B-2016-3119 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT Nth B-2016-3119
10166 BONNY DR CUPERTINO,CA 95014-2904(359 11048) BLACK DIAMOND
ROOFING INC
MARTINEZ,CA 94553
OWNER'S NAME: LEWIS MARILYN M TRUSTEE DATE ISSUED:11/15/2016
OWNER'S PHONE:408-410-0806 PRONE NO:(925)978-9150
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-39 Lic.#996268
Contractor BLACK DIAMOND ROOFING INC Date 01/31/2017 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:
REROOF;TEAR-OFF;INSTALL OSB;INSTALL COMP SHINGLES-
I hereby affirm under penalty of perjury one of the following two declarations: (30 SQ)
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
i .I lrformance of the work for which this permit is issued.
2.y I' ve and will maintain Worker's Compensation Insurance,as provided for by
erection 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$16500.00
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 Type:
and state laws relating to building construction,and hereby authorize 359 11 048
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 stands and the comply
hg of this permit.
intWITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the plicant understands and will comply with all non-point
source regula/'F e Cupertino Muni '.al Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature ,.. • ./- Date 11/15/2016 Issued by:AbbyAyende
Date: 11/15/2016
8 .ht .-: II I : I ; 114 ilk
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 obtainin: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) - ,/� ,
2. I,as owner of the property;am exclusively contracting with licensed Signature of Applican//
contractors to construct the project(Sec.7044,Business&Professions Code)/' Date:11/15/2016
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
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 2$532(x)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 win 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 1.1 7 ons 25505,25533 and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall wd r
be deemed revoked. 4,0 joy0110)1111P„:,
G.Ownerr
or authorized agent:
APPLICANT CERTIFICATION Date:11/15/2016
I certify that I have read this application and state that the above information is CONSTRUCTIONNDTNGAGI ►
correct.I agree'to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending a•'ncy 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. I understand my plans shall be used as public records.
Licensed
Signature Date 11/15/2016
Professional
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTINO.
(408)777-3228• FAX(408)777-3333•building(a cupertino.orq
PROJECT ADDRESS/0! APN
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OWN-ERNAME g fT
ene
STREET ADDRESS CITY,STATE,ZIP FAX
CONTACT NAME .\e2'r� fic,
I) PHON i7
STREET ADDRESS/ ✓ �_ ��® CITY,STATE,Z;747, / e 4 p 02
OWNER 0 OWNER-BUILDER 0 OWNER AGENT 0 CONTRACTOR 0 CONTRACTOR AGENT 0 ARCHITECT 0 ENGINEER 0 DEVELOPER 0 TENANT
y-�
CONTRACTOR NAME J� / / LICENSE NUMBERQ ,2 g. LICENSE TSPFs^ BUS.LIC.F 2 0
COMPANY NAME E-MAIL ( t� J FAX
STREET ADDRE � J CITY,STATE,ZIP �� p� � PHONE
ARCHITECT/ENGINEER NAME CA,- LICENSE NUMBER �j✓ BUS.LIC.F
COMPANY,NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE.
USE OF SFD or Duplex ❑: Multi-Family ROOF AREA: VALUATION: q�
SIM
STRUCTURE: 0. Commercial .,J V 00 `�I
EXISTING ROOF TYPE: 0 BUILT-UP ROOF 0 ASPHALT SHINGLES 0 WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY)
REMOVE/REPLACE 0 YES IF NO, PLYWOOD ❑ 'A" 0 PLYWD ❑ OSB rPITCH ROOF
0 NO Y LAYERS: THICKNESS: 0 5/8" TYPE: 0 CDX •12 I CLASS: A
PROPOSED ROOF TYPE: 0 BUILT-UP ROOF ❑ASPHALT SHINGLES 0 WOOD SHAKES 0 WO.II GLES 1:1OTHER ICC-ES REPORT
DESCRIPTION OF WORK: "re
Cile)
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 .ve 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 relat',to building constructio I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Age. . �� ; Date: r-
SUPPLEMENTAL INFORMATION 1QUIRED OFFICE IISE o 4L1
If building is associated with a Home Owner's Association,provide letter w PLAN CHECKIPE ROUTING SLIPS
of approval from HOA. OVER,THE COUIITER BLILDIN.GrLAI'REQIEW
Provide Planning a royal to verify if there anyrestrictions.
ISP �' � E3,PRESS ❑ PLAN'I�I�G PLAN RE\'IES3 '
Provide copy of Manufacturer's Installation Specifications. I] ST4�DARD I� FIRE DEPT
_Provide signed copy of Cupertino's Tear-Off Policy. ❑ OTE R
y k -
Rerooftlpp__20.11.doc revised 03/16/11
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
ALBERT SALVADOR, P.E.,C.B.O.,BUILDING OFFICIAL
UPERTfl�df3 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228• FAX(408)777-3333•building( cupertino:orq
PROJECT ADDRESS T) / 6 6 ( y AIN
OWATERNAME / I / f�
°at&PI /i,Pi L✓/ 15 '7 lO C ' E-MAIL
STREET ADDRESS /6 / J ✓ CITY,GG STATE.ZIP FAXAX
CONTRACTOR NAME 61/' I� 1) ,c_ipg LLI ENSE NUMBER9V.e 2,4. LICENSE TIDE,.- >q BUS.LIC.
COMPANY NAME t 1/ ( Lam/ fG E-MAIL /7[� ("'�; FAX
STREET ADDRESS . ;44e,
e, 2. }.of_ CITY,STATE,ZIP/4/ P N£ 5
F 2
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: I am the property owner or authorized agent to act on the
property owner's behalf. I understand and agree e omply with the re-roof policy stated above. I also understand that
smoke detectors and carbon monoxide detector. . required to be installed in accordance with Sections R314 and R315 of
the 2013 California Residential Code.
Signature of Applicant/Agent: � ,.�"" _aide Date:
Rer•oofPolicy 20I4.doc revised 01/15/14