15090174 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10502 RAMPART AVE CONTRACTOR:CUPERTINO ROOF,INC PERMIT NO: 15090174
OWNER'S NAME: OWYANG-LEE 1' [CfE1052 KELLY DR DATE ISSUED:09/28/2015
OWNER'S PHONE: 4087770927 SAN JOSE,CA 95129 PHONE NO:(408)973-9427
!4 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
REMOVE EXISTING COMP;INSTALL OSB;CLASS A COMP
License Class CC Lic.# S�p�'�. 7 ROOFING SYSTEM(24SQ)
Contractor Ci1npa�I.�'o IZWC% Date L -2.f- 'L-o/S
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: Sq.Ft Floor Area: Valuation:$10000
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 APN Number:36925009.00 Occupancy Type:
performance of the work for which this permit is issued.
2. 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. PERMIT EXPIRES IF WORK IS NOT STARTED
APPLICANT CERTIFICATION WITHIN 180 DAYS OF PERMIT ISSUANCE OR
I certify that I have read this application and state that the above information is 180 DAYS FROM LAST CALLED INSPECTION.
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 '�l
upon the above mentioned property for inspection purposes. (We)agree to save Issued by: Date:
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 RE-ROOFS:
all non-point so egulations per the Cupertino Municipal Code,Section 9.18. All roofs shall be inspected prior to any roofing material being installed.If a roof is
Signature Date ��,r— 1S installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
❑ OWNER-BUILDER DECLARATION Signature of Applicant: Q Date: / 2Y %
I hereby affirm that I am exempt from the Contractor's License Law for one of ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
the following two reasons:
1. 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 HAZARDOUS MATERIALS DISCLOSURE
sale(Sec.7044,Business&Professions Code) I have read the hazardous materials requirements under Chapter 6.95 of the
2. 1,as owner of the property,am exclusively contracting with licensed contractors to California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
construct the project(Sec.7044,Business&Professions Code). compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Safety Code,Section 25532(a)should I store or handle hazardous material.
I hereby affirm under penalty of perjury one of the following three declarations: Additionally,should I use equipment or devices which emit hazardous air
1. I have and will maintain a Certificate of Consent to self-insure for Worker's contaminants as defined by the Bay Area Air Quality Management District I will
Compensation,as provided for by Section 3700 of the Labor Code,for the maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
performance of the work for which this permit is issued. Health&Safety Code,Sections 25505,25533,and 25534.
2, I have and will maintain Worker's Compensation Insurance,as provided for by Owner or agent: p e
Section 3700 of the Labor Code,for the performance of the work for which this /- Date:6 L8'-oaf S
permit is issued.
3. I certify that in the performance of the work for which this permit is issued,I shall CONSTRUCTION LENDING AGENCY
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 I hereby affirm that there is a construction lending agency for the performance of work's
become subject to the Worker's Compensation provisions of the Labor Code,I for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
must forthwith comply with such provisions or this permit shall be deemed
revoked. Lender's Address
APPLICANT CERTIFICATION ARCHITECT'S DECLARATION
I certify that I have read this application and state that the above information is I understand my plans shall be used as public records.
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 Licensed Professional
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.
Signature Date
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE• CUPERTINO, CA 95014-3255
GUPERTINO
(408)777-3228 • FAX(408)777-3333• building(5�cupertino.orq
v j
PROJECT ADDRESS � k� ATN# /C I 7-! oO
OWNER NAME PHONE V E-MAIL
�oa1 u ���s 1�c �n(- 777-0917
STREET ADDRESS [� D CITY, TATE,7IP FAX
O J �z Y�K✓h .�� i^ �� G Ar- /5D I
CONTACT NAME PHONE908'— ,-(_ E-MAIL
STREET ADDRESS 10 �� //- �� CITY,S�� ZIP tc G.^ / /� FAX
OUTNER ❑ 0NVN'ER-BUTLDPR`G ❑ OWNER AGENT ❑ CONTRACTOR ❑C0117RACTORAGEN'T I,❑-f-ARCHITECT ❑ENGA'EER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME ^D Raa r'^ LICENSE NTUMBER r�� �5 LICENSE TYPE3 BUS.LIC.
0 S `[
COMPANY NAME (r E-MAIL FAX
OcY-�'s
STREET ADDRESS �� Z 1 t n CITY,STATE,ZIP ( n �D� -1 29 PHONE jD ` ��7� Qin 7
ARCHITECT/ENGINEER NAME tJ` LICENSENUMBER x BUS.LIC.
