B-2016-1198CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-1198
938 MILLER AVE CUPERTINO, CA 95014-4641 (375 41 008)
( CALIFORNIA
RAINGUARD
INCORPORATED)
SAN JOSE, CA 95112
OWNER'S NAME:
DATE ISSUED: 01/15/2016
OWNER'S PHONE:
PHONE NO:
LICENSED CONTRACTOR'S DECLARATION ATION
BUILDING PERMIT INFO:
`
License Class Lic. #
Contractor ( CALIFORNIA RAINGUARD INCORPORATED ) Date 1
X BLDG —ELECT _PLUMB
MECH X RESIDENTIAL COMMERCIAL
I hereby affirm that I am licensed under the provisions of Chapter 9 (om encing
with Section 7000) of Division 3 of the Business & Professions Code and that my
license is in full force and effect.
JOB DESCRIPTION:
DUPLEX 938 - 940 - TEAR OFF (E) WOOD SHAKE, INSTALL (N)
I hereby affirm under penalty of perjury one of the following two declarations:
CLASS A COMP ROOF SYSTEM (30 SQ'S)
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.
I have and will maintain Worker's Compensation Insurance, as provided for
uW by Section 3700 of the Labor Code, for the performance of the work for which
Sq. Ft Floor Area:
Valuation: $10400.00
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
APN Number:
Occupancy Type:
ordinances and state laws relating to building construction, and hereby
375 41 008
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
PERMIT EXPIRES IF WORK IS NOT STARTED
expenses which may accrue against said City in consequence of the
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally, the applicant understands and will
comply with all non -point source regulations per the Cupertino Municipal
180 DAYS F LED INSPECTION.
Code, Section 9.18
Signature Date � �
Issue�1445 �
�S o
Date:
OWNER -BUILDER DECLARATION
RE -ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of the
All roofs shall be inspected prior to any roofing material being installed. If a roof is
following two reasons:
installed without first obtaining an inspection, I agree to remove all new materials for
1. I, as owner of the property, or my employees with wages as their sole
(_ inspection.
compensation, will do the work, and the structure is not intended or offeredJ`�
r
for sale (Sec.7044, Business & Professions Code)
Signature ofApplic /
2. I, as owner of the property, am exclusively contracting with licensed
Date:
contractors to construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COV RINGS TO BE CLASS "A" OR BETTER
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
HAZARDOUS MATERIALS DISCLOSURE
performance of the work for which this permit is*issued.
I have read the hazardous materials requirements under Chapter 6.95 of the .
2. 1 have and will maintain Worker's Compensation Insurance, as provided for
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
by Section 3700 of the Labor Code, for the performance of the work for which
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
this permit is issued.
Health & Safety Code, Section 25532(a) should I store or handle hazardous
3. I certify that in the performance of the work for which this permit is issued, I
material. Additionally, should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the
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
Worker's Compensation laws of California. If, after making this certificate of
the Health & Safety Code, Se 'ons 25505, 25533, and 25534.
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
Owner of autliorized agent: 'W'
be deemed revoked.
Dater / is i4
%
APPLICANT CERTIFICATION
((( CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is
I hereby affi m that there is a construction lending agency for the performance
correct. I agree to comply with all city and county ordinances and state laws
of work's for which this permit is issued (Sec. 3097, Civ C.)
relating to building construction, and hereby authorize representatives of this city
Lender's Name
to enter upon the above mentioned property for inspection purposes. (We) agree
to save indemnify and keep harmless the City of Cupertino against liabilities,
Lender's Address
judgments, costs, and expenses which may accrue against said City in
consequence of the granting of this permit. Additionally, the applicant
ARCHITECT'S DECLARATION
understands and will comply with all non -point source regulations per the
I understand my plans shall be used as public records.
Cupertino Municipal Code, Section 9.18.
Licensed
Professional
Signature Date
CUPERTINO
I MI
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 85014-3255
(408) 777-3228 • FAX (408)777-3333 - buildinuta` niyertino.orq
Zol6 - {ITB
PROJECT ADDRESS 3 b ^ q 4o APN # :�7 5 '//
-7 p2—
OWNER NAME ' 4 E!�/_ t J {)Y�� ��1� PHONE A at) lqj ` S"732-1
E-MAIL
STREET ADDRESS j q �Q p
CITY, STATE, ZIP( . S a I
FAX
CONTACT NAME `�=
PHONE
STREET .ADDRESS L J I T W S L
CITY, STATE, ZIPS 2g `
,❑G
FAh
❑ OwNFTt ❑ ON iWER-BLRLDER ❑ OWNER AGL-i7T L CONrR+ CTOR ❑ CONTRACTOR AGENT ARCIRITCT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
� ,y. G
__TCONTRAGTORNAMEf�
LICE•NSENUMBER g4��r�P'
LICENSE'IYPL _31
BUS. LIC. t1 /„ ��
COMPANY NAME
E-MAIL
FAX
STREET ADDRESSCITY. STATE, ZIP.
