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B-2016-1406CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-1406 20150 APPLE TREE LN CUPERTINO, CA 95014-2002 (316 33 078) ( JOHN INDUSTRIES INC) MARINA, CA 93933 OWNER'S NAME: KURTZ FRED N AND DONNAL TRUSTEE DATE ISSUED: 02/22/2016 OWNER'S PHONE: 408-446-5554 PHONE NO: 408-625-1180 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C-39 Lia. #550915 Contractor ( JOHN INDUSTRIES INCA Date 02/22/2016 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) WOOD SHAKE & INSTALL (N) OSB, 30# FELT, CLASS I hereby affirm under penalty of perjury one of the following two declarations: A COMP ROOF SYSTEM (25 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 j performance of the work for which this permit is issued. 1, 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 this permit is issued. Sq. Ft Floor Area: Valuation: $12250.00 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 APN Number: Occupancy Type: ordinances and state laws relating to building construction, and hereby 316 33 078 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 CALLEDINSPECTION. Code, Sectio .18. Issued by: SAN Signature/ ►ofl' '1 "", Date 02/22/2016 Date: 02/22/2016 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. 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 inspection. for sale (Sec.7044, Business & Professions Code) Signature ofApplicant�� z. I, as owner of the property, am exclusively contracting with licensed Date: 02/22/2016 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 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 C pertiio Municipal Code, Chapter 9.12 and Worker's Compensation laws of California, If, after making this certificate of the Health & Safety Co ections 25505, 25533, and 255,4. exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such or this shall vA Ong r%%jL/_ provisions permit Owner or authorized agent. 6 be deemed revoked. Date: 0212 2/2 01 6 APPLICANT CERTIFICATION CONSTRUCTION LENDI AGE 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 (See. 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 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 02/22/2016 REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(�Dcupertino.org ( — Zv 16 r R L 0S PROJECT ADDRESS ��I I ! APN # *3 6 OWNERNAME bLe-djC A A ` PHONE gy e P� j p E-MAIL STREET ADDRESS ` ® a� Z4jlCONTACT CITY,CI . j 8 �L� / FAX NAME Q hrl V f / HONE y ��� 7® j Q 5 E-M1AIL { f / / ( STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR I-] CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR N A 6 'a y A �� d�j� ��D� LICENSE NUMBER.5; o LICF,�§sT BUS. LIC. # 15- (� //^�� COMPANY N /� O ,// _ E-MAIL FAX X ,0e „w a � J STREET ADDRES� � CITY, STATE, ZIP � � � PH � : �Yl � � � � � ARCHITECT/BNGINEEER-NAME LICENSE NUMBER - BUS. LIC. # COMPANYNAME _ E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF SFD or Duplex ❑ Multi -Family ROOF AREA: VAL ❑ Commercial /ON: o STRUCTURE: EXISTING ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES 00D SHAKES ❑ WOOD SHINGLES ❑OTHER (SPECIFY) REMOVE /REPLACE WYES IFNO, PLYWOOD ❑❑ PLYWD SB PITCH: ROOF ❑ NO # LAYERS: THICKNESS: �''/:" 9-5/8" TYPE: 11 Cox —,/' 12 CLASS: A PROPOSED ROOF TYPE: ❑ BUILT-UP ROOF ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER ICC -ES REPORT # DESCRIPTION OF WORK: L By my signature below, I certify to ach f 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 ave ovided is correct. I hav ad e Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relati to b ilding construction. th epresentatives of Cupertino to enter the above-ide 'feed pr perry for inspection purposes. �`vvL Date: �� Signature of Applicant/Agent: SUPPLEMENTAL INFORMATIO QUIRED' , h_ Qc>Isorly a" t1 If building is associated with a Home Owner's Association, provide letter p ` i o x Tai co�N LlurlvrNPLAItS IPR: of approval from HOA. Provide Planning approval to verify if there any restrictions. ❑VLjxf>zss ©P��Lv�Nlrc' REyIEw _ Provide copy of Manufacturer's Installation Specifications. [_] ST1A�n� ❑ D� Provide signed copy of Cupertino's Tear -Off Policy. ?iced , � �, i ReroofApp_2011.doc revised 03/16/11 RE -ROOF 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 - buiiding(c)cupertino.org 26 f -6 / c f [)-.0 PROJECT AD1 S 1 `j © (/ > � ' Z� APN OWNERNAME / �r PHONE E-MAIL STREETAjD'� SS (� q l�Kf� ,�Z• CIT�T T IP FAX CO CT MIS, _ LICENSE NUMBEY�-o 15 LICE iFE BUS. LIC. # COWAN/ft- E-MAIL FAX STREET ADD A41CITY, ATF /y /�j y�� P O 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 o, the following is true: I am the property owner or authorized agent to act on the property owner's behalf. I unders and agree to comply with the re -roof policy stated above. I also understand that smoke detectors and carbon mo xi detectors are r d to be installed in accordance with Sections R314 and R315 of the 2013 California Residenti Co Signature of Applicant/Agent: �'��G Date: ReroofPo1icy_2014.doc revised 01/15/14