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15090181CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10889 N DE ANZA BLVD CONTRACTOR: PLATINUM ROOFING INC PERMIT NO: 15090181 OWNER'S NAME: FORGE-VIDOVICH MOTEL LIMITED P 1900 DOBBIN DR DATE ISSUED: 09/28/2015 OWNER'S PHONE: 6502093232 SAN JOSE, CA 95133 PHONE NO: (408)280-5028 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ CUPERTINO INN - 1 BLDG - TEAR OFF (E) CAP SHEET, G q -� Cr 0' Z INSTALL (N) 60 MIL, TPO ROOFING SYSTEM OVER 1/4" License Class Lic. # l DENSDECK (CLASS A) (213 SQ'S) r� ' o/ Contractor I r M Date q `" I hereby affirm that I am licensed and he provisions of Chapter 9 (commencing with Section 7000) of ivision 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: $147281 i. 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 p ormance of the work for which this permit is issued. APN Number: 32610058.00 Occupancy Type: have 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 ermit 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 correct. I agree to comply with all city and county ordinances and state laws relating 180 D YS FROM LAST CALLED INSP CT ON. to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save �/� �J� �� �� (' Issued by: JIJv 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 underst ds and will comply with all non -point source regulations per the Cupertino rpal Code, Section 9.18. RE -ROOFS: �i j All roofs shall be inspected prior to any roofing material being installed. If a roof is Signature Date S installed without first obtaining an inspection, I agree to remove all ew materials for inspection. q spy J Signature of Applicant: ❑ OWN DER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of ALL ROOF COVE 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) 2. I, as owner of the property, am exclusively contracting with licensed contractors to I have read the hazardous materials requirements under Chapter 6.95 of the construct the project (Sec.7044, Business & Professions Code). California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & I hereby affirm under penalty of perjury one of the following three declarations: Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air i. 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 MuniciVAPPOde, Chapter 9.12 and the performance of the work for which this permit is issued. Health & Safety Code, Sections 25505, 255 nd 25534. 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 Owner or authori�r permit is issued. Date: 9 3. 1 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 NSTRUCTION LENDING AGENCY 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.) must forthwith comply with such provisions or this permit shall be deemed Lender's Name revoked. Lender's Address APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is ARCHITECT'S DECLARATION correct. I agree to comply with all city and county ordinances and state laws relating I understand my plans shall be used as public records. to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save Licensed Professional 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 is COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CVPERTINQ (408) 777-3228 • FAX (408) 777-3333 • building(a)cupertino.org PROTECT ADDRESS ' Y AP Io to19 7 G APN # -3 Z_ � - / C) - 0 J� Q C/ L� O ER NA E '► " ��-►,E PRONE X9.3 23 Z E-MAIL STREET ADDRESS 7c),,J 1 i E ! `f CITY, STATE, ZIP c.o �0 5 c A. `l 4O 2--Z- ZCONTACT FAX CONTACTNAMEn PHONE E- IL 10617 REST ADDRCS %P '� _ `� CITY, STATE, ZIP C FA��, r 10,f 0, / ❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT ❑ CONTRACTOR Jt1CONTRACrOR AGENT ❑ ARCHnTcr ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONT/R�ACTORINAME NUMBER 'No / • G� LICENSEE TYPE BUS. LIC. # ! ZCt)LICENSE / PANY NAME L I F^ -MAIL E- t i/ E %,'L4!F cv FAX STR ET ADDRE S / ItCy 11Z133 1 �. CITY, ST TE, ZIP ,� ©c �� s! 3 3 PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC. # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ElSFD or Duplex ❑ Multi -Family ROOF AREA: VALUATION: Commercial A i /fiZT►��i�~% $ -2-1300 J0 d'O j 1�� �q STRUCTURE: 1 EXISTING ROOF TYPE: BUILT-UP ROOF ❑ ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER (SPECIFY) REMOVE /REPLACE YES IF NO, PLYWOOD ❑ Y" ❑ PLYWD ❑OSB PITCH: ' 12 �7�� ROOF ❑ NO #LAYERS: THICKNESS: ❑ 5/S" TYPE: ❑ CDX ' CLASS: H 60^1 PROPOSED ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES MOTHER V 0 J� I 1 ICC -ES REPORT # (0 n�q DESCRIPTION OF WORK: � _T Pe) , C t 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 Cu c above -identified property for inspection purposes. Signature of Applicant/Agent: Date: I / SUPPLEMENTAL INFORMATI QUIRED OFFICE USE ONLY PLAN CHECK TYPE ROUTING SLIP _ If building is associated with a Hos Association, provide letter ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW of approval from HOA. Provide