ARCIIITECT/ENGINEER NAME LICENSE NUMBER
PHO,q3(tV ca) 2-?q�11 6
BUS. LIC. I:
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF E SFD or)upleX ❑ Multi -Family
STRUCTURE: [3 Commercial
ROOF AREA,
31 D(o _54
VALUATION: }A�
4 (® *6 V
EXISTING ROOF TYPE: ' ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES Fl_W__0_0DSHAKESS ❑ WOOD SHINGLES ❑ OTHER (SPECIFY)
REMOVE (REPLACE
❑ NO
IF NO,
LAYERS:
.,,
PLYWOOD �' :4" ❑ J
THICKNESS: ❑ srs"
PLl \VD USO
TYPE: ❑ CDX
PITCFI:
:12
ROOF
CL1SS: A
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF tm ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER ICC -ES
DESCRIPTIO` OF WORK:
rev � (`tJ �✓V l ytf-w � . � tM �r v .
Q.
O 5 Q S
90
By my signature below, I certify to each of the following: I am the property o«mer or authorized agent to act on the property owner's behalf. I have read this
application and the information I have pro Led is correct. 1 have read the Description of Work and verity it is accurate. I agree to comply with all applicable local
ordinances and state laws relatingto gnsuatctiAtL.I�r presentatives of Cupertino to enter the above-identifi d property for inspection purposes.
Signature of Applicant/Agent: Date:
3UPPLEMEN,f'A h F RMATIO RREQUIRED
If building is associated with a home Owners Association, provide letter
of approval from 140A.t
_ Provide Planning approval to verify if there any restrictions. I
Provide copy of Manufacturer's Installation Specifications.
Provide signed copy of Cupertino's Tear -Off Policy.
OFFICE USE ONLY
4 L.AN CHECK TYPE
ROUTING SLIP
R -THF -COUNTER
❑ EXPRESS
❑ STANDARD
❑ BUILDING PLAN-REVIrW
❑ PLANNING PLAN REVIEW
❑ FIRE DEPT
❑ OTHER:
Ret-ogf_4pp_2011.doe revised 03/16111
CITY OF CUPERTINO'
RR_ 27 FEE ESTIMATOR - BUILDING DIVISION
lalADDRESS: 938 - 940 MILLER AVE
DATE: 01/1512016
REVIEWED BY:
MELISSA
APN: 375 41 008
BP#: B-2016-1198
*VALUATION:
1$10,400
PERMIT TYPE: Minor Building Permit
PLAN CHECK TYPE:
Re -roof
PRIMARY SFD or Duplex
USE:
Permit Fee:
PENTAMATION
PERMIT TYPE:
1 SFDWLROO
WORK
DUPLEX 938 - 940 - TEAR OFF E WOOD SHAKE INSTALL
N CLASS A COMP ROOF SYSTEM
SCOPE
(30 SQ'S)
%i:%och. Check
0ZheT
b:<' cll. 1 }.`.SIJ.
FEE ID ROOF AREA
(s.L)
1 REROOFFRES 3,000
Pi'vinb, Ala;,, f.tit'C.k_
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.). These_lees are based on the preliminary information available ana are only an estimate, contact the uept.jor aaan-t tnjo.
FEE ITEMS hee Resolution .11-053 .ff. 7,!1/.131
FEE
QTY/FEE
MISC ITEMS
Man (:laesclk,.Fee:
Permit Fee:
Ad;nirtiVro,iive Fee:
Work Without Permit? 0 Yes Q No
$0.00
D`LT`v`x''.'i£:?L ltil£i;?€r;'7t712.`€'v';S;
Strong Motion Fee: IBSEISMICR
$1.35
Select an Administrative Item
CIO Z. 3
B1d�4 Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$512.35
$0.00 FEE:
Revised: 01/01/2016
CUPERTINO
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�cupertino.orb 3- &616 Hq
PROJECT ADDRESS a 3 a 40 @' i'l (e✓ Avp- 00
OWNER NAME PHONF�` J
311-573 2� E-htAIt
STREETADDRESS J
{1
CITY, STATE ZIP
FAX
rr�
CON rRACTOI2 NAME C j ty-/ ��j �� ,�
1 ` ` j G
LICE SE NUMBER 143 1 Z�
LICENSE TYPE
BUS. LIC.
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS (/ -! (" g Ia '
CITY, STATE, ZIP P/,
PTIONE
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-
2:30pYn (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 (lion-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.peiformed.
6. A Final Inspection and apUroyal 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 1/a" 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 tArith Sections 8314 and R315 of
the 2013 California Residential Code _
Sianature of Apnlicant/Azent: �` Date:
2eroofPo1icJ- 2014.doc revised 01115114