHITECT/ENGINEERNAME LICENSENUMBER (� l� B BUS.LIC.9
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑ SFD or Duplex ❑ Multi-Family ROOF AREA: VALUATION:
STRUCTURE: ❑ Commercial ccc���yyy
EXISTING ROOF TYPE: ❑BUILT-UP ROOF I�ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY)
REMOVE/REPLACE YES IFNO, / PLYWOOD ❑ w, ❑
PL ❑ OSB PITCH: OOF
❑NO #LAYERS: THICKNESS: ❑ 518" TYPE: ❑ CDX 2 CLASS: A
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER IC -
DESCRIPTION OF WORK: 6
.� LC
S L-L_ Nr C- vxj 00 U 3LF /.S- c vul- � ,-T_ aL C ,�
'"9v.'77}L, =W 6D PO ``?a�l S' T 3
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 pro � e 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 buil tructian. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date: S— �� — 2-D /1—
SUPPLEMENTAL
SSUPPLEMENTAL INFORMATION REQUIRED '
If building is associated With a Home Owner's Association,provide letterPLa t`CHECK TYPE t i z RoV IAG'sLIP
of approval from HOA. � Iz=rHE Cot51VTSIz�i i!� , L7�BUIfJDIIVGPLANIiEVIEw ,''��4
—Provide Planning approval to verify if there any restrictions. 'EZPREss ❑
F PLANNING PLAN REVIE\Y r
' 4 l
Provide copy of Manufacturer's Installation Specifications. D sTAr r w kLj FIREDEPT
Provide signed copy of Cupertino's Tear-Off Policy. 4
ReroofApp_2011.doc revised 03/16/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 21771 STEVENS CREEK BLVD DATE: 05/11/2015 REVIEWED BY: MELISSA
APN: 326 48 036 BP#: *VALUATION: 1$9,000
*PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY PENTAMATION
USE: Commercial Building PERMIT TYPE: 1COMMLR00
WORK TEAR OFF E COMP INSTALL N 15# FELT WITH SHEET METAL EDGE & N CLASS A COMP
)WORK
ROOF SYSTEM
FEE ID ROOF AREA
s.f.
1REROOFCOM 3,000
l tech. Plan C:'lu:ek Plumb.Plant Check lslec..Plan Check
Me& Permil Fee: Plumb. Permit Fee: Flee. Permit Fee:
Other Alech.Ins). Other Plumb Insp. Li Other Eke.Imp.
.)dech,Insp.Fee: Plumb. h p. Fee: Elec.Insp.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 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. 7/1/131 FEE QTY/FEE MISC ITEMS
Plan (.'heck Fee:
Suppl, P('F'ee
Plulnb./Alech./Elee
Permit Fee: $394.00
Sippl. Insp Fee
Plzlmb.A,&ch.,•''lslec
Phlnlb.111ech./Flee Permit Fee:
Construction Tax:
Administrative ve ree:
Work Without Permit? 0 Yes Q No $0.00
Advanced Planning Fees:
Trcmel Doe-umenialion Fees. A
Strong Motion Fee: 1BSEISMICO $2.52 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00
SUBTOTALS: $397.52 $0.00 TOTAL FEE: $397.52
Revised: 04/01/2015
f.
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•building aC�.cupertino.org
PROJECT ADDRESS 1.72( S I�VtFIV Ci2 � 6 �/ APN 4
OWNER NAME �6 H lS Zs-!K Vu 0 2 E-MAIL
STREET ADDRESS� O F .\/ a/�/� CITY
, ^4"����C�G
CONTRACTOR NAME (�j��(�� r��y`� C/ LICENSE NUMBE ///3� LICENSE TYPE2� BUS.LIC.k
COMPANY NAME 114,/ I``'a ?�Y� 1/m�� E-MAIL D J FAX
STREET ADDRESS 78 A 6 -AM CTTY,STATE,ZIP �,A^ mayPHONE
I UNDERSTAND AND AGREE TO THE FOLLOWING:
I. 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 monoxid etectors are required to be installed in accordance with Sections R314 and R315 of
the 2013 California Residential CodAl
_
Signature of Applicant/Agent: Date: 2-0/s`
ReroofPolicy_2014.doc revised 01/15/14