B-2017-0527 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-0527
10160 PARK CIRCLE E CUPERTINO,CA 95014-1953(326 32 046) D&M QUALITY
ROOFING
SAN JOSE,CA 95112
OWNER'S NAME: PARK CIRCLE,LLC DATE ISSUED:04/03/2017
OWNER'S PHONE:408-729-4818 PHONE NO:(408)313-4408
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-39 Lic.#646795
Contractor DI&M QUALITY ROOFING Date 06/30/2018 X BLDG _ELECT _PLUMB
MECH X RESIDENTIAL COMMERCIAL
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing —
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
UNITS 1-4;REROOF;INSTALL TPO;INSTALL(N)PIPE JACK
I hereby affirm under penalty of perjury one of the following two declarations:
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:$7750.00
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 326 32 046
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 FROM LAST CALLED INSPECTION.
C`.Signature Date 4/3/2017 Issued by:Abby Ayende
Date:04/03/2017
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 prior to any roofing material being installed.If a roof is
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)
2. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
0
contractors to construct the project(Sec.7044,Business&Professions Code). Date:4/3/2017
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 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
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 Code,Sections 25505,25533,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:4/3/2017 (�`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 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. I understand my plans shall be used as public records.
Licensed
Signature Date 4/3/2017 Professional
/
._"11 ' 02:
• REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
s.s„,
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
..„.. ,
(408)777-3228•FAX(408)777-3333•buildinq(a cupertino.orq
CUPERTINO
PROJECT ADDRESS 6 it(70
61 I , 7 APN# 'brae2^' Of 1(„
OWNER NAME era_,,,,,,�� PHONE 'lei A r lr��r� E-MAIL
STREET ADDRESS /a i tc a circle. ` CITY,STATE,ZIP ��n ik`(wOO-- CA\ Ct50 lL FAX
CONTACT NAME PHONE I E-MAIL-MA •
STREET ADDRESS '' CITY,STATE,ZIP FAX
Elv COWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ONTRACTOR 0 CONTRACTOR AGENT ❑ ARCHITECT 0 ENGINEER- 0 DEVELOPER 0 TENANT
CONTRACTOR NAME 4 LIC I SE NUXBER, LIC NSSEr.41 BUS.LIC.#) "3 9
COMPANY NAME C4--6
(ct E-MAIL lerB j FAX
STREET ADDRESS / 7 1( Ser CITY,STATE ote GP-[! PHONE � 1(0_2
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC.#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF DVS-AD or Duplex 0 Multi-Family ROOF AREA: VALUATION:
STRUCTURE: 0 Commercial ....0-4:10.- 7?S"c
EXISTING ROOF TYPE: 11KUILT-UP ROOF 0 ASPHALT SHINGLES 0 WOOD SHAKES 0 WOOD SHINGLES 0 OTHER(SPECIFY)
REMOVE/REPLACE ❑YES IF NO, PLYWOOD 0 W' 0 PLYWD 0 OSB PITCH: ROOF
/PM) #LAYERS: THICKNESS: 0 5/8” TYPE: 0 CDX '12 CLASS: A
,,��,,//"' ICC-ES REPORT#
PROPOSED ROOF TYPE: 0 BUILT-UP ROOF 0 ASPHALT SHINGLES 0 WOOD SHAKES 0 WOOD SHINGLES t3/`OTHER iCr
DESCRIPTION OF WORK: r 7
h S R t( ik-il4,1C__ I. /15J cti el t,,,/, i .5
cete c ,e.etcC ,-ri 51 c. ( I 62 ;II tic c -c--- v
J, V ` f2 -e_cJQQC bU 5
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 b ; construction. I authoriz- -•_- ,tatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date: "— / 7
SUPPLEMENTAL INFORMA ON REQUIRED OFFICE USE ONLY
If building is associated with a Home Owner's Association,provide letter PLAN CHECK TYPE ROUTING SLIP
of approval from HOA. 0 OVER-THE-COUNTER 0 BUILDING PLAN REVIEW
Provide Planning approval to verify if there any restrictions. ❑ EXPRESS 0 PLANNING PLAN REVIEW
Provide copy of Manufacturer's Installation Specifications. 0 STANDARD 0 FIRE DEPT
Provide signed copy of Cupertino's Tear-Off Policy. 0 OTHER.
ReroofApp_2011.doc revised 03/16/11