15100154CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22420 ST ANDREWS AVE CONTRACTOR: JE JOHNSON ROOFING PERMIT NO: 15100154
INC
OWNER'S NAME: PAN HONG JUN AND XIA WEI 13347 HICKERSON DR 1 DATE ISSUED: 10/20/2015 1
OWNER'S PHONE: 4086216760 1 SAN JOSE, CA 95127 1 PHONE NO: (408) 876-9630 1
.00" LICENSED CONTRACTOR'S DECLARATION
License Class 7 Lic. #
O _ o
Contractor L' i ate
I herebyaffirm that I am licensed under thprovisions of Chapter 9
P P
(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:
i. I have and will maintain a certificate of consent to self -insure for Worker's
Compen n, as provided for by Section 3700 of the Labor Code, for the
Vve�of the work for which this permit is issued.
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.
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 Pis permit. Additionally, the applicant understands and will comply with
all non-poiq source regulations per ie Cupertino Municipal Code, Section 9.18.
Signatur & a o U21 -11r Date 10 —,ZQ --/f
❑ � J OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
t. 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. 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.
Signature
Date
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
REMOVE (E) WOODSHAKE ROOF; INSTALL (N) OSB; (N)
ROOF LANDMARK PRO CERTAINTEED ROOFING CLASS A
(22SQ)
Sq. Ft Floor Area: I Valuation: $8000
APN Number: 35603005.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS EIOM LAST CALLED INSPECTION.
Issued by:
Date: I 0 I qc)
/ /,�—
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: Date: Id/ 10-5
ALL RODF 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.
ora orized ent•
o�Q �i '` Date: p
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
r
CUPERTINO
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333 - building E( cupertino.orq
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PROJECT ADDRESS
APN # .-
OWNER NAME s 0, P n
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E-MAIL
STREET ADDRESS
CITY, STATE, ZIP
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CONTACT NAME� � � O
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E-MAIL
STREET DRESS A
CITY. STATE, ZIP
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FAX
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❑ 01AI NTER ❑ OWNER -BUILDER ❑ OWNTER AGENT & CONTRACTOR ❑ CONI-RACTOR AGENrr ❑ ARCHITECT ❑ ENGLN7EER ❑ DEVELOPER ❑ TENAI"r
CONTRACTOR NAME
LICENSE NUMBER
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LICENTSE TYPEC?BUS.
LIC. "
COMPANY NAME 0 1 E-MAIL
FAX
STREET ADDRESS CITY, STATE, ZIP
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PHONE �-
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ARCHITECT/ENGINEER NAME
LICENSE NUTABER
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BUS. LIC. R
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COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ SFD or Duplex ulti-Family
ROOF AREA:
VALUATION:
❑ Commercial
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STRUCTURE:
It
EXISTING ROOF TYPE: ❑ BUILT-L'P ROOF ❑ ASPHALT SHINGLES lJ'DJOOD SHAKES
EW OOD SHINGLES ❑ OTHER (SPECIFY)
REMOVE /REPLACE ❑ YES
IF NO,
PLYWOOD,/ ❑
PLYWD e0SB
PITCH:
ROOF
❑ NO
n LAYERS:
THICKNESS: 0 5/8"
TYPE: ❑ CDX
' 12
CLASS: A
PROPOSED ROOF TYPE: ❑ BUILT-UP ROOF ASPHALT SHINGLES ❑ WOOD SHAKES
❑ WOOD SHINGLES ❑ OTHER
ICC -ES REPOR u
DESCRIPTION OF WORK:
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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 rel atin to building constr ion. I au rite represen tives of Cupertino to enter the above -identified prope�r+ty for inspection purposes.
Signature `
Date:
ofApplicant/Agent:
SUPPLEI\JAL II�'FOR1vIATION REQUIRED
_
_ - „>, . OFFICE USE ONLI
z,PLAA'CHECKTI'PE i
ROUTING.SLIP
If building is associatith a Home 0��'ner's Association; provide letter
OVER THE COUNTER =
BUILDL'�G PLAN REVIE
of approval from HOA.
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Provide Planning approval to verify if there any restrictions.EGRESS$
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❑ PLANI�TL'1G PLA1� RE�'iEPV
Provide copy of Manufacturer's Installation Specifications.
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DEPT
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Provide signed copy of Cupertino's Tear -Off Policy.
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ReroofApp_2011.doc revised 03/16/11
CITY OF CUPERTINO
I�f�l FEE ESTIMATOR —BUILDING DIVISION
FEE ID ROOF AREA
s.f.
1 REROOFFRES 2,200
22420 St Andrews Ave DATE: 10/20/2015
REVIEWED BY: Phuong
JimADDRESS:
APN: 356-03-005 BP#:
*VALUATION: 1$8,000
PERMIT TYPE: Minor Building Permit
PLAN CHECK TYPE: Re -roof
PRIMARY SFD or Duplex
lzer Elec. Ins).
PENTAMATION 1 SFDWLROO
USE:
lin-, Fee:
PERMIT TYPE:
WORK
Remove a woodshake roof; Install N OSB' N roof Landmark Pro Certainteed roofing Class A
SCOPE
(22SQ)
FEE ID ROOF AREA
s.f.
1 REROOFFRES 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 preliminary information available and are only an estimate Contact the Dept for addn 7 info.
FEE ITEMS (Fee Resolution 11-053 E ..' 7%1/131
Alech. Piart t I I
I i t}ir',`�. 1 .
L% I lai. '.
tlech. PerrinI Fee:
Plumb, Permit Fee:
I lec. Pt zzit f
`")then Uech. Ins).
Vier Plumb Irup.
lzer Elec. Ins).
',z,t . FPc
? 3. Tec';
lin-, Fee:
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 7 info.
FEE ITEMS (Fee Resolution 11-053 E ..' 7%1/131
FEE
QTY/FEE7-
MISC ITEMS
Plan C.'/tc �, , .
Svppl. P(" Fee
Plum b.111ech.; `. , lee
Permit Fee:
$374.00
ar x�l. MsP Fee
Phan b. lillleeh. /Elee
I'la�nab. l'�1E�ch.%Elec Per mil F'ee:
t.'onstr action Kiv:
Administr ative Fee:
Work Without Permit? O Yes 0 No
$0.00
id lrlC'j-?d PIunnink;' Fees:
'A
Strong Motion Fee: 1BSEISMICR
$1.04
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
$1.00
SUBTOTALS:
$376.04
$0.00 TOTAL FEE:
$376.04
Revised: 10/01/2015
CUPERTINO
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
(408) 777-3228 - FAX (408) 777-3333 - buildina5cupertino.org
PROJECT ADDRESS
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OWNER TAMEO
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PHONE ( (fin
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E-MAIL
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STREET ADDRESSJ
CITY, STAT , ZIP
FAX
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CONTP.ACTOR NAME
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LICENSE NUMBER
LICENSE TYPE
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COMPANY NAME
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STREET ADDRES �
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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 (1NIon-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-roofpolicy 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. n 1 F
Signature of Applicant/Agent: � �� Date: �� `a 0 --1 5
�. ReroofPolicy_2014.doc revised 01/1.5/14