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B-2016-2978 CITY OF CUPERTINO BUILDING PERMIT BUILD ENG ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2978 21721 SANTA BELLA PL CUPERTINO,CA 95014-4833(356 22 021) R A CONSTRUCTION SAN JOSE,CA 95136 OWNER'S NAME: CHENG DONNA WAN-CHUN DATE ISSUED:10/25/2016 OWNER'S PHONE:408-215-8411 PHONE NO:(408)559-1877 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C39 Lic.#633438 Contractor R A CONSTRUGTION Date 12/31/2017 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: RE-ROOF;TEAR OFF;INSTALL OSB;COMP ROOF SYSTEM(25 I hereby affirm under penalty of perjury one of the following two declarations: 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. 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:$11500.00 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 22 021 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 FR NPECTION. Signature �,�1-12, Date 10/25/2016 Issued by:MELISSA NAMES Date: 10/25/2016 OWNER-B✓77T'D R D RATION 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 spection. sale(Sec.7044,Business&Professions Code) - -----� z. 1,as owner of the property,am exclusively contracting with licensed Signature ofApplicant� contractors to construct the project(Sec.7044,Business&Professions Code). Date:10/25/2016 XIle I hereby affirm under penalty of perjury one of the following three declarations: ALL RO-F 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. I will permit is issued. I 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 shall not employ material. Additionally,should I use equipment or devices which emit hazardous p y an y 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,atter 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 C�Secq25533,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;10/25/2016 , 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. Signature Date 10/25/2016 Licensed Professional REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228•FAX(408)777-3333-buildingp_cupertino.org CUPERTINO (3 - Zt6 - z PROJECT ADDRESS - ^' APN# 7 "Z- �a ' ts,-a 3 .G - Z Z O Z OWNER NAME /// �°/) /�// jr✓Y` PHONE c/- r--213-:Gj 1,1 E-MAIL STREET ADDRESS CITY,STATE,ZIP ®Zd FAX CONTACT NAME g� ,r �g� PHONE �e v,,, E MAIL STREET ADDRESS / CITY,STATE,ZIP T L u✓ FAX ❑ OWNER ❑ O4.=ER ❑.OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME LICENSENU vIBER LICENSE TYPE BUS.LIC.# k�0101V �1�-',;, 3 2 COMPANY NAME /�. _ l E-MAIL FAX STREET ADDRESS �^ , C TATE,ZIP C C' .x ,13 PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS'.LIC.# I� COMPANY NAME E-MAIL ®„„ FAX STREET ADDRESS ✓ CITY,STATE,ZIP ! PHONE USE OF WSFD or Duplex, ❑ Multi-Family ROOF AREA: VALUATION: STRUCTURE: ❑ Commercial EXISTING ROOF TYPE: BUILT-UP ROOF El ASPHALT SHINGLES WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY) REMOVEIREPLACE ILrXES IF NO, PLYWOOD w%” ❑ PLYWD OSB PITCH: ROOF h1 ❑ 0 #LAYERS: 1 THICKNESS: El 5/8- TYPE: ❑ CDX '12 iAss. A PROPOSED ROOF TYPE: ❑BUILT-UP ROOF XASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER PCC-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--,l have read the Description of Rork and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building o.Cis"'Zr a$n. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: a` m' Date: (/ s SUPPLEMENTA61d'1~ORMATION REQUIRED .OFFICE USE Ol\LX., r If building is associated with a Home Owner's Association,provide letter P cHr cx TLE R©tiTZNc SLIP of approval from HOA. ER1HE cazmTE ❑ sIIILDI4GPi�ANREi1iE�V Provide Planning approval to verify if there any restrictions. E] rLA�mING rL�n zzE«w Provide copy of Manufacturer's Installation Specifications. I] ST "ARD Provide signed copy of Cupertino's Tear-Off Policy. ❑ DIRER Re7•0ofApp_201.1.doc revised 03116111 REROOF TEAR-OFF POLICY COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION ALBERT SALVADOR, P.E.,C.B.O., BUILDING OFFICIAL CITPI~IiTtl�tC3 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228• FAX(408)777-3333•building(alcupertino,org PROJECT ADDRESS ��./�j� ��l"V/✓( !-`'�5�/ /� APN# O\NNERNAME � / PHONE 4�(/�zls- E-MAIL STREET ADDRESS V Q„ /J� CITY,STATE,`IZIPJ �/ 1�.� 7/ FAX CONTRACTOR NAME j ! y���•-` LICENSE NUMBER , r LICENSE TYPE� BUS.LIC.# COMPANY NAME / E-MAIL FAX STREET ADDRESS /yG °'vt rGYtK0 CITY>STATE ZIP I IN2 I UNDERSTAND AND AGREE/TO THE FOLLOWING: C 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 iiispections online or call (408) 777-3228 from 7:30-3:30pin(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 followin is true: I ain the property owner or authorized agent to act on the property owner's behalf. I understand and as ee to com ly with the re-roof policy stated above. I also understand that smoke detectors and carbon monoxide detectors are re Ired to be installed in accordance with Sections R314 and R315 of the 2013 California Residential Go`de. Signatare of Applicant/Agent: Date: (f r Re7-0ofPo1icy_2014.doe revised 01/15114