15120040VA
Ai
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 11258 TERRA BELLA DR
CONTRACTOR: NEIGHBORS ROOFING PERMIT NO: 15120040
AND GUTTERS
OWNER'S NAME: LI ERIC C AND SU -LI SUSAN C
200 FORD RD STE 236 DATE ISSUED: 12/07/2015
OOVVN,ER'S PHONE: 4088914261
SAN JOSE, CA 95138 PHONE NO: (408) 472-3869
LQ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL
TEAR OFF (E) WOOD SHAKE, INSTALL (N) OSB, 30#
License Class K. , 9 Lic.*#�b6 �5-6Q
FELT, CLASS A ROOF SYSTEM (32 SQ'S)
Contractor�1%��S 64oTr�A Dahl Z
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:
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
erformance of the work for which this permit is issued.
Sq. Ft Floor Area:
Valuation: $17040
ave 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
APN Number: 35621004.00
Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
PERMIT EXPIRES IF NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating
WITHIN 18 OF PE ISSUANCE OR
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
18 S FROM LLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence oft
Issued Date:
granting of this permit. Additionally, the applicant understands and will ply
with all non -point source regulations per the Cupertino Municipal Code, Section
-ROOFS:
9.18.
_ ���
Signature `�— Date
All roofs shall be inspec or 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.
❑ OWNER -BUILDER DECLARATION
Signature of Applicant: Date:.d4f"z
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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)
I, as owner of the property, am exclusively contracting with licensed contractors to
HAZARDOUS MATERIALS DISCLOSURE
construct the project (Sec.7044, Business & Professions Code).
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
I hereby affirm under penalty of perjury one of the following three
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
declarations:
Health & Safety Code, Section 25532(a) should I store or handle hazardous
I have and will maintain a Certificate of Consent to self -insure for Worker's
material. Additionally, should I use equipment or devices which emit hazardous
Compensation, as provided for by Section 3700 of the Labor Code, for the
air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued.
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sections 25505, 25533, and 25534.`
Section 3700 of the Labor Code, for the performance of the work for which this
�� e— ` Z
Owner or authorized agent: �n'-�� Da
permit is issued.
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
CONSTRUCTION LENDING AGENCY
Compensation laws of California. If after malting this certificate of exemption, I
become subject to the Worker's Compensation provisions of the Labor Code, I must
I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked.
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
APPLICANT CERTIFICATION
Lender's Address
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
ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
I understand my plans shall be used as public records.
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
Licensed Professional
9.18.
Signature Date
�cytlyss
RER®®F PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(a)cupertino.org
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PROJECT ADDRESS /]
APN #
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❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME j
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LICENSE NUMBER
LICEZt TYPE
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LICENSE NUMBER
BUS. LIC. #
COMPANY NAME
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STREET ADDRESS
CITY, STATE, ZIP
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USE OF >91SFD or Duplex 4n Multi -Family
ROOF AREA:
VALUATION:
STRUCTURE: ❑ Commercial
S
OO
EXISTING ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES
C�1*001) SHAKES ❑ WOOD SHINGLES ❑ OTHER (SPECIFY)
REMOVE /REPLACE DYES
IF NO,
PLYWOOD
E %w, ❑
PLYWD iI—OSB
PITCH:
ROOF
❑ NO
# LAYERS:
THICKNESS:
El 5/8,,
TYPE: 11CDX
12
CLASS: A
PROPOSED ROOF TYPE: ❑ BUILT-UP ROOF .ice ASPHALT SHINGLES
❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER
ICC -ES REPORT #
DESCRIPTION OF WORK: � L
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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 relating to building construction. I authorize
representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Ageig=__-_;
Date: j Z
SUPPLEMENTAL INFORMATION REQUIRED
oICE
usE oNiY
P CHECK!TYPE
ROUTINGSLIP
If building is associated with a Home Owner's Association,
provide letter
VER
❑ BUILDING PLAN REVIEW
_
Of approval from HOA.
THI<COUNTER
,
Provide Planning approval to verify if there any restrictions.
❑ EXPxREss
❑ PLANNING PLAN REVIEwt
Provide copy of Manufacturer's Installation Specifications.
D sTANnARD
❑, FIRE WEPT >i L
_ Provide signed copy of Cupertino's Tear -Off Policy.
—t
❑ OTHER e ,
ReroofApp_2011.doe revised 03/16/11
CITY OF CUPERTINO
WE FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 11258 TERRA BELLA DR
FEE
DATE: 12/07/2015
REVIEWED BY: MELISSA
APN: 356 21 004
BP#:
*VALUATION: 1$17,040
*PERMIT TYPE: Minor Building Permit
PLAN CHECK TYPE: Re -roof
PRIMARY SFD or Duplex
USE:
PENTAMATION 1SFDWLR00F
PERMIT TYPE: 'A
WORK
TEAR OFF (E) WOOD SHAKE, INSTALL
(N) OSB, 30# FELT, CLASS A ROOF SYSTEM (32 S 'S)
SCOPE
ller,;V;;,,
lap.
1-1
P?e,
1_hec, Non I
NOTE. This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.). Theselees are basest on the preliminary information available anti are only an estimate. Contact tneueptjor aaan't injo
FEE ITEMS (Fee Resolution 11-053 Eff.71111Y
FEE
QTY/FEE
MISC ITEMS
F -F
Permit Fee:
$p .00
onsiplaclion 7 tx:
T
Work Without Permit? 0 Yes (j) No
$0.00
A
Doclimentation P'eLS:
Strong Motion Fee: IBSEISMICR
$2.22
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUB'OTALS:
$1
1347.22
$0.+ TOTAL FEE.
0
Revised: 10/01/2015
REROOF TEAR -OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
'10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333 - building(cDcupertino.org
PROJECT ADDRESS I I i
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APN #
OWNER NAME,&rilGLi
PHONFJ' J QZ 6/
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EMAIL
STREET ADDRESS 2
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CITY, STATE, ZIP
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FAX
CONTRACTOR NAME At, I/
LICENSENUMBFy$_, f
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LICENSE TYP
BUS. LIC.#
COMPANY NAME �' j1 J �iG
E-MAIL L `_ '
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STREET ADDRESS4WL
CITY, WEE.P
PHO 161
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 detectors are required to be installed in accordance with Sections R314 and R315 of
the 2013 California Residential Code. 2
Signature of Applicant/Agent: Date:
RerooJPo1icy_2014.doc revised 01/15/14