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11840 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 11840 UPLAND WAY CONTRACTOR:PETERSEN-DEAN INC PERMIT NO: 15100184 OWNER'S NAME: YOW JOSE R AND PEI-PEI L TRUSTEE 7980 ENTERPRISE DR DATE ISSUED: 10/22/2015 OWNER'S PHONE: 4082577501 NEWARK,CA 94560 PHONE NO:(510)494-9982 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 0 COMMERCIAL 0 !Cc ^ TEAR OFF(E)WOOD SHAKE,INSTALL(N)OSB,30# License Class C Lic.# FELT,CLASS A COMP ROOF SYSTEM(31 SQ'S) Contractor?€Ten.%etJ be - Date Id JZ1.1 i`' 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:$14003 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:36603048.00 Occupancy Type: performance of the work for which this permit is issued. 2. I have and will maintain Worker's Compensation Insurance,as provided for by rc 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 DA • ' 1 M 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 „ter d C upon the above mentioned property for inspection purposes. (We)agree to s.- - Isamu d-Fad: �. 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. •I ditionally,the applicant understands and will comply with � RE-ROOFS: all non-poin •s % e ations per the Cupert. Municipal Code,Section 9.18. All roofs shall be ins cted prior to any roofing material being installed.If a roof is Signature l �� • , e Q(7,Z/( c installed without first obtaining an inspection,I agree to remove all new materials for / inspection. _/ic 0 1 ER-BUILDER DECLARATION Signature of Applicant: Date: Olt l 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. I,as owner of the property,am exclusively contracting with licensed contractors to California Health&Safety Code,Sections 25505,25533,and 25534. I 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 Health&Safety Code,Sections 25505,25533,and 25534. performance of the work for which this permit is issued. / 2. I have and will maintain Worker's Compensation Insurance,as provided for by �+© a thorized age / 721 /Section 3700 of the Labor Code,for the performance of the work for which this Date: r 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 for which this permit is issued(Sec.3097,Civ C.) become subject to the Worker's Compensation provisions of the Labor Code,I Lender's Name must forthwith comply with such provisions or this permit shall be deemed revoked. Lender's Address APPLICANT CERTIFICATION ARCHITECT'S DECLARATIO N 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 (408)777-3228 • FAX(408)777-3333 • buildina(a�cupertino.orq CUPERTINO /57o / Y %1 [PROJECTADDRESS l i% `a up t.A tot) t. r A �N �j _ a 3 `� OWNERNAME 3oS'� �0l C1,0%PHONE �"�.57� 7 ( 7ose/ow e&Mr4iL. tor\ STREETADDRESS (� CITY, STATE ZIP ZIP FAX CVP CONTACT NAl`4E • P ONE 0-1 A.V.AtiicAPPereit-ceyb4/4N.em I��Alls mila (S T d) 2J- Z C( STREET ADDRESS FAX - . 6cid Tod �-t1 iNe. Da- C2wA4Egz1Cidoiq c 6 o ❑ OWNER 0 OWNER-BUILDER 0 OWNER AGENT 0 CONTRACTOR CONTRACTOR AGENT 0 ARCHITECT 0 ENGLNiEER 0 DEVELOPER 0 TENANT CONTRACTOR NAME LICENSE NUMBER 4,C�1 1 7 LICENSE TY C . BUS.LIC.R l'4,so j l 1 ce�cg e NZ e / CO1-`N MA 1 S l v/vi' d �l MAIL ��I� 5.44 11 N•(OM FAX STREET ADDRESS t,Inwn fr I Q�l'f•• O PeCti 0'V 9•4-2.q 1 o 'x°110 ENrtRPRiSe Oa— cf 4Tit (4 "l > ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC.n COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF >:-S'FD or Duplex 0 Multi-Family ROOF AREA: VALUATION: STRUCTURE: 0 Commercial e 3I, SC) S V Ni IV 03 EXISTING ROOF TYPE: 0 BUILT-UP ROOF ❑ASPHALT SHINGLES 26-WOOD SHAKES ❑WOOD SI-LINGLES 0 OTHER(SPECIFY) REMOVE/REPLACE `�.I YES IF NO, PLYWOOD 0 ,A" 0 PL\WD 0 OSB PITCH: ROOF /❑ NO R LAYERS: THICKNESS: 0 5!8" TYPE: 0 CDX :12 CLASS: A PROPOSED ROOF TYPE: ❑BUILT-UP ROOF 0 ASPHALT SHINGLES 0 WOOD SHAKES 0 WOOD SHINGLES 0 OTHER ICC-ES REPORT R DESCRIPTION OF WORK: 3 t s( J A titb 1._ e A(tit o ( R E F t, 0 0 J SI-4`,K-e x3 b' ( IN-ICI-AIL iuG-- Coon i . 