B-2016-2321 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2321
10398 HENEY CREEK PL CUPERTINO,CA 95014-0829(342 48 036) EL CAMINO ROOF
SYSTEMS CO INC
SAN JOSE,CA 95112.
OWNER'S NAME: JONES BERNICE G TRUSTEE DATE ISSUED:07/15/2016
OWNER'S PHONE:808-741-6776 PHONE NO:(408)639-0224
LICENSED CONTRACTOR' DECLARATION
BUILDING PERMIT INFO:
License Class ROOFING Lic.#987803
Contractor EL CAMINO ROOF SYSTEMS Co INCDate 09/30/2016 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:
I hereby affirm under penalty of perjury one of the following two declarations: TEAR OFF;INSTALL OSB;COMP SHINGLE(36 SQ'S)
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.
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 work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$20900.00
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 342 48 036
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.
Additionally,the applicant understands and will comply with all non-point WITHIN 180 DAYS OF PERMIT ISSUANCE OR
source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST INSPECTION.
Signature; iA
Date;07/15/2016 Issued�by:Date: 5/2016 --- _
OWNER-Bi7Ii DER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the RF-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
i. 1,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(Sec.7044,Business&Professions Code)
z. 1,as owner of the property,am exclusively contracting with licensed Signature ofApphcant
contractors to construct the project(Sec.7044,Business&Professions Code). Date:07/15/2016
Thereby 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 1
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. I 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 25505,25533S and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent
APPLICANT CERTIFICATION Date:07/15/2016
I 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 07/15/2016
Professional
3
R' REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•building(a)-cupertino.org
CU, PERTINOll
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OWNERNAME J/�� A• _¢ ��L� T PHONE ! �
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1501e-All atV s y-1-61761
STREET ADDRESS C
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CONTACT NAME
PHONE E-MAIL
STREET ADDRESS 7 CITY,STATE,ZIP �® ;e CA- If/I
FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑CONTRACTORAGENT ❑.ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME ^ •„ 1"WT }, LICENSE NUMBER MO C-31
LICENSE TYPE BUS.LIC.# C
COMPANY NAME C ,`r' J 7G E-MAIL FAX
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STREET ADDRESS //_fir-/, S• +� {� CITY,STATE,ZIP San �"'�,A �y r�„ PHONE jtd2�7�p
ARCHITECT/ENGINEEORJNAMVE ! LICENSE NUMBER Y/ G BUS.LIC.#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF SFD or Duplex ❑ Multi-Family ROOF AREA: VALUATION: J �y
STRUCTURE: ❑ Commercial
EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES KO,SHAKES ❑WOOD SHINGLES Il OTHER(SPECIFY)
REMOVE/REPLACEES IF NO, PLYWOOD w, ElPLYWD OSB PITCH: ROOF
EY( #LAYERS: THICKNESS: 5/8" TYPE: ❑ CDX '12 CLASS: A
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER IC
C-ES REPORT r#
DESCRIPTION OF WORK: -F � ® n G �rGe keO le 4 !kT j r�/ 6
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 gelatin to 'lding construction. I autho re nTa fives of Cupertino to enter the above-iden d prop for inspection purposes.
Signature of Applicant/Agent: A) Date: 07 /G
SUPPLEMENTAL INFORMATION REQUIRED x oFFIc Its "otLf
If building is associated With a Home Ownees Association,provide letter PI AN CHECK°TYPE ROUTING SLIP
of approval from HOA- - C[ OVEJi.FW cDrnvTER sz LDmIGaiv vzEw
_Provide Planning approval to verify if there any restrictions. ❑ ,XPRES$ p ry�NNt �PLXIN REVIEW
Provide copy of Manufacturer's Installation Specifications. [( sTANDnRD L7 ,z jRE DEPT
r
_
Provide signed copy of Cupertino's Tear-Off Policy. L�>-OTHER
,..
ReroofApp_2011.doc revised 03/16/11
h
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
ALBERT SALVADOR, P.E.,C.B.O.,BUILDING OFFICIAL
CU 'ERTIN } 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333 building(a)cupertino.ora
PROJECT ADDRESS1 6,3 9 G l/e A J �Y APN Z f&7
OWNER NAMECCZ_ Vo /V i7S PHONE UF)7tf/-(Y7/(7 EMAIL
STREET ADDRESS ee CITY, STATE,ZIP FAX
CONTRACTOR NAME LICENSE NUMBERQ aG 3 LICENSE TYPE BUS.LIC.#
COMPANY NAME /! /1� ,hA n�q0 �L y�y,^( E-MAIL 0 ® FAX /OF ZqL
STREET ADDRESS 6 ((�/I �Av / [ CITY,STATE,ZIP PHONE
!(vSb S• 7 st- 5cw� 3-o�rc �4-� 2 y0�
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 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/"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: 1 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 Reside ode.
Signature of Applicant/Agent: ✓ 4__�elDate:
ReroofPolicy_2014.doe revised 01115114