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15090108I CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 21381 MILFORD DR I CONTRACTOR: CUPERTINO ROOF, INC I PERMIT NO: 15090108 OWNER'S NAME: BIRKHOLZ JACK L AND JANET A TR 11052 KELLY DR I DATE ISSUED: 09/17/2015 OWNER'S PHONE: 4082577721 1 SAN JOSE, CA 95129 1 PHONE NO: (408)973-9427 An LICENSED CONTRACTOR'S DECLARATION License Class C 3 1 Lic. # S- 6sq- � Contractor -c L) < l r�� eel:] Date —1 -1 '- I hereby affirm that I am licensed under tlie 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: 1. 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 of the work for which this permit is issued. ve and will maintain Worker's Compensation Insurance, as provided for by Se on 3700 of the Labor Code, for the performance of the work for which this permit is issued. 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, 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-omt rce regulatio s er the Cupertino Municipal Code, Section 9.18. Signature Date ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1. 1, 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) 2. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: t. 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. 2. 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 permit is issued. 3. 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 become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. 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, 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 the Cupertino Municipal Code, Section 9.18. SignaturC Date JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ REMOVE (E) SHAKE ROOF AND INSTALL (N) OSB PLYWOOD AND (N) LIFETIME COMP. ASPHALT SHINGLES - 22 SQ'S Sq. Ft Floor Area: I Valuation: $15000 APN Number: 32641103.00 1 Occupancy Type. PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSP C N. / Q 5 Issued by: NdDate: > 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. ^� Signature of Applicant: I )CU a— Date: q—)-7 — � ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. agent: Date: CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional REROOF PERMIT APPLICATION ly156qo COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPERTINO (408) 777-3228 • FAX (408) 777-3333 • building(8cupertino.org PROJECT ADDRESS\MI ` Y n APN #U11 *110-3 0Y,NER NAME J A C PHONE , {° D% ^.LE ,� 7T C� MAIL E-MAIL "�` STREET ADDRESS / 4 I \ 1 ii CITY, STATE, ZIP � FAX v CONTACT NAME PHONE n �Q E-MAIL STREET ADDRESS 0 CITY, STA ZIP FAX LJx�ta'r-1❑C( a ❑ OWNER 13OWNER-BUILDER❑ OWNER\ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TEN,11 CONTRACTORNAME Q ; v n LICENSE NUMBER �r-y r J �7 LICENSE TYPE � BUS. LiC. X COMPANY NAME ' \ E-MAIL FAX STREET ADDRESS I V 1 r C ' ` J CITY, STATE, ZIP PHONE ARCHITECT/ENGINEERNAME 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: I STRUCTURE: ❑ Commercial EXISTING ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ ITHER (SPECIFY) REMOVE/REPLAZI�QYES IF NO, PLYWOOD ❑ /," ❑ PLYWD OSB PITCH:L ❑ NO T LAYERS THICKNESS: ❑ 5/B" TYPE: ❑ CDX qR:OOF LASS: A �, PROPOSED ROOF TYPE: ❑BUILT-UPROOF �6iASPHALTSHINGLES ❑WOODSHAKES ❑ WOOD SHINGLES ❑ OTHER C -ES REPORT 9 DESCRIPTION OF WORK: +,�, Qf D p �Q +I Vh� �ol� Gt+ • ` v "1 \y -, A 75) Y `� C 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 th to ormation rovided 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 relati to bui g c struction. I authorize representatives of Cupertino to enter the above -identified property for in ection purposes. Signature of Applicant/Agent: Date: . SUPPLY AL INFORMATION REQUIRED :��''.. ` .= oFt✓�. _ ;; sEOJ.tiz. _ If building is associated with a Home Owner's Association, provide letter g.;, 4 (`1T� of approval from HOA. « THE<- OUNTEIi Provide Planning approval to verify ifthere any restrictions. INE ZPR> ss`1' 3 — N Provide copy of Manufacturer's Installation Specifications. tsr� ar - Provide signed copy of Cupertino's Tear -Off Policy. ReroofApp_2011.doc revised 03/16/11 CITY OF CUPERTINO F�FEE ESTIMATOR — BUILDING DIVISION FEE ID ROOF AREA s. f. 1REROOFFRES 2,200 ADDRESS: 21381 Milford Dr. DATE: 09/17/2015 REVIEWED BY: PAUL A -tech. Permit Fee: APN: 326 41 103 BP#: *VALUATION: 1$15,000 °PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re -roof PRIMARY SFD or Duplex USE: !nmb. Insp. Fr, PENTAMATION 1SFDWLR00F PERMIT TYPE: WORK Remove E shake roof and Install N OSB plywood and N lifetime comp. asphalt shingles - 22 S 's SCOPE Suppl. Znsp Fee FEE ID ROOF AREA s. f. 1REROOFFRES 2,200 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 preliminar information available and are only an estimate. Contact the Dept for addn7 info. FEE ITEMS (Fee Resolution / 1-053 Eff. 7/1/13) Ile& Plan Check ixrrtb. Plan Check Elec. Plan Check A -tech. Permit Fee: Phrmb, Permit F, Elec. Permit Fee: Other ;idech .lrtsp. I _urn tu.,F+Ej I ,, /j,,, jr', - !nmb. Insp. Fr, 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 preliminar information available and are only an estimate. Contact the Dept for addn7 info. FEE ITEMS (Fee Resolution / 1-053 Eff. 7/1/13) FEE QTY/FEE MISC ITEMS Plan Checkl,ee: SuPpl. PC tree Plumb. kfech.!F,lec Permit Fee: $374.00 Suppl. Znsp Fee Plumb./Mech.iElec Plumb.iMech./Elec Permit Fee: (7onstruction Tax: AdminWrative Fee: Work Without Permit? © Yes (F) No $0.00 Advanced Planning Fees: Travel Documenlation Fees. Stronjz Motion Fee: IBSEISMICR $1.95 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $376.951 $0.00 TOTAL FEE: $376.95 Revised: 07/02/2015 REROOF TEAR -OFF POLICY 15040105 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 - buildingQcupertino.org PROSECT ADDRESS I 2 M� �Q I APN tim I I -Q-41 III n OWNER NAME L I /.�� r 1% 1/ d o l PHONE O I a t.S 0R.7w J J� `�Q E-MAIL ✓(J CITY, STATE, ZIP I STREET ADDRESS Z l I FAX CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE-, -, BUS. LIC. COMPANY NAME E-N4.AIL. FAX STREET ADDRESSz1 F PH01VZ_ �91 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-roofmg 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 behal 7 erstand and agre comply with the re -roof policy stated above. I also understand that smoke detectors an carbon monoxide detectors are r quired to be installed in accordance with Sections R314 and R315 of the 2013 California esidential Cod&. Signature of Applicant/Aaent: Date: C)— 1 I - ReroojPolicy_2014.doc revised 01115/14