05-‘ .?O ,..--�6-7--- 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 build'ng construction. I authorize re resent`tives of Cupertino to enter the above-identified property for inspection purposes. Signature of Appl icant/Agent: i L Date: (O 22/( S ,gn SUPPLEMENTAL INFORMATION REQUIRED -• _ - ; OFFICE:USE OI. ,1 = If building is associated with a Home Owner's Association,provide letter PLAIQ C.H�CKTYPE ROUTING SLIP of approval from HOA. ❑ OVER THE-COUNTER Dk BUILDTG PLAN REW %' Provide Planning approval to verify if there any restrictions. ❑ \2 ERESS -G PLUNThG;PLANRE«Ew :, Yt x r i. r z T _ Provide copy of Manufacturer's Installation Specifications. O ADARn 5 CFLRDET4 - Provide signed copy of Cupertino's Tear-Off Policy. 0 OTHER l�.i L G' F _ t ReroofApp_2011.doc revised 03/16/11 CITY OF CUPERTINO FEE ESTIMATOR— BUILDING DIVISION ADDRESS: 11840 UPLAND WAY DATE: 10/22/2015 REVIEWED BY: MELISSA "-''r,. APN: 366 03 048 BP#: *VALUATION: $14,003 *PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof PRIMARY PENTAMATION USE: SFD or Duplex PERMIT TYPE: 1 SFDWLROO F WORK TEAR OFF (E) WOOD SHAKE, INSTALL (N) OSB, 30# FELT, CLASS A COMP ROOF SYSTEM SCOPE FEE ID ROOF AREA (s.f.) 1REROOFFRES 3,100 Mech. Plan Checki Plumb. Plan(:'heck Elec. Plan Check Lii u Mech. Permit Fee' Plumb.Permit Fee Elec.. Permit l'e Other-1lech. last. n )her Plumb lnsp. Other Elec.Insp. n ;:Vtech.Imp th. l.:,, lnsp.Hee. 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 preliminary information available and are only an estimate. Contact the Dept for addn'I info. FEE ITEMS (Fee Resolution 11-053 Eff 7/1/13) FEE QTY/FEE MISC ITEMS Plan Cheek Fee: Suppl. .PC Fee II 4 Plumb. 11lech./Elec Permit Fee: $5 ?6b Suppl. Insp Fee Plumb./Mech./Elee Plttnrb.i:Vlecb.iElcc Permit Construction Tax: Administrative Fee: Work Without Permit? 0 Yes 0 No $0.00 Advanced Planning Fees: Travel Docurnenlaiion Ices 4 Strong Motion Fee: IBSEISMICR $1.82 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 5-0Z. g 2 SUBTOTALS: $529.82 $0.00 TOTAL FEE: $529.82 Revised: 10/01/2015 1 . - REROOF TEAR-OFF POLICY COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION Stab? ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228 • FAX(408)777-3333• buildina(a�cupertino.ora PROJECT ADDRESS lrisLi 0 UP 1 n Ph APN# / / o O (43, OWNERNAME r,�`J e l,� o w PHONEC. or /25",-7c at ES'ate y0 w€61W;c.COwi J V STREET ADDRE$S�cc L r' "f vv 1 4 CITY, STATE(Z1P 41-` lJo 4 CA A g 0 1 FAX CONTRACT R Nll 1E V LICENSE NUM ER LICENSE TYPE BUS.LI �� AN`I s �,� u � � Clot � t COMPANY rev e c ) b e�1 N 41,4111-1 E-MAIL (AO Per r2SP F✓ A w l N. conk FAX STREET 1DRESS • CITY,STATE,ZIP ? 7o) r�RP�r S�2 �(� . Zttv c,q t i she qq,-lar 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 7:30-1.0:30am 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 monoxide detectors are required to be installed in accordance with Sections R314 and R315 of the 2013 California Residential Code- NA44v Signature of Applicant/Agent: Ii v Date: 1 111-1 � c ReroofPolicy_2014.doc revised 01/15/14