B-2016-3038 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-3038
22588 LAZY OAK CT CUPERTINO,CA 95014-5610(342 32 004) STATEWIDE ROOFING
INC
SAN JOSE,CA 95138
OWNER'S NAME: CHEN LI-CHUAN AND HWANG SHIN-JIA DATE ISS! D:11/04/2016
OWNER'S PHONE:408-559-1977 PHONE NO:(408)286-7828
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C39 Lic.#803926
Contractor STATEWIDE ROOFING INC Date 02/28/2018 X BLDG ELECT _PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing —MECH X RESIDENTIAL_C I MMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
BLDG 7-PARTIAL RE-ROOF; :AR OFF WOOD SHAKE;INSTALL
I hereby affirm under penalty of perjury one of the following two declarations: CDX;COMP ROOF SHINGLE SARD ROOF)(27 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
j....2::::"-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:$.3613.00
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 ordinances APN Number: Occupancy .e:
and state laws relating to building construction,and hereby authorize 342 32 004
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 ORK IS NOT STARTED
may accrue against said City in consequence of thegranting l this permit. WITHIN 180 DAYS 0 PERMIT ISSUANCE OR
Additionally,the applicant understands and will complyywith all non-point
source regulati s per a Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAS CALLED INSPECTION.
Signature Date 11/04/2016 Issued b
Date: 11/04/2016
OWNER-BUILDER DECLARATIOlY
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-'OOFS:
following two reasons: All roofs shall be inspected prior to an roofing material being installed.If a roof is
i. I,as owner of the property,or my employees with wages as their sole installed without first obtainine an inspe tion,I agree to remove all new materials for
compensation,will do the work,and the structure is not intended or offered for ins o ection..
' sale(Sec.7044,Business&Professions Code)
2. I,as owner of the property,am exclusively contracting with licensed Signature ofApplicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:11/04/2016 f'
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS Ts 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 MAT RIALS 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,S-ctions 25505,25533,and 25534. I will
permit is issued. maintain compliance with the Cupe 4 o Municipal Code,Chapter 9.12 and the
s. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 2553r(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 e uipment or devices which emit hazardous
air contaminants as defined by the B Area Air Quality Management District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the C- ertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,s ctions 2 ! ,' ,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent:; f
APPLICANT CERTIFICATION Date:11/04/2016
I certify that I have read this application and state that the above information is CONSTRUCTIO LENDING AGENCY
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a constru tion lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issu d(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' DECLARATION
Code,Section 9.18. I understand my plans shall be used s public records.
Licensed
Signature Date 11/04/2016
Professional
/ REROOF PERMIT APPLICATION
• COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
,.."41.15., 10300 TORRE AVENUE,CUPERTINO,CA 95014-3255
CUPERTINO- (408) 777-3228•FAX(408)777-3333 building@cupertino.orct
13 10f6 - 5o3 2
PROJECT ADDRESS 22588 Lazy Oak Ct. APN# 342-32-004
OWNER NAME Westridge HOA C/O CMS 1 PHONE 408.559.1977 E-MAIL cs@comrnunitymanagement.com ,
STREET ADDRESS 1935 DRYCREEK ROAD#203 CITY,STATE,ZIP CAMPBELL,CA 95008 FAX 408.559.1970
CONTACT NAME Jim Lyons CSI PHONE j
Y { ) 408.210.6344 E-MAIL
( jim@csibayarea.com
STREET ADDRESS AO.Box 54190 CITY,STATE,ZIP San Jose,CA 95154 FAX NIA '-----
1p OWNER 0 OWNER-BUILDER 0 OWNER AGENT ❑X CONTRACTOR 0 CONTRACTOR AGENT 0 ARCHITECT 0 ENGINEER 0 DEVELOPER 0 TENANT
CONTRACTOR NAME Jon Robertson(PM) LICENSE NUMBER LICENSE TYPE BUS LIC.8 23509
803926 G39
COMPANY NAME Statewide Roofing,Inc. E-MAIL )robertson@swroof.net FAX 408.286.7820
STREET ADDRESS 5542 Monterey Rd.#201 CITY,STATE,ZIP San Jose,CA 95138 PHONE 408.286.7828
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS LIC.it
COMPANY NAME E-MAIL
FAX
STREET ADDRESS I CITY,STATE,ZIP
PHONE
USE OF 0 SFD or Duplex l Multi-Family ROOF AREA: VALUATION:
STRUCTURE: 0 Commercial 2,658 s.f. 53,f:13.00
1
EXISTING ROOF TYPE: 0 BUILT-UP ROOF 0 ASPHALT SHINGLES Il WOOD SHAKES 0 WOOD SHINGLES 0 OTHER(SPECIFY)
REMOVE/REPLACE ❑YES IF NO, PLYWOOD ® 1" 0 PLY WD 0 OSBPITCH ' ROOF
0 NO #LAYERS: THICKNESS: 0 5/8" TYPE: ll CDX 20 ._12 I CLASS: A
PROPOSED ROOF TYPE: 0 BUILT-UP ROOF IE ASPHALT SHINGLES 0 WOOD SHAKES 0 WOOD SHINGLES 0 OTHER ICC-ES REPORT#
DESCRIPTION OF WORK:
Tear off existing shake roof,install 1/2"CDX plywood,Install Certainteed Presidential
Shake TLT'"shingles over Certainteed Diamond Deck"'underlayment.
