B-2016-1431 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR; PERMIT NO:B-2016-1431
10550 S DE ANZA BLVD CUPERTINO,CA 95014(369 38 002) (KUHLMAN ROOFING
CO INC)
FREEDOM,CA 95019
OWNER'S NAME: GERA NICHOLAS TRUSTEE&ET AL DATE ISSUED:02/25/2016
OWNER'S PHONE; PHONE NO:831-724-6293
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class S-39 Lie.#809467
Contractor(KUHLMAN ROOFING CO INC)Date 02/25/2016 X BLDG _ELECT PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing _MECH_RESIDENTIAL X COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
Remove existing shake roofing and install one layer of 15#felt
I hereby affirm under penalty of perjury one of the following two declarations: underlayment,new flashing,and install composition roofing(2500 sq ft).
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
kj by Section 3700 of the Labor Code,for the performance of the work for which
this permit is issued. Sq.Ft Floor Area: Valuation:$10000.00
APPLICANT,CERTIFICATION
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 369 38 002
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..
g Z/ Issued by:Sean Hatch
Signature Date 02/25/2016
Date;02/25/2016
OWNER-BUH,DER 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 inspection.
compensation,will do the work,and the structure is not intended or offered
i
for sale(Sec.7044,Business&Professions Code) Signature of Applicant; (/
2. I,as owner of the property,am exclusively contracting with licensed Date:02/25/2016
contractors to construct the project(Sec.7044,Business&Professions Code).
I hereby affirmunder penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
i. 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 HAZARDOUS MATERIALS DISCLOSURE
performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95of 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 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,Sec' ns 25505,25533,an 5534.
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:02/25/2016
APPLICANT NT RTIFI ATION 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, tender'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 02/25/2016 Professional
i
REROP PERMIT APPLICATION —,
COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION
10300 TORRE AVENUE»CUPERTINO, CA 95094-3255
CtJ> lE t t' C (408)777-3228 FAX(408)777-3333•building0-cupertino.org
PROJECT ADDRESS APN#
OWNER NAME P E-MATL
STREET ADD 5SZ ks f 21 ZI CITY, STAT ® T;A;
CONTACT NAME / PHONE E-MAIL
STREET ADDRESS CITY,STATE,ZIP FAX
❑OWNER ❑ OWNER-BUILDER ❑.OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ M
CONTRACTOR NAME V � LICENSE NUMBER �y f jLICENSEPE BUS.LIC.# e�
COMPANY NAME =n ff?!s B t B(® E-MAIL 61�/f I �d,�ago
Il F ( j"
STREET ADDRESS �J t CT � PHONE P
ARCHITECT/ENGINEER NAME ® LICENSE NUMBER BUS.LIC.# (�
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE„ZIP PHONE
USE OF ' ,AFD or Duplex ❑ Multi-Family ROOF AREA: _ VALUATION:
STRUCTURE: X Commercial Z$0 P Ff r, 14 Q140<60
EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES SKOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY)
REMOVE/REPLACE '0 YES IF NO, PLYWOOD ❑ '/:" ❑ PLYWD ❑ OSB PITCH: ROOF
❑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:
,_69C A11577A MOP 6 S W51 L fes# �G
MAI Sfi'/IV�?6CS
By my signature below,I certify to each of 1ho 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 relating tgob, iMin construction. I authorize resentatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date: ' l
SUPPLEMENTAL INFORMATION RE D 0IFFICE QSE oNL'Y
_If building is associated with a Home Owner's Association,provide letter PIAN.C1-tEMTWF I:ouTmrr sz IP
of approval from HOA. 6VE T' caVW(!F z BUIELDI r rr,Aty Wvll w>.
,.
Provide Planning approval to verify if there any restrictions. tEvu-
L
Provide copy of Manufacturer's Installation Specifications. �` TA15nan []; ix> n�Pr
Provide signed copy of Cupertino's Tear-Off Policy. Q QT=R;
ReroofApp_2011.doc revised 03/16/11
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION.
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
CU ERTINO 10300 TORRE AVENUE.CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333 building(c)cupertino.org
PROJECT ADDRESSAPN#
OWNER NAME PHONE E-MATL
STREET ADDRESS CITY, STATE,ZIP FAX
CONTRACTOR NAME tt CENSE NUMBER LICENSE TYPE BUS.LIC.#
2
COMPANY NAME .1f
� , MAILa FAx �..
STREET ADDRESS ( CITY,STATE,ZIP Ir v(f� k p�j') l PH NE x
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 Dour 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 1/4"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 R f
the 2013 California Residential C
Signature of Applicant/Agent: % / Date:
ReroofFolicy_2014.doc revised 01113/14