B-2016-2390 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2390
21522 REGNART RD CUPERTINO,CA 95014-4819(356 23 042) EAST/WEST .
BUILDERS
SAN JOSE,CA 95117
OWNER'S NAME: MARTEN GARY L DATE ISSUED:07/26/2016
OWNER'S PHONE:408-868-8703 PHONE NO:(408)561-2004
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class GENERAL BUILDING CONTRACTOR Lic,#891264 X BLDG ELECT _PLUMB
Contractor EAST/WEST BUILDERS Date 08/31/2016
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. I JOB DESCRIPTION:
I hereby affirm under penalty of perjury one of the following two declarations:. TEAR OFF;INSTALL OSB;COMP SHINGLE(29 SQ'S)
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.
�6�%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:$11000.00
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 356 23 042
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 understan s nd4ill comply with all non-point
source regulations per the Cupertino i al Code,Section 9.18. 180 DAYS FROM LAST C D INSPECTION.
Signaturer//V y Date 07/26/2016 Issued by:ME
V Date:07/26/2016
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 por 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//.inspection,I agree t move all new materials for
compensation,will do the work,and the structure is not intended or offered for inspe- On,
sale(Sec.7044,Business&Professions Code) i
2. 1,as owner of therope
p rty,am exclusively contracting with licensed .Signature of Applicant•/ t
contractors to construct the project(Sec.7044,Business&Professions Code). Date:07/26/2016
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1. 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
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. 1 will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Health&Safety Code;Section 25532(a)should I store or handle
a. I certify that in the performance of the work for which this permit is issued,I hazardous
shall not employ any person in any manner so as to become subject tthe 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 Co g,Sections 25505,2`�5 ,a 34.
Labor Code,I must forthwith comply with such provisions or this permit shall 1 y � V
be deemed revoked. Owner or authorized agent
APPLICANT CERTIFICATION Date:07/26/2016
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 buildingconstruction,and hereby authorize representatives of this city of works 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 07/26/2016 Professional
t
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228• FAX(408)777-3333•buildingO-cupertino.org
CUPERTINO
f 2- 6
PROJECT ADDRESS � � d� � (� APN# � In f] � v V / "
OWNER NAME ' 1` W Y� \ 1�✓ W�, P\\7 Y �✓ ( E L
. STREET ADDRESS 1/UR,�, p� XI'13. CITY,STATE,ZIP '� -
FAX
1 (.
CONTACT NAME PHONE / a777
AIL
STREET ADDRESS .
CITY,STATE,ZIP FAy
❑OWNER ❑ OWNER-BUB,DER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAMES ' WXPii LICENSE NUMBER (,P LICENSE TYPE BUS.LIC.# I
COMPANY NAME V E-MAIL _ FAX IVr9
STREET ADDRES CITY,STATE,ZIP PHONE
ARCHITECT/ENGINEERNAME F LICENSE NUMBER BUS.LIC.#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
n r~
USE OF SFD or Duplex El Multi-Family Roo$ A. VALUATION:
l
STRUCTURE: ❑ Commercial 1 6
EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES 19WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY}
REMOVE/REPLACE\LYES IF NO, PLYWOOD ❑ %" ❑ FPW
WD OSB PITCH: ROOF❑NO #LAYERS: THICKNESS: ❑ 5/8" E: ❑ CDX 12 CLASS: `�
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES 0 OTHER ICC-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�cription of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to buildm* ons fon. I u ves of Cupertino to enter the abovv}e-i jentifie(d p p rte for inspection purposes.
Signature of Applicant/Agent:• Date: 1 l� tj
B
SUPPLEMENTAL INFORMATION REQUIRED
If building is associated with a Home Owner's Association,provide letter PLANCH>cK i E ROUTING SLIP_
of approval from HOA. z oVER rim CGdNTER BUII DIIiG PI AN REY.TEw
Provide Planning approval to verify if there any restrictions. �',EXPRESS D Pi ANNI vG rLAN xLV
Provide copy_of Manufacturer's Installation Specifications.
❑ s2alvD
Provide signed copy of Cupertino's Tear-Off Policy. '"oTIIER
c x-,
ReroofApp_2011.doc revised 03116111
`F REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
ALBERT SALVADOR,P.E.,C.B.O., BUILDING OFFICIAL
C1.PERTINO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228 FAX(408)777-3333•building(a)-cupertino.ora
PROJECT ADDRESS
_ 1v N#11, y � $ K ZV \� ✓ (
OWNERNAME (,V
E-MAIL
V1Q17703
STREET ADDRESS V CITY,STATE,ZIP
FAX
CONTRACTOR NAME , LICENSE" a V' LICENSEOE BUS.LIC.#
COMPANY NAME o n ( 1 E-MAIL FAX
STREET ADDRESS CITY,STATE, PH` + ll
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 1/"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- oof policy stated above. I also understand that
smoke detectors and carbon monoxide de ectors ardyequ' ed to b inst in accordance with Sections R314 and R315 of.
the 2013 California Residential Code.
Signature of Applicant/Agent. l� Date: L
I
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