15100141CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20875 VALLEY GREEN DR I CONTRACTOR: NEMMER ROOFING PERMIT NO: 15100141
OWNER'S NAME: KORET VC I LP 15348 AUDUBON PARK CT I DATE ISSUED: 10/19/2015
OWNER'S PHONE: 6505923960 1 FREMONT, CA 94538 1 PHONE NO: (510) 919-2930
JtF_ LICENSED CONTRACTOR'S DECLARATION
License Class0Lic. # % z1'9 3 d r
Contractor "Pler-;KJ N Date 5 — 3
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:
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
performance of the work for which this permit is issued.
P
ve and will maintain Worker's Compensation Insurance, as provided for by
ion 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 -point ce regulati er the Cupertino Municipal Code, Section 9.18.
Signatur Date A0 A��
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
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
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:
1. 1 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.
Signature
Date
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
REC ROOM - TEAR OFF (E) WOOD SHAKE, INSTALL (N)
OSB, 30 # FELT, CLASS A ROOF SYSTEM (28 SQ'S)
Sq. Ft Floor Area: I Valuation: $12907
APN Number: 32609064.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS- OF PERMIT ISSUANCE OR
180 DAYS F CALLED INSPECTION.
Date:
All roofs shall be inspected prior many roofing material being installed. If a roof is
installed without first obtaining an inspect n, I agree to remove all new materials for
inspection.
Signature of Applican Date:
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.
r autho ' nt:
Date: /0 ' /fr/ S
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
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
CUPERTINO I
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PROJECT ADDRESS .., O � � � % � .�� � i APN r
OVITTER NAME _Z
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STREET ADDRESS CIT ,STATE, ZIP FAX
CONTACT NAME E2- 1 C E-MAIL
STREET ADDRESS CITY, STATE, ZIP FAX
❑ OWAINER ❑ OWNER -BUILDER ❑ ON;WER AGENT ❑ CONTRACTOR ❑ coN TRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR 44EA LICENSE NUMBER LICENSE TYPE BUS. LIC. 9
COMPANY NAME, Q E-MAIL FAX
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STREET ADDRESS , CITY, STATE, ZIP PHON
ARCHITECT/ENGINIEER NAME LICENSE NUMBER BUS. LIC. R
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY, STATE, ZIP PHONE
USE OF ❑ SFD or Duplex pLmulti-Family ROOF AREA: VALUATION:
STRUCTURE: ❑ Commercial Z gooth / 0�sl!!q 0 --)
EXISTING ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES AWOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER (SPECIFY)
REMOVE /REPLACE AYES IF NO, PLYWOOD ❑ w, ❑ PLYWD O -OSB PITCH: ROOF
❑ TATO # LAYERS: THICKNESS: ❑ 5/8" TYPE: ❑ CDX � ' 12 CLASS: A
PROPOSED ROOF TYPE: ❑ BUILT-UP ROOF ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER ICC -ES REPORT 9
DESCRIPTION OF WORK: �
Cp , 7-z a-,rf
By my signature below, I certify to each of the following: I am the property oxNner or authorized agent to act on the property mmer'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 la,,vs relating to UefNing construction. I aL ri esentatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: Date: _ 315
SUPPLEMENTAL INFORMATION REQUIRED ,�..... OFFICE
If building is associated with a Home O-wrier's Association, provide letter PLAri'CHECKTYPE IiouTlNGsiIP = -
of a royal from HOA. 3t -� y
Pp OVER THE -COUNTER x C� BUILDINGI AN REVIE\V }
Provide Planning approval to verify if there an restrictions. 4
pp y ❑ EXPRESS r �-� PLANI�'II�G PLAi' REVIE\Y
Provide copy of Manufacturer's Installation Specifications. ❑ sT,>snARv = 731,
x ❑ FIRE DEPT s
x }
Provide signed copy of Cupertino's Tear -Off Policy. ❑, OTHERy a
ReroofApp_2011. doc revised 03/16/11
� ��, CITY OF CUPERTINO
IiN�//JI FEE ESTIMATOR -BUILDING DIVISION
FEE ID ROOF AREA
s.f.
1REROOFMRES 2,800
20875 VALLEY GREEN DR DATE: 10/19/2015
REVIEWED BY: MELISSA
JimADDRESS:
APN: 326 09 064 5P#:7
*VALUATION: 1$12,907
7PERMIT TYPE: Minor Building Permit
PLAN CHECK TYPE: Re -roof
PRIMARY Multi -Family Dwelling
USE:
Buildina is
>3 Stories ® Yes O No
PENTAMATION 1 R2ROOF
PERMIT TYPE: A
WORK
REC ROOM - TEAR OFF E WOOD SHAKE INSTALL N OSB 30 # FELT CLASS A ROOF
SCOPE
SYSTEM (28 SQ'S)
FEE ID ROOF AREA
s.f.
1REROOFMRES 2,800
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
nictriot_ oto_ )_ Thoco fooc aro ha.cod an the nreliminary information available and are onlv an estimates Contact the Dent for addh 7 info.
FEE ITEMS (Fee Resolution 11-053 Eff.' i%Z '13)
;tlech. flan Ckteck1'lrurrb.
Plan Check
I:lec. Pian Check
:Lfech. Perrtfit / .
� �ltA n13. 1'r:,`rrt
Fr -tee.Permir ICC
Other Alec°h. Ins i
Other Plumb Inv?
Other Elec. Insp.
Mech. Insp. Hee."
',Iffllb. hisp. Fee:
L;l<'r Insp. Fee.,
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
nictriot_ oto_ )_ Thoco fooc aro ha.cod an the nreliminary information available and are onlv an estimates Contact the Dent for addh 7 info.
FEE ITEMS (Fee Resolution 11-053 Eff.' i%Z '13)
FEE
QTY/FEE
MISC ITEMS
/Flan Cheek Pee:
Supl. P(::'Iee
F-1
i'hrnzt�. ���fech.'Flc�e�
Permit Fee:
$476.00
suppl. Insp Tee
Plumh./illleeh./Flee:.
Permit Feet':
(' Onsirti 'tion Tax:
.-ldminr`strcrtrve It'eex.°
Work Without Permit? Yes (F) No
$0.00
,1c/vonced Planning; Fees:
A
Prul,el Doeurnen1.,v,"o;,t ;'c,—
Strong Motion Fee: 1BSEISMICR
$1.68
Select an Administrative Item
Bldg, Stds Commission Fee: 1BCBSC
$1.00
SUBTOTALS:
$478.68
$0.00 TOTAL FEE:
$478.68
Revised: 10/01/2015
REROOF TEAR -OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(40$) 777-3228 - FAX (408) 777-3333 - buildinaQcupertino.orq
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PROJECT ADDRESS
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APN # % ,
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OWNER NAME
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PHONE Q
E-MAIL
STREET ADDRESS � �
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ITY, ESTATE, ZIP � � I
FAX
CONTRACTOR ME
LICENSE NUMBER
LICENSE TYPE
BUS. LIC. 9
COMPANY NA�`•iFy
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E-MAIL
FAX
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STREET ADDRESS
CITY, STATE, ZIP
PHOT\
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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 7:30-10:30am 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 monoxide tectors are re uired t installed in accordance with Sections R314 and R315 of
the 2013 California Residential Cod
Signature of Applicant/Agent: Date:
ReroofPolicy_2014.doc revised 01/15/14