B-2017-0368CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0368
21255 STEVENS CREEK BLVD CUPERTINO, CA 95014-5724 27
(326 039) ROOFLINE BUILDERS
INC
PLEASANTON,CA
94566
OWNER'S NAME: MODENA INVESTMENT LP
DATE ISSUED: 03/06/2017
OWNER'S PHONE: 408-257-2103
PHONE NO: (925) 201-1924
LICENSED CONTRACTOR'S DECLARATION A R ATT
BUILDING PERMIT INFO:
License Class M2.Lic. #95 ,Wl
Contractor ROOFLINE B ll DERS INCDate 05/31/2017"
X BLDG _ELECT _PLUME
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
— MECH — RESIDENTIAL X 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:
RE-ROOF/RE-APPLY; REMOVE (E) CLAY TILE (NO PLAY); RE-
have and will maintain a certificate of consent to self -insure for Worker's
INSTALL CLAY SHINGLES (82 SQ'S)
S)
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
2.,";' 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: $30800.00
APPLICANT CERTIFI ATION
1 certify that I have read this application and state that the above
APN Number:
Occupancy Type:
information is correct. I agree to comply with all city and county ordinances
and state laws relating to building construction, and hereby authorize
326 27 039
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
may accrue
PERMIT EXPIRES IF WORK IS NOT STARTED
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 CALLED INSPECTION.
Signatu a :' I S.Z \ 60 b'\'i~U l Date 03/06/2017
Issued by: MELIS
Date: 03/06/2017
OWNER -B I DER DECT ARATif)N
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
inspection.
sale (Sec.7044, Business & Professions Code)
z. I, as owner of the property, am exclusively contracting with licensed
.
Signature ofApplicani �n -z. ,Q `� \
contractors to construct the project (Sec.7044, Business & Professions Code).
Date: 03/06/2017
I hereby affirm under penalty of perjury one of the following three declarations:
1. I have and will maintain a Certificate of Consent to self -insure for Worker's
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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 25532(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 equipment or devices which emit hazardous
Worker's Compensation laws of California. If, after making this certificate of
air contaminants as defined by the Bay Area Air Quality Management District I
exemption, I become subject to the Worker's Compensation provisions of the
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Sections 25505, 25533, and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
," f
Owner or authorized agent:.'\°Q
APPLICANT ..RTIFI ATION Date:
/f
03/06/20171 L
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 1
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
ARCHITECTIS DECLARATION
Code, Section 9.18. 1
understand my plans shall be used as public records.
Licensed
Signature Date 03/06/2017 Professional
J
RERO®F PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
Is 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
CUPERTINO (408) 777e3228 • FAX (408) 777-3333 • building(cilcupertino org
PROJECT ADDRESS ! j
APN # 27
OWNER NAME�. g;
SCD V—ft? PHO E-MAIL
STREET ADDRESS 03
CITY, STATE, ZIP FAX
CONTACT NAME
1� � to tom,> C 1 CC -A 9 �' o 8 q-
PHONEE MAIL
iQ 5)?Q
STREET ADDRESS
CITY STATE ZIP
' FAX
OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTORAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER El TENANT
CONTRACTORN LICENSIE ���
r � SDC, LICE TYPE BUS. LIC
COMPANY NAME V "1
E-MAIL
FAX
STREET ADDRESS f, y CITY, ST ZIP 1 PHONE
A ` She \'�C n���f �_i ► �C�.,
ARCHITECT/ENGINEER NAME
LICENSENUMBER
COMPANY NAME --�
i E-MAIL
STREET ADDRESS I CITY, STATE, ZIP
USE OF ❑ SFD or Duplex ❑ Multi -Family ROOF AREA: VALUATION:
STRUCTURE: Commercial ¢y
EXISTING ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPFLALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SIIINGLES
REMOVE /REPLACE�CIYES IF NO, PLYWOOD El ❑ PLYWD ❑ OSB
rn —
PROPOSED ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES
DESCRIPTION OF WORK:
M
9
BUS. LIC. #
FAX
PHONE
-0CL-
13 OTHER (SPECIFY) 9
C( e- (9-0
PITCHROOF
:
12 CLASS: A
❑ OTHER _ I ICC -ES REPORT #
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 relatin to building construction. I authorize representatives of Cupertino to enter the abov-identi ed property for inspection purposes.
Signature of Applicant/Agent: ys.p � C(--pW� Date: �7j �d 6 � 2
SUPPLEMENTAL INFORMATION REQUIRED o>icE usE ONLY
If building is associated with a Home Owner's Association, provide letter IPl CHECK TTPEr.'7R
ali\G SLIP
of approval from HOA.
THE-COULTERAi\ REVIEW
Provide Planning approval to verify if there any restrictions. EGRESSAN REVIEW
Provide copy ofManufacturer's Installation Specifications.sTanvaliD Provide signed copy ofCupertino's Tear-OffPolicy.TH
ReroofApp_2011.doc revised 03116111
REROOF TEAR -OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building cuperti g gMR p Z0 (3 o `� 6'k
PROJECT ADDRESS TW644 S 6R V & 6 L %Jf->
APN #
CJ
OWNERNAME
5fo"x-.6azaor- & J
PHONE'^V
q6g-ZS-7-210
E-MAIL
STREET ADDRESSS� s �_
Z 1-7 (o s ; &ocws oac/. .2a s'CU
CITY, STATE, ZIP
P6_12 --f-7 ns cs Gni F ) i
FAX
CONTRACTOR NAME
goagolj� �, G� �
LICENSE NUMBER
�����
LICENSE TYPE
—�q
BUS. LIC. #
i� 3c,3J7
COMPANY NAME
iZGo(c � atr u ��e ire
E—MAIL
A�� i2wc-i
FAX
?,?,Y- 3
STREET ADDRESS
CITY, STATE, ZIP
PHONE
I UNDERSTAND AND AGREE TO THE FOLLOWING:
1. The re -roof project shall comply with all applicable provisions of the 2016 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 Inspectionis required. -Any and all dry -rotted wood shalilbe replaced prior to thisinspection.
Unless new plywood roof sheathing is proposed throughout, all the nails/fasteners shall be either
completely knocked -down or removed prior to this inspection. Y
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. AlFinal 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 %4" 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-� e to T ew at tho dime of thy; �inspectlon.
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 nay, signing b Dlow, I ccitifjr .cacti of the follbwipg is- true: I am, the prop -ty ovmer or auffid nized age tis ac t- 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 8314 and 8315 of
the 2016 California Residentia Code.
Signature of Applicant/Agent: Date: 31h11_0 (%
Rer^oo)Policy_2014.doc revised 12/15/16