Planning approval to verify if there any restrictions. ❑ EXPRESS ❑ PLANNING PLAN REVIEW Provide copy of Manufacturer's Installation Specifications. A ❑ FIRE DEPT Provide signed copy of Cupertino's Tear -Off Policy. ❑ OTHER: Cd ReroofApp_2011. doc revised 03116/11 Mil CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION FEE ID ROOF AREA s.f. 1REROOFCOM 21,300 ADDRESS: 10889 N DE ANZA BLVD DATE: 09/28/2015 REVIEWED BY: MELISSA :Rech. Permit Fee- APN: 32610 058 BP#: *VALUATION: 1$147,281 *PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re -roof PRIMARY USE: Commercial Building Plumb./,ilfech.;Flet: PENTAMATION PERMIT TYPE: 1COMMLR00 i WORK CUPERTINO INN - 1 BLDG - TEAR OFF E CAP SHEET INSTALL N 60 MIL TPO ROOFING SCOPE SYSTEM OVER 1/4" DENSDECK (CLASS A) (213 SQ'S) FEE ID ROOF AREA s.f. 1REROOFCOM 21,300 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 vreliminary information available and are onlv an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff' 7,%1:"13) Meth. flan Check Numb. Plant Check Elec..Pian (.'heck :Rech. Permit Fee- Plumb. Permit Fee: Islet. Permit Fee: Mier Mech. Insp Plumb Insp. )rlaerElec. Insp.El Plumb./,ilfech.;Flet: 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 vreliminary information available and are onlv an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff' 7,%1:"13) FEE QTY/FEE MISC ITEMS Plan Check Fee: .Suppl..PC Fee Plumb./,ilfech.;Flet: Permit Fee: $1,647.00 .Suppl. Insp Fee PlumbAkfech./Ele, Phnnib./Alleeh./Elec Permit Fee: Construction Tax: Administrative Fee: Work Without Permit? 0 Yes 0 No $0.00 Advanced Planning Fees: � Travel Documentation Fees: Strong Motion Fee: IBSEISMICO $41.24 Select an Administrative Item Bldg, Stds Commission Fee: IBCBSC $6.00 SUBTOTALS: $1,694.24 $0.00 TOTAL FEE: $1,694.24 Revised: 07/02/2015 REROOF TEAR -OFF POLICY COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL CUPERTINO 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 •FAX (408) 777-3333 • buildinatcr�cuper6no.or-a /,�5 e PROIECTADDRESS ICJ�10(;qG� ` 10. / C 1� / J�• ^/ APN# % r //J (/ (/J OWNER NAME Z ►� s PHONE 6 -2_0C? E-MAIL` S'fg,?DDR S" 514.)/e/rTo110 7crIc CW , STATE, ZIP 14/f/G�Z FAX CONTRACTOR NAME '� LICENSE NUMBER nO/ 1 BUS. LIC.# , 3,LICENSE COMPANY NAME _ � �F'IL�N N E9-01'�E3 .- *?Wi FAX ST ET ADDRESS t' 7G + IA )JZ . CI Y, STATE, ZIP r. ni . rr C A 5/ P OY I UNDERSTAND AND AGREE TO THE FOLLOWING: 1. The re -roof project shall comply with all applicable provisions of the 2007 California Building Code. 2. You must schedule all needed inspections a minimum of one day before the requested inspection date. Please schedule inspections online or call (408)777-3228 between 7:30-3:30 (Mon -Fri). 3. Tear -off roof inspection is required. Please call for tear -off inspection after the roof is torn off and all the nails/fasteners have been removed. Any and all dry -rotted wood shall be replaced prior to this inspection. A building inspector will be available within one hour. There are special hours for this service: 7:30 — 10:30am and 1:00 — 3:30pm (Mon — Thurs); 7:30 — 10:30am and 1:00 — 2:30pm (Friday). 4. If plywood is installed, a plywood nailing inspection is required. 5. In-Proeress roof inspection is required. Call for an in -progress roof inspection to verify building is weather tight after installation of approximately 25% of the roofing material. 6. New roof coverings shall not be applied without first obtaining all inspections 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. 7. A final inspection and approval shall be obtained from the building inspector when the re -roofing is complete. To receive a final sign -off, the following items will be verified: a. Flat roofs shall have a minimum of 114" per foot of slope and must 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. 8. 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 of $126.00. 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 a re comply with there-rnnf rnt;nv Crated above. Signature of Applicant/Agent: / /' Date: ReroofPo1icy_2010.doc revised 05/17/10 Patricia Garcia From: Alex Lau [alau@platinumroofinginc.com] Sent: Tuesday, December 01, 2015 8:54 AM To: Patricia Garcia Cc: 'Maria Ortiz'; 'Sam Ruiz' Subject: 10889 N De Anza Blvd Hi Pat - Per our conversation this morning Tuesday Dec. 1st 8:40am I need to void / delete this permit # 15090181 for Cupertino Inn located at 10889 N De Anza Blvd. in Cupertino CA. Unfortunately there is a duplicate and we only need 1 permit. Also I believe there will be full refund for permit # 15090181 in couple of weeks paid to Platinum Roofing Inc. Thanks for your help and please don't hesitate to call me if you have any concerns. Alex Lau Platinum Roofing Inc. Roof ing,Waterproofing & Energy Main office: (408) 280-5028 Cell: (408) 502-1307 alauC@platinumroofineinc.com www.platinumroofinginc.com W"N't- � #A PLATINUM A'',70e44 i9C1`4i3fl'