B-2016-1259 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1259
10394 GLENVIEW AVE CUPERTINO,CA 95014-4511(3 69 1102 1) (QUALITY ROOFING
CO)
GILROY,CA 95020
OWNER'S NAME: DENESHA RICHARD J TRUSTEE DATE ISSUED:01/26/2016
OWNER'S PHONE:408-761-1185 PHONE NO:408-461-0474
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-39 Lic.#922868
Contractor(QUALITY ROOFING CO)Date 01/26/2016 X BLDG _ELECT _PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing MECH X RESIDENTIAL_COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
tear off(e)layer comp&install 30#felt,(n)class a comp roof(no ply)(26
I hereby affirm under penalty of perjury one of the following two declarations: sq's)
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.
L 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. Sq.Ft Floor Area: Valuation:$8600.00
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 69 Number: Occupancy Type:
3
ordinances and state laws relating to building construction,and hereby 369 11 021
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 FRO CALLED INSPECTION.
Code,Section 9.18.
Issued b .
Signatur14Date 01/26/2016 Date:01/2 2016
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. 1,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 offered r1
for sale(Sec.7044,Business&Professions Code) Signature of ApplicatZY.' —
2. 1,as owner of the property,am exclusively contracting with licensed Date:01/26/2016
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 COVERINGS 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. I 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 became subject to the air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cu�p�ertino Municipal Code,Chapter 9.12 and
Worker's Compensation laws of California. If,after making this certificate of the Health&Safety CotgS'"ections 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 or authorized agent Craif�
be deemed revoked. Date: 01/26/2016
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is I hereby affirm 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 01/26/2016
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPIER71NO
(408)777-3228• FAX(408)777-3333• building(a�cupertino.org
PROJECT ADDRESS16 � a� L ( ,L V\ `C 6u w APN# C� / 1 l r z-L
OWNER NAME PHO // E-MAILl
�IZ�• mss - Kd876 - jtaS
STREET ADDRESSCITY, STATE,ZIP FAX
.,
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CONTACT NAME y� n I n PHONEL1 E-MAIL
STREET ADDRES CITY, TA E, ZIP b FAX
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❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR � I LICENSE NUMBER LICENSE TYPE BUS.LIC.#
C'
COMPANY\.f C\,\,`� `,1tie E-MAIL FAX
STREET ADDRESSCIT SATE,ZIP PHONE
ARCHITECT/ENGINEERNAME LICENSE NUMBER BUS.LIC.#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑ SFD or Duplex 2�Multi-Family ROOF AREA: VALUATION:
STRUCTURE: ❑ Commercial C;L G 6Q d ^
EXISTING ROOF TYPE: ❑BUILT-UP ROOF ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑'OTHER(SPECIFY)
REMOVE/REPLACE OYES IF NO, PLYWOOD ❑ %" NG PLYWD ❑ OSB PITCH: ROOF
t:❑ NO #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#
DESCRIPTION OF WORK:
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 C �relating\\ �. lS��to building constructio `I authori a representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: ,J t✓ `L Date: ` -b
SUPPLEMENTAL INFORMATION REQUIRED o%FicEii`s`E,o1VLY ,,,,. _ ,� „=� _
r
If building is associated with a Home Owner's Association,provide letter PLAN cIIECK;TYPE a >: RouTINc SLIP
Of approval from HOA. OVER THE COUNTER ❑ BUILDING PLAN REVIEW h
Provide Planning approval to verify if there any restrictions. N �k
— ppEXPRESS � ❑ PLANNINGTLANREVIEW6, ,
Provide copy of Manufacturer's Installation Specifications.
V-1 sTAriDaRD ❑ >IRE nPT a
Provide signed copy of Cupertino's Tear-Off Policy. OTHER
rr
ReroofApp_2011.doc revised 03/16/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 10394 Glenview Way DATE: 01/26/2016 REVIEWED BY: MELISSA
APN: 369 11 021 BP#: 'EVALUATION: 1$8,600
`PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY PENTAMATION
USE: SFD or Duplex PERMIT TYPE: 1SFDWLR00 A
WORK tear off a layer comp & install 30#felt n class a comp roof no I 26 s 's
SCOPE
FEE ID -ROOF AREA
s.f.)
1REROOFFRES 2,600
?��£'.{;17. i��-'.�I.'i'.•�'.:::1;': /'...71?f;. 17;'ii Check
r-
iAE'.G'Yt lj;'i'rw;h d'i"'e. r.'rniff.`{;r.': fsii'.C'.1'Z:t`.«p>z'
�.)Lf?e'z`�✓�e'�`�..Ril:'Fi �)ii"?i,'.".�'�iflilti 13'r'.±r°"+ 1;:178?`P'.ie':.. t`i:`�I.
Uecb. 141'Slo. 1`11't'. .t'3/!#trd) .bw[.'. j,"ec. .lr.'t.. 1f'v;. Fee:
NOTE. This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,Sc/tool
District,etc. . These.fees are based on the preliminar information available and are only an estimate. Contact the De t or addn'1 in o.
FEE ITEMS (Fee Resolution 11-053 E f. 7/1/13) FEE QTY/FEE MISC ITEMS
Plan
Permit Fee: $442.00
Work Without Permit? 0 Yes (E) No $0.00
Stron,g Motion Fee: IBSEISMICR $1.12 Select an Administrative Item
BldgStds Commission Fee: IBCBSC $1.00
SUBTOTALS:.; $444.12 $0.00 . . TOTAL FEE:; $444.12
Revised: 01/01/2016
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
CUP:I_RTICN0
(408)777-3228•FAX(408)777-3333-buildingacupertino.org
PROJECT ADDRESS / \ APN#
b � b CSU\2�+.1 W
OWNERNAME �`L �� PHONE (7�) � 6 _� �� E-MAIL
STREET ADDRESS ` CITY, STATE,ZIP (J FAX
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC.#
0 t,3C- 1 6 (, 68 C-3
COMPANY NAME �\ E-MAIL FAX
t
STREET ADD ES Qw �V CITY,STATE,KP o ��^ v "a PHONE
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 un 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 Residentia Code. ,(
Signature of Applicant/Agent: Date: 1
ReroofPolicy_2014.doc revised 01/15/14