3LDG�
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 buildi'g constr; 'ZIon. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. ''
Signature of Applicant/Agent: .ter% -. - Date: 111)3116
v.
SUPPLEMENTAL INFORMATION REQUIRED OFFICE I'EONLY
X If building is associated with a Home Owner's Association,provide letter PLAN t IIECK"IVP1_ ROt TING Slip
Of approval from HOA. 0 o6t--:rt iron-cot NTER 0 in II.DING PLAN REV'E%v
Provide Planning approval to verify if there any restrictions. 0 EXPRESS 0 PLANNING PLAN REVIEW
X Provide copy of Manufacturer's Installation Specifications.
y illi) 0 LIRI'.DEPT
X Provide signed copy of Cupertino's Tear-Off Policy, ❑ f)r11I:R:
ReroofApp_2011.doc revised 03/16/11
\\,,,,,H\ REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
4,1,ps, ALBERT SALVADOR, P.E., C.B.O.,BUILDING OFFICIAL
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTINO
(408) 777-3228.FAX(408)777-3333•buildino cupertino.org w26 '
PROJECT ADDRESS 22588 Lazy Oak Ct.-22669 Weeping Oak Ct.(8 Bidgs.) 1 APN a 342-32-004
OWNER NAME Westridge HOA C/O CMS PHONE E-MAIL
9 408.559.1977 cs@communitymanagement.com
STREET ADDRESS 1935 DRYCREEK ROAD#203 CITY, STATE,71P CAMPBELL,CA 95008 FAX 408,559.1970
CONTRACTOR NAME Jon Robertson(PM) LICENSE NUMBER 803926 LICENSE TYPE C-39 BUS.LIC,a 23509
COMPANY NAME Statewide Roofing,inc. E-MAIL jrobertson@swrootnet
FAX 408,286.7820
STREET ADDRESS 5542 MontereyRd.#201 CITY,STATE,7IP PHONF,
San Jose,CA 95154 408.286.7828
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 Y" 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, 1 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 Residential Code.
Signature of Applicant/Agent: fr'
Date: 11/03/16
ReroofPol icy_2014.doc revised 01/15/14
WESTRIDGE 110A
C/O COMMUNITY MANAGEMENT SERVICE.
1935 DRYCREEK ROAD 4203
CAMPBELL CA 95008
November 3, 2016
City of Cupertino
Attn: Planning/Building Department
RE: Westridge HOA
Mansard Roof Replacement Project
To Whom It May Concern:
Please be advised that Westridge HOA retained the firm Statewi e Roofing, Inc. to
act as our agent for the above referenced repair project for the AA.sociation.
Statewide Roofing, Inc. is authorized to work on our behalf and with the City of
Cupertino on this project.
Please contact the undersigned, if you have any questions or nee. additional
information.
Sincerely,
On behalf of the Westridge HOA.
1 .
Jim Lyons
Construction Manager, Construction Services, Inc.
cc: Board of Directors