/ 14c
COMPANY NAME E-MAIL FAX
S'rREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑ SFD or Duplex .t—TT4ulti-Family ROOF AREA. VALUATION:
STRUCTURE: ❑ Commercial 2 / 60, 00
EXISTING ROOF TYPE: ❑BUILT-UP ROOF ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY)
REMOVE/REPLACE �'£S IF NO, PLYWOOD /," ❑ __ PLYIVD ❑,�/OSB PITCH: L-I ROOF
❑ No LAYERS: THICKNESS: ❑ 5/8" TYPE: E CDX / 12 CLASS:
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF -ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT
DESCRIPTION OF WORK:
�Movc.. z ,� GAS O� GwM�.�- Rao • ^ , n Sial l OS k�
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=' ruction, I authorize representatives of Cupertino to enter the above-identifiedproperty for inspection purposes.
Signature ofApplicant/Agent: �� Date:
SUPPLEMENTAL INFORI4ATION REQUIRED _FFICETJSEONLI = N.
_If building is associated With a Home Owner's Association;provide letter0��TYPERouTFNcsiFP r
of approval from HCA. = OVER THE-COIII�TER f $UII,DING PL.S-N'REVIEW
Provide Planning approval to verify if there any restrictions. Y
EVPRESS PL9IsT�L'�GPLA7TRE�IEW=
Provide copy of Manufacturer's Installation Specifications. ❑ S� Dy� 4 z >t> DEPT
Provide signed copy of Cupertino's Tear-Off Policy. OTHER
XeroofApp_2011.doc revised 03,116/11
CITY OF CUPERTINO
FEE ESTIMATOR— BUILDING DIVISION
ADDRESS: 10502 RAMPART AVE DATE: 09/28/2015 REVIEWED BY: PHUONG
APN: 369-25-009 BP#: *VALUATION: j$10,000
*PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY PENTAMATION
USE: SFD or Duplex PERMIT TYPE: 1SFDWLR00
WORK REMOVE EXISTING COMP INSTALL OSBa CLASS A COMP ROOFING SYSTEM 24SQ
SCOPE
FEE ID ROOF AREA
s.f.
1 REROOFFRES 2,400
.14ech.Plan Check :'trmh. Plan Check New Check
Mech, Permit Plumb. Perlub Istec. Permit Fee:
other.,,Ucch.Irisp. ",_her Plumb Insp. Li Other Elec. Insp.
ce:
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 onlv an estimate. Contact the Dept for addn'I info,
FEE ITEMS (Fee Resolution /1-053 E . 7/I/13Z FEE QTY/FEE MISC ITEMS
Platt (.;heck I'ee:
Supr/. PC Fee
Plrtmh"_Wech
Permit Fee: $408.00
Si,g)jd. lnrsp 1`c
Plzatnb.;'1lec°lz.:'1Iec°
Plumb,IWech./Elec Permit Fee:
Construction Tax:
A(Iministrcxtivc Fee:
Work Without Permit? 0 Yes (F) No $0.00
.Advctnced.Planizin�x Fees:
Travel.Documernadon Pees:
Strong Motion Fee: IBSEISMICR $1.30 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $410.30 $0.00 TOTAL FEE: 1 $410.30
Revised: 07/02/2015
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• buildino a()cupertino.org
f i
PROJECT ADDRESS J R" !� PN#
-3 roA OO
OWNERNAME PHONE E-MAIL
plod'-72Z—Dai �
STREET ADDRESS j ��b Z �S CIT41.4 Au,4-
Y�STATE,ZIP��� ��
CONTRACTOR fzNAME// rDD�,^ LICENSFAIUt�E�j� LICENSETGF BUS.LIC.0
21�
COMPANY NAME/+ (�' �E-MAM FAX
STREET ADDRESS ID ILt/(/C iCITY,STATE,ZIP_5, QS PHONE, ,(J. v r`7� Jq,27
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 7:3040:30am 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
sinoke detectors and carbon monoxide detectors are required to be installed in accordance with Sections R314 and R315 of
the 2013 California Residential Code. QS_
Signature of Applicant/Agent: Date: L '� �' 10l
ReroojT of icy_2014.doc revised 01/15/19
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