B-2016-1772 i
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1772
21811 RIFREDI CT CUPERTINO,CA 95014-2852(357 16 122) A-1 ROOF
MANAGEMENT AND
CONSTRUCTION INC
SAN LEANDRO,CA
94577
OWNER'S NAME: MA SAM AND DIANA DATE ISSUED:04/15/2016
OWNER'S PHONE:650-248-3931 PHONE NO:(510)347-5400
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B C-39,C-33 Lic.#229384 X BLDG —ELECT _PLUMB
Contractor A-1 ROOF MANAGEMENTAND CONSTRUCTION INC Date —
05/31/2017 —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 JOB DESCRIPTION:
license is in full force and effect. PARTIAL RE ROOF,TEAR OFF 1 LAYER OF COMP SHINGLES,
INSTALL 30 FELT PAPER AND NEW COMP SHINGLES
I hereby affirm under penalty of perjury one of the following two 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
� performance of the work for which this permit is issued.
tl 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 Sq.Ft Floor Area: Valuation-$3000.00
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above 57 Number: Occupancy Type:
357
information is correct.I agree to comply with all city and county ordinances 3 16 122
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 PERMIT EXPIRES IF WORK IS NOT STARTED
City of Cupertino against liabilities,judgments,costs,and expenses which WITHIN 180 DAYS OF PERMIT ISSUANCE OR
may accrue against said City in consequence of the granting of this permit.
Additionally,the applicant understands and will comply with all non-point 180 DAYS FROM LAST CALLED INSPECTION:
source regulations per the Cupertino Municipal Code,Section 9.18.
Issued by:AbbyAvende
:Signature 40 :: Date 4/15/2016 Date:04/15/2016
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
installed without first obtaining an inspection,I agree to remove all new materials for
following two reasons:
inspection.
r. 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 for
sale(Sec.7044,Business&Professions Code) Signature of Applicant:
2. I,as owner of the property,am exclusively contracting with licensed Date:4/15/2016
contractors to constrict 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:
r. 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 by California Health&Safety Code,Sections 25505,25533,and 25534. I will
Section 3700 of the Labor Code,for the performance of the work for which this maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Health&Safety Code,Section 25532(a)should I store or handle hazardous
permit is issued.
s. 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 shall Owner or authorized agent: /' )�–T `1
be deemed revoked. Date:4/15/2016
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 understands I understand my plans shall be used as public records.
and will comply with all non-point source regulations per the Cupertino Municipal
Code,Section 9.18.
Licensed
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE-CUPERTINO,CA 95014-3255
CUPERTIN0 (408)777-3228 FAX(408)777-3333*building 5cupertino.org
PROJECT ADDRESS2 ,R 6 Y ot/Y APNm
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01ANER NAME carr, �cel I f�PHONE5E-M�IAIL
STREET ADDRESS CITY, STATE,ZIPFAX
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CONTACT NAME PHONE E-MAIL
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STREET ADDRESSCITY,STATE, ZIP FAX
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OIAI+MR ❑ OWNER-BUILDER ❑ OWNER AGENT Co?dI7LACTOR ❑CONURACTOR AGENT ❑ ARCHITECT ❑ENGINEER. ❑ DEVELOPER ❑ TENANT
CONTRACTORNAME LICENSENUMBER LICENSETYPE BUS.LIC.R j �
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STREET ADDRESS CITY,STATE,ZIP PHONE
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COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF SFDorDuplex El Multi-Family ROOF AREA: VALUATION
STRUCTURE: ❑ Commercial {
EXISTING ROOF TYPE' 1:1 BUILT-UP ROOF ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY)
REMOVE/REPLACEES IFNO, PLYWOOD ❑ '7:" ❑ PLYWD ❑OSB PITCH: ROOF
❑NO mLAYERS: THICKNESS: ❑ 5/8" TYPE: ❑ CDX :12 CLASS: A
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF 9ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER I ?CC-ES REPORT
DESCRIPTION OF WORK:
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 relating to building construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: , Date: Ll
SUPPLEMENTAL INFORMATION REQUIRED
_
If building is associated with a Home O�amer's Association,provide Ietter P�Ar`CHECKTYPE = ouTuaeSLIP,
F _ -mak -t �
of approval from HOA. D o«x TBE coiJnrEii BrMriDn.cra AI REvsEty
Provide Planning approval to verify if there any restrictions. z L� ExrxEss `r fl P�9� u.GrLnr,xEFIEi �
_Provide copy of Manufacturer's Installation Specifications. gLl sT� Da2zDRr DEPT r
Provide signed copy of Cupertino's Tear-Off Policy.. _ 3-
OTHER
Reroof.App 2011.doc revised 03/16/11
a
9 REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
L M_ ALBERT SALVADOR, P.E., C.B.O.,BUILDING OFFICIAL
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
GUPERTFPIO
(408)777-3228 •FAX(40_8,),-7,.77-3333•buildino(�cuoertino.orp
PROJECT ADDRESS I L 1C9 4PN n
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01A1IvERNAME I PHOT 2`I -3`1 -3MAIL
STREET ADDRESS -a-t `�iv l p j �Vv,_ CITY, STATE,ZIP 9� I Ly I Fax
CONTRACTOR N ME G� LICENSE 1\UMBER LICENSE TYPE BUS.LIC.n�� �r
T 1?51(_-3-)
COMPANY NAME E-MAIL
-,+ 1 n eC ry. . Cv —
STREET ADDRESS CITY,STATE,Zt SPL 7 PH NE
-by SG wI v � `'l ( 9� 3 3"1-7 SL-lo 0
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-
2:30pm (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-roofmg is
completed. To receive a final sign-off, the following items will be verified:
a. Flat roofs shall have a minimum of V4"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 truer 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 Code.
Signature of Applicant/Agent: Date:
ReroofPolicy_2014.doc revised 01115114