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B-2016-2289 CITY OFC PERTINO BUILDING PERMIT BUILDING ADDRESS: I CONTRACTOR: PERMIT NO:B-2016-2289 10480 N FOOTHILL BLVD CUPERTINO,CA 95014-0801(326 13 030) LINDY ROOFING COMPANY INC SAN JOSE,CA 95110 OWNER'S NAME: TERADA LILLIAN ET AL DATE ISSUED:07/11/2016 OWNER'S PHONE:650-209-1582 PHONE NO:(408)286-9990 LICENSED CONTRACTOR'S DECLARATION I BUILDING PERMIT INFO: License Class C-39 Lic.#215816 Contractor LINDY ROOFING COMPANY INC Date 08/31/2016 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;INSTALL OSB;INSTALL COMP SHINGLES(42 SQ'S) I hereby affirm under penalty of perjury one of the following two d clarations: 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 Laboi Code,for the performance of the work for which this permit is issued. z. I have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the ork for which this permit is issued. Sq.Ft Floor Area: Valuation:$20000.00 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 o dinances APN Number: Occupancy Type: and state laws relating to building construction,and hereby authorize 326 13 030 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 regulationsper the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signatur� Date 7M 1 2016 Issued by:Abby yende Date:07/11/2016 OJAAVVVA(( 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(See.7044,Business&Professions Code) —yam z. I,as owner of the property,am exclusively contracting with licensed Signature of Applican —o contractors to construct the project(Sec.7044,Business&Professions Code). Date:7/11/2016 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 z. 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 s. 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 shall not employ any person in any manner so as to become subject to the material. Additionally,should I use equipment or devices which emit hazardous 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 dor this permit shall be deemed revoked. Owner or authorized agent: APPLICANT CERTIFICATION Date:7/11/2016 1 certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY 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 relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C.) 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. Licensed Signature Date 7/11/20 6 Professional �1 j RER®®F PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•C I PERTINO, CA 95014-3255 (408)777-3228•FAX(408)7 CUPERTINO 77-3333•building(g)cupertino.org �✓��� � �l� PROJECT ADDRESS 80 rte')` / I� �J� APN# off% OWNERNAME bu&pu PHONE /_ 2O 1j 1 - MAIL STREET ADDRESS L CITY, STATE,(ZIP FAX CONTACT NAME �/ 'Ip �JPHONE /BOO^ Z�/ L1Cu E IyxAl��� � ��`�/L, e '6J STREET ADDRESS /s`�/1`j cb`C• � CITY,ST ZZ cJG7 r�L* 6^ i l(^!lO FAX �Lf ❑OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑"(ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME `n,r� LICENSE Nf2t LICENSE TYPE BUS.LIC.# C_- -3!!? COMPANY NAME ,v G/ E-MAIL`L' ( FAX S' STREET ADDRESS CITY,STATE,ZIP PHONE ARCHITECT/ENGINEER NAME Li CENSE NUMBER BUS.LIC.# S COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑ SFD or Duplex ❑ Multi-Family ROOF AREA: VALUATION: STRUCTURE: ❑ Commercial 2@©S F EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLEI ZrWOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY) REMOVE/REPLACE El YES IF NO. PLYWOOD ❑ '/:" ❑ PLYWD El PITCH: ROOF El NO #LAYERS: THICKNESS: El 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: ' `i.+vllE7'(�L ��� � -•F- � r'LV'i ��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 infonnation I have provided is correct. I have read the Description of Work and v 'fy it is accurate. I agree to comply with all applicable local ordinances and state laws relating to buildin construction. I authorize rep�rese tivas.of u rtino to enter the above-id ntifie property for inspection purposes. Signature of Applicant/Agent: — Date: 1�i SUPPLEMENTAL INFORMATION REQUIkED OFrICE USE ONLY _If building is associated with a Home Owner's Association,provide letter PLAN CHECK TYPE ROUTING SLIP Of approval from HOA. ❑ OVER-THE-COUNTER 0 BUILDING.;PLAN REVIEW Provide Planning approval to verify if there any restrictions. I].: EXPRESS ❑ PLANNING PLATY REVIEW Provide copy of Manufacturer's Installation Specificati Ins. D STANDARD ❑, FIRE DEPT Provide signed copy of Cupertino's Tear-Off Policy. ❑ OCHER. ReroofApp_2011.doc revised 03/16111 r:d REROOF TEAR- - FF POLICY COMMUNITY DEVELOPME T DEPARTMENT•BUILDING DIVISION ALBERT SALVADOR, P.E., .B.O., BUILDING OFFICIAL CUPERTfNCs 10300 TORRE AVENUE•C PERTINO,CA 95014-3255 (408)777-3228•FAX(408) 77-3333•building(cDcupertino.org PROJECT ADDRESSyj ( APN# �5` �f� w�o OWNER NAME � � PHONE(, ZOq- f5�2 E-MAIL STREET ADDRESS �� CITY,STATE,ZIP��// FAX CONTRACTOR NAME �,�p� L CENSE NUMBER � �0 n LICENSE TYPE BUS.LIC.# COMPANY NAME `Y E-MAH,R C A ^ 1 „ Y Q L/ t,^ FAX STREET ADDRESSn D / CITY,STATE,ZIP - PHONE 'M l l� W, � 02 7, 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 (F 'iday). 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 roposed throughout, all the nails/fasteners shall be either completely knocked-down or remove'I prior to this inspection. 4. If plywood is installed, a plywood Naili ng Inspection is require 5. Roofing shall not be applied without fir 3t obtaining all prior inspection and written approvals from the building inspector. Any roofing which' s 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 shal.be obtained from the building inspector when the re-roofing is completed. To receive a final sign-off, he following items will be verified: a. Flat roofs shall have a minim of I/"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 tl le 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 Co Signature of Applicant/Agent: Date: ReroofPolicy 2014.doc revised 01/15/14 n SMOKE I C, SON MONOYJD ALARMS OWNER CERTIFICATE OF COMPUANCE i woc,7 !- E-- r ,gy m-1 „ Addrtml PER" aDiv, . 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