B-2016-1326CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-1326
22555 SALEM AVE CUPERTINO, CA 95014-5648 (342 12 099)
( TRI - CITY ROOFING
INC)
FREMONT, CA 94538-
6395
OWNER'S NAME: SINGH INDERJEET AND KAUR MANVEEN
DATE ISSUED: 02/09/2016
OWNER'S PHONE:
PHONE NO:
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class Lic. #
Contractor ( TRI - CITY ROOFING INC) Date '
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:
RE -ROOF - REMOVE EXISTING ROOF, APPLY 1/2# OSB APPLY 30LB
I hereby affirm under penalty of perjury one of the following two declarations:
FELT UNDERLAYMENT, APPLY 34SQ CLASS A COMP SHINGLES
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.
z. 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: $14500.00
APPLICANT CERTIFICATION
1 certify that I have read this application and state that the above
APN Number:
Occupancy Type:
information is correct. I agree to comply with all city and county
ordinances and state laws relating to building construction, and hereby
342 12 099
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
granting of this permit. Additionally, the applicant understands and will
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
comply with all non -point source regulations per the Cupertino Municipal
180 DAYS FROM LAST CALLED INSPECTION.
Code, Section 9.18.
Issued by 1441
Signature Date
Date:
RE -ROOFS:
OWNER -BUILDER DECLARATION
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 ali new materials for
r. 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 offered
for sale (Sec.7044, Business & Professions Code)
Signature ofApplicant:
2. i, as owner of the property, am exclusively contracting with licensed
Date:
contractors to construct the project (See.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
a 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 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, Sections 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:
be deemed revoked.
Date'
APPLICANT CERTIFICATION
CONSTRUCTION LENDING AGENCY
1 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 thiscityLender'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
Signature Date
Professional
CUPERTINO
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 FAX (408) 777-3333 buildingempertino.oro
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❑ OWNER ❑ OWNRR-11JILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENOINEER ❑ DEVELOPER ❑ TENANT
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DESCRIPTION OF WORK:
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gy my signature below, I certify to each of the following: I am the property owner or outhorizcd agent to act on the property owner's behalf [ have read this
application and the information I have provided is correct. I have read the bcscliption of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating tobuilding construction. I authorize representatives of Cupertino to enter the abov -i lntified property for inspection purposes:
Signature of ApplicantlAgent Date: % J
SUPPLEMENTAL INFORMATION REQUIRED
If building is associated with a Home Owner's Association, provide letter
of ap 'zoVal from HOA_
Provide Planning approval to verify if there any restrictions.
Provide copy of Manufacturer's Installation Specifications.
Provide,Gigned copy of Cupertino's Tear -Off Policy.
O>rFrCE USE.OnY ....... ... .:. ......
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ReroofApp 20]1.doc revised 0311 +5/11
REROOF TEAR -OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B4O., BUILDING OFFICIAL
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 7774228 - FAX (408) 777-3333 - building0cupertino.org
PROJECT ADDRESS JKL
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APN #ZZ555
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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.
PIease 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;30-1.0;30arn 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 bailing 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 V4" 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 8314 and R315 of
the 2013 California Residential Code.
Signature of Applica!WAgent: Date:
ReroofP011ey_2014.doc revised 01115114
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Affidavit -Self Certification for C_-o=mpliance of
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Property _ /Permit Number:
Number ofbattery operated smoke detectors instaUed;
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Number ofcarbon monoxide detectors hlstale��d� -'
Smoke detectors shall beinstalled ineach sleeping room, and outside each separate sleeping area hmthe
immediate vicinity ofthe bedrooms, and oneach additional story mfthe dwelling, including basements
and habitable attics osrequired bvsection R314.G,ofthe 2O1OCalifornia Residential Code /CRQand
Section 907.2,1l'2,42O.4,ofthe 2O1OCalifornia Building Code (C&C) and the Health and Safety Code
Section 13113.7
For dwellings orsleeping units containing fuel burning appliances orhaving attached garages, carbon
monoxide detectors shall beinstalled outside each separate sleeping area}ntheimmrnediutev|dnitvof
the bedrooms, and on each additional story of the dwelling, including basements as required by Section
R315.3nfthe 2O1OCRC and Section 42O.4ofthe 2U1OCBC.
Multipurpose (combination carbon monoxide and smoke) alarms may beused. CRC R31B1and CBC
907.2.11.2
Ail alarms shall comply with requirements for listing and approval by the Office of the State Fire
Marshal.
As owner of the above -referenced propertv, I hereby certify that I have installed the smoke detectors
and carbon monoxide detectors in accordance with the California Residential Code, California Building
Code and California Health and Safety Code.
I declare under penalty of perjury that the
executed on (Date)-
owner's Name ( 'm):
Signature ofOwner:
I
hn8istrue and correct, and that this declaration was
The completed certification must be presented with permit to the building inspector priortVfina|sign-
off
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