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B-2016-1526 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1526 21979 SAN FERNANDO AVE CUPERTINO,CA 95014(357 10 008) OWNER/BUILDER 21979 SAN FERNANDO OWNER'S NAME: CITY OF CUPERTINO DATE ISSUED:03/15/2016 OWNER'S PHONE: PHONE NO:408-460-1821 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class Lie.# Contractor OWNER/BUILDER Date 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: REROOF CAFE AND PUMP ROOM WITH ASPHALT I hereby affirm under penalty of perjury one of the following two declarations: SHINGLES(41 SQ) "BLACKBERRY FARM" 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 this permit is issued. Sq.Ft Floor Area: Valuation:$21000.00 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 ordinances APN Number: Occupancy Type: and state laws relating to building construction,and hereby authorize 357 10 008 A(Tenant Improvements) 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 expenses which PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature` / / ter/ ` Date -311514; Issued by:PHUONG DEVRIES Date: OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is 1. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for compensation,will do the work,and the structure is not intended or offered for inspection. sale(Scc.7044,Business&Professions Code) 2. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant: contractors to construct the project(Sec.7044,Business&Professions Code). Date: 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 performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE 2. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code,for the performance of the work for which this California Health,&Safety Code,Sections 25505,25533,and 25534. I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the 3. 1 certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store or handle hazardous 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 Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health'&Safety Code,Sections 25505,25533,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent—'A", APPLICANT CERTIFICATION Date: I certify that I have read this application and state that the above information is ON T TION L Idi A NC correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued(Sec.3097,civ C.) relating to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments,costs,and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code,Section 9.18. 1 understand my plans shall be used as public records. f Licensed Signature Date 3//_ professional R - REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION 10300 TORRE AVENUE CUPERTINO, CA95014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333•build ingaacupertino.ora PROJECT ADDRESS 17 �S �' �✓ sl' .8/£ APN m 3 5 OVARNERINAME�1 / (��' C !/�` �� ���Z/� PHONEgag,�901p Y��2� E-MAIL STREET ADDRESS ( CITY,STATE IPP I FAX G tr �r�, Ce/ CONTACT NAM I PHONEL10Llc E-MAIL STREET ADDRESS CITY,STATE,ZIP FAX , X-owNNER ❑ owNTTER-BUILDER ❑ ON;WERAGFNT ❑ CONTRACTOR ❑CONTRACTOR AGENT 0 ARCHITECT ❑EI.'GATEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME /�ti�✓ LICENSE NUMBER LICENSE TYPE BUS.LIC.R COMPANY NAME EMAIL FAX 61 STREET ADDRESS I CITY,STATE,ZIP PHYEFOL� / 1 V 2 ARCHJTECT/ENGINEERNAME LrCENSEINUMBER I BUS.LIC:m COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑ SFD Or Duplex ❑ Multi-Family ROOF AREA: VALUATION: STRUCTURE: I&Commercial EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIM REh40VE/REPLACE' ❑YES IF NO, PLYWOOD - ❑ 'w, ❑__FT ❑OSB PITCH: ROOF ❑NO' f4LYJ ARS: THICKNESS: ❑5/S" TYPE: ❑CDX 12 CLASS: `� PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAPES ❑WOOD SHINGLES ❑OTHER I ICC-ES REPORT n DESCRIPTION OF WORK: f e/'j7& / r C e f e S� �j C/- / e2 sb! It ESP-I 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 ofWork and verify iit is accurate. I agree to comply with all applicable local ordinances and state laws relating tobuildingconstruction. I authorize representatives of Cupertino to enter the above-id ntified property for inspection purposes. Signature of Applicalit/Agent/` l Date: 3 I✓� 1 SUPPLEMENTAL INFORM ION REQUIRED 5 - If building is associated witIi a Home Ow'ner's Association,provide Ietter = rL�CHE�KTYPE ° RouTn.GSL� of approval . 004, F j pp l fHOALL© OEIiTHECOJhTER Y BbILDII�GPLAAREFTESI . Provide Planning approval to verify if there any restrictions. Provide copy of Manufacturer's Installation Specifications. 017i sTAI�DaRD t D FTRFDEP� _Provide signed copy of Cupertino's Tear-OffPblicy. Reroof.4yp 2011.doc revised 03116111 i z' REROOF TEAR-OFF POLICY COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL CUPERTtt4o 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228• FAX(408)777-3333 buildinn cDcuoertino.org PROJECT ADDRESS APN9 f Cf 7 � i�-" �E'�ivy-y' p I '� Z OWNERNAME PHONE . E-MAIL STREET ADDRESS CITY, STATE,ZIP ( FAX CONTRACTOR NAM C LICENSENLWER LICENSE TYPE BUS.LIC. COMPANY NAME�lam—e ��� E-MAIL FAX STREET ADDRESS / CITY,STATE,ZIP PHONE 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 un 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- 2:3Opm (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 aminimum 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 an the property owner or authorized agent to act on the property owner's behalf. I understand and agree to comply Nvith 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 de. Signature of Applicant/Agent; /cy Date: �� l ReroofPo1icy_2014.doc revised 01/15114