B-2016-1418 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1420
19041 BARNHART AVE CUPERTINO,CA 95014-3501(375 09 035) (SHELTON ROOFING
CO INC)
MOUNTAIN VIEW,CA
94043
OWNER'S NAME: HENDERSON RENEE DATE ISSUED:02/23/2016
OWNER'S PHONE:808-410-1355 PHONE NO:650-961-7699
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-39 Lia#261091
Contractor(�SHELTON ROOFING CO INC)Date 2/23/2016 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 OLD TAR AND GRAVEL,REPLACE DRY ROT,INSTALL
I hereby affirm under penalty of perjury one of the following two declarations: (N)PLYWOOD(1900 SQ)
t. 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
by Section 3700 of the Labor Code,for the performance of the work for which
S�• this permit is issued. Sq.Ft F1oor.Area: Valuation:$12185.00
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above APN
information is correct.I agree to comply with all city and county 7509 035
Number: Occupancy Type:
3
ordinances and state laws relating to building construction,and hereby 375
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.
c Issued by:ABBY AYENDE
Signatur Date 2/23/2016 Date:2/23/2016 ;
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
inspection.
1. 1,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
for sale(Sec.7044,Business&Professions Code) Signature ofApplicant:
z. 1,as owner of the property,am exclusively contracting with licensed Date:2/23/2016
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:
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
z I have and wilt 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.
a. 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 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 shallOwner or authorized agent is lef f
be deemed revolted. C Date:2/23/2016
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 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 2/23/2016
F
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION IMEW
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERT[Nf0 (408)777-3228•FAX(408)777-3333•build ingacupertino.org
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PROJECT ADDRESS �10/ 7( Q Q(A, 0[.)5
OVrN'ERNA EPHON O[� Y/l'° I.I S� E-MAIL
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STREET ADDRESS - CITY,STATE,ZIP
CONTACT NAME PHONE E-MAIL
STREET ADDRESS CITY,STATE,ZIP FAX
❑ owi\Ta ❑ OWNER-BUILDER ❑O\VNERAGENT ❑ CONTRACTOR ❑CONTRACTORAGENT ❑ ARCHITECT El ENGINEER ❑ DEVELOPER ❑TENANT
CONrRACTORNAME LICENSENUMBER / `� LICENSETYPE �—�
COMPANY NAME f E-MAIL E� / FAX p(
STREET ADDRESSCITY STATE,ZIP s" PHONE
ARCHITECT/ENGINEERNAME LICENSE NUMBER I BUS.LIC:R
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑ SFD or Duplex 9-fAniti-Family ROOF AREA: VALUATION:
STRUCTURE: ❑ Commercial.' 12oo —
EXISTING ROOF TYPE: 2-BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY)
REMOVE/REPLACE ❑YES IFNO, PLYWOOD 11w, 11PLYWD El OSB PITCH: ROOF
❑NO I „LAYERS: THICKNESS: ❑ 5/8" TI'PE: ❑CDX :12 CLASS: A
PROPOSED ROOF TYPE: �UILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT m
DESCRIPTION OF WORK: /p /®
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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 relatingto ding construction. I authorize representatives of Cupertino to enter the above-id ntified property for inspection purposes.
SignatureofApplicant/Agent: 4. Date: /5X 3 ��
SUPPLEMENTAL INFOR.4ATION REQUIRED k "
If building is associated with a Home Owner's Association,provide letter � PLAt`CHECK�YPE � �ROUTING SLS
of approval from HOA. r g
Pp ._• o��R Ta>;-CouNT1+rR�� L7 �tllLvn.��.�Ai,.xEv;��v �
_Provide Planning approval to verify if there any restrictions.
_Provide copy of Manufacturer's Installation Specifications. fl E FrRFD$P � K
Provide signed copy of Cupertino's Tear-Off Policy fiF oTxER� r
ReroofApp 2011.docrevised03116111
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
C'UPERTTHO
(408)777-3228• FAX(408)777-3333•building(a,cupertino.orq
PROJECT ADDRESS /9 Ll 4
YL 14 I APN
OWNERNAME / ,, PHONE ro l� E—MAIL
��.vS'P�YI Y
STREET ADDRESS CITY,STATE,ZIP ( FAX
CONTRSCTORNAME '
LICE NSFNUMBER ct LICENSE TYPE BUS.LIC.9
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP a PHO I�TF
Q e r-h S Ou V a lir�0 �To) f ?e
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: 7:30-10:3Oam 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 Residential Coded 2
Signature of Applicant/Agent: Date:
ReroofPol cy_2014.doc revised 01115/14