B-2016-1387CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-1387
11921 PLACER SPRING CT CUPERTINO, CA 95014-5103 (366 55 010)
(JIREH INC)
LOS GATOS, CA 95031
OWNER'SNAME: WILLIS LING LU TRUSTEE
DATE ISSUED: 02/17/2016
OWNER'S PHONE: 4088888812
PHONE NO: 4082989399
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class C39 Lic. #DDD707
Contractor ( JIREH INC ) Date 2/17/2016
X BLDG —:ELECT —PLUMB
MECH X RESIDENTIAL COMMERCIAL
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.
JOB DESCRIPTION:
REMOVE (E) SHAKE ROOF AND INSTALL (N) LIFETIME COMP
I hereby affirm under penalty of perjury one of the following two declarations:
ASPHALT SHINGLES (NO NEW PLYWOOD) - 28 SQ'S
i. 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
Sq. Ft Floor Area:
Valuation; $8239.00
this permit is issued.
APPLICANT CERTIFICATION
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
366 55 010
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
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 FROM LAST CALLED INSPECTION.
Code, Section 9.18.
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Issued. by: PAUL O SULLNAN
Signaturez:�4 Date 2/17/2016
Date: 2/17/2016
OWN R -B II D R 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
installed without first obtaining an inspection, I agree to remove all new materials for
following two reasons:
ection.
i. 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
f
for sale (Sec.7044, Business & Professions Code)
Signature of Applicant:
2. I, as owner of the property, am exclusively contracting with licensed
Date: 2/17/2016
contractors to construct the project (Sec.7044, Business & Professions Code).
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
I hereby affirm under penalty of perjury one of the following three declarations:
i. I have and will maintain a Certificate of Consent to self -insure for Worker's
Compensation, as provided for by Section 3700 ofthe 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
Health & Safety Code, Section 25532(a) should I store or handle hazardous
this permit is issued.
material. Additionally, should I use equipment or devices which emit hazardous
s. i certify that in the performance of the work for which this permit is issued, I
air, contaminants as defined by the Bay Area Air Quality Management District I
shall not employ any person in any manner so as to become subject to the
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 agentU.�/�
be deemed revoked.
Date: 2/17/2016
APPLICANT CERTIFICATION
certify that I have read this application and state that the above information is
CONSTRUCTION LENDING AGENCY
I hereby affirm_that there is a construction lending agency for the performance
C.)
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
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
Lender's Address
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments, costs, and expenses which may accrue against said City in
ARCHITECT'S DECLARATION
consequence of the granting of this permit. Additionally, the applicant
I understand my plans shall be used as public records.
understands and will comply with all non -point source regulations per the
Cupertino Municipal Code, Section 9.18.
Licensed
Professional
Signature Date 2/17/2016
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-32551
(408) 777-3228 • FAX (408) 777-3333 • building aQcupertino.org
PROJECT ADDRESS f�
APN# j
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OWNERNAME
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PHO
E-MAIL
STREET ADDRESS L3Pam
CITY, TAT
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FAX
CONTACT NAM
PHO, n ,�
E-MAIL
STREET ADDRESS
CITY, STATE, ZIP
FAX
El OWNER ❑. OWNER -BUILDER El AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER 11 DEVELOPER ❑ TENANT
El OWNER ED OWNFR-BUILDER El OWNER AGENT V 1
CONTRACTOR NAME
LIC SENUMBER
LIC SE:..
BUS. LIC. #
COMPANY NAMEE
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STREET - D D S
CITY, STA ZIP
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ARCHITECT/ENGINEERNAME
LICENSE NUMBER
BUS. LIC. #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE .
SFD or Duplex [I Multi -Family
ROOF AREA:
vALUATI
USE of
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STRUCTURE: ❑- Commercial
f ¢J.�®c-`
EXISTING ROOF TYPE: ❑ BUILT-UP ROOF ASPHALT SHINGLES ❑ WOOD SHAKES
❑ WOOD SHINGLES 13 OTHER (SPECIFY)
REMOV® P ySCE ❑YES
t
IFNO,
PLYWOOD ❑ Y" El;W0
PLYWD ❑ OSB
PITCH:
:��qc
ROOF
3 ONO
# LAYERS:
THICKNESS:. ❑. 5/8"
TYPE* ❑ CDX
CLASS:AC-ES
PROPOSED ROOF TYPE: ❑ BUILT-UP ROOF ASPHALTSHINGLES ❑ WOOD SHAKES.
❑ WOOD SHINGLES ❑.OTHER
REPORT #
DESCRIPTION OF WORK:
4
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 ehalf. I have read this
and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to c ply with all applicable local
application
ordinances and state laws relating to bui din struct' $. I authorizer sentatives of Cupertino to enter the above -identified erty`f r inspection purposes.
Date:
Signature of Applicant/Agent:
o cE uss oNi t Int
SUPPLEMENTAL INFORMATION REQUIRED
c_ _
N If building is associated with a Home Owner's Association,rovide letter
P
r rz A7�CHECK3YPE Rot1TINGSL7P
T
from HOA.!
%w•��n
OVER TH1aryTERs. M L BIIII,DINGPL'°ANREVIEW��x ��-�
COU1`r
of approval
Provide Planning approval to verify if there any restrictions.
�rnExRREss' Pr ANNnvG�LAvREv1Ew ,
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Provide copy of Manufacturer's Installation Specifications.
�TANDARD ❑nEP% t
_
Tear Policy.
; ®oTi�R 406�1
Provide signed copy of Cupertino's -Off
ReroofApp 2011.doc revised 03/16/11
0
REROOF TEAR -OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT BUILDING. DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL'
CUP15ItTlN 10300 TORRE AVENUE CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 - buiidingg-cupertino.org
PROJECT ADDRESS
APN #
e
OWNER NAME
PHONE EI- -ES-2
E MAIL
STREET S
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CITY TATE, ZIP
FAX
Cel- 14 s
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CONTRACTOR NAME 1
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LICENS SW25R_2
LIC ' SE TYPE
BUS. LIC. # /�
CO NAME
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E-MAIL OS I Y! C
FAX fltJ / Ey
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STRE _ AI11SS
CITY TATE,
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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: 7:30-10:30`am 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 %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 detector are required to e installed in accordance with Sections 14 d R315 of
the 2013 California Residentialo j
Sianature of Auulicant/Aaent: %�C/%,//� Date:1
ReroofPolicy_2014.doc revised 01/15/14
Fm CITY OF CUPERTINO ���� ®��
FFF ESTIMATOR — RIIII.11INC I11Vrcrnly
ADDRESS: 11921 PLACER SPRINGS CT W, -_
DATE: 02/17/2016
REVIEWED BY. PAUL
APN: 366 55 010
BP#:
*VALUATIONS 1$8,239 —�
PERMIT TYPE: Minor Building Permit
PLAN CHECK TYPE: Re -roof
PRIMARY SFD or Du lexT
USE: P
PENTAMATION
PERMIT TYPE: 1 SFDWLROOF
WORK
REMOVE E SHAKE ROOF AND INSTALL N LIFETIME COMP ASPHALT SHINGLES NO NEW
SCOPE
PLYWOOD) - 28 SQ'S
FEE ID ROOF AREA
1REROOFFRES 2,800
I Week Plan art t:'€ T' . mh, P Check / ec, .1' a zt ;
tr%Z%F"'
0z U;, -V eyf-.
,fet./I X`fX ht:. 't. -c.. X�z%t.}3103, fr2Sz I'c'e'. £ 4',, r£...cj 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 prelimina in ormation availahle and are onjV an estimate. Contact the Dept for addn7 info.
FEE ITEMS (Fee Resolution 1.1-053 Lf' 7.1113)
FEE
QTY/FEE
IVIISC ITEMS
Plan CIw Fe e:
Permit Fee:
$476.00
tt ,.
z
t
i�Llff3'tt ..,:i .r..s.Zx,L%It'i'PI?If'I`i''i'.'
DO <Z.i.
_T
A 4
Work Without Permit? C) Yes (j)No
$0.00
Advanced 1,'IwlPbw ,Ftee,s"
Strong Motion Fee: IBSEISMICR
$1.07
Select an Administrative Item
Bldg Stds Commission Feer IBCBSC
$1.00
IlBT(3TALS
$478.07
$0.00 TtQTAL FEE:
$478.07
Revised: 10/01 /2015
01