B-2017-0789CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR. PERMIT NO: B-2017-0789
19845 PORTAL PLAZA CARL BECKS AND
SONS ROOFING
SPECIALISTS
SAN JOSE, CA 95123
OWNER'S NAME: THEO KUBILEC
DATE ISSUED: 05/18/2017
OWNER'S PHONE: 408-255-2744 1 1 PHONE NO: (408) 365-8979 1
License Class C-39: B-1 Lic. #411239
Contractor CARL BECKS AND SONS ROOFING SPECIALISTS Date 09/30/2017
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.
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
p ormance of the work for which this permit is issued.
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.
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
and state laws relating to building construction, and hereby authorize
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 against said City in consequence of the granting of this permit.
Additionally, the applicant understands and will comply with all non -point
source regulations per OV Cupertigc, Municipal Code, Section 9.18.
E�/'✓I//. �'
Date 5/18/2017
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
1. I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for
sale (Sec.7044, Business & Professions Code)
2. I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec.7044, Business & Professions Code).
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
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.
I certify that in the performance of the work for which this permit is issued, I
shall not employ any person in any manner so as to become subject to the
Worker's Compensation laws of California. If, after making this certificate of
exemption, I become subject to the Worker's Compensation provisions of the
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
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 and state laws
relating to building construction, and hereby authorize 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 against said City in
consequence of the granting of this permit. Additionally, the applicant understands
and will comply with all non -point source regulations per the Cupertino Municipal
Code, Section 9.18.
Sig
Date 5/18/2017
BUILDING PERMIT INFO:
BLDG —ELECT —PLUMB
MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
G-1 - RE-ROOF;TEAR-OFF; INSTALL ISO; DENS-DECK;TPO (15 SQ)
Sq. Ft Floor Area: I Valuation: $16000.00
APN Number: I Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: Abby Ayende
Date: 05/18/2017
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspect_i f-
SignatureofApplicant:_v%
Date: 5/18/2017
ALL ROOF COVERINGS TO BE CLASS "A"
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safe Code ections 251051J25533, and 2 4.
Owner or authorized age
L!4
Date: 5/18/2017
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
of work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed
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(d)cupertino.org
PROJECT ADDRESST�_E /C� APN 4 e� r
oa
OMNER NAME ee j� PHO ! E M� f r i i.�� 8 6 C'
STREET ADDRESS J J� Cr CITY, STA/T� Z,IP l FAX
6 /" L 'G'/�✓�s
CONTACT NAME 5av" ^ S PHONE E-MAIL
STREET ADDRESS YYI (� CITY, STATE, ZIP FAX
❑ O-AWER ❑ ONTTER-BUILDER ❑ ONTTER AGENT CONTRACTOR ❑ CONTRACTOR AGE1T ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME , LICENSE NUvIBE LICENSE TYPIJ
BUS. LIC. Q /5
COMPANY NAME t�
LF.,kAlLge--�
r, �✓-
FAX
1 G
i
STREET ADDRESS /� 1
CITY, STATE; ZIP I i / 7�
C�
J
PHONE
S�
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC. r
COMPANY NAME
E-MAIL
FAX
STREETADDRESS
CITY STATE ZIP
PHONE
USE OF ❑ SFD or Duplex ❑ Multi -Family ROOFAR)EA: VALUATION:Ajwr
STRUCTURE: ❑ Commercial
EXISTING ROOF TYPE: 21 BUILT-UP ROOF ❑ ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER (SPECIFY)
REMOVE/REPLACE a'�ES IF NO, PLYWOOD PLYWD ❑ OSB PITCH: ROOF
❑ NO LAYERS: THICKNESS: ❑ 5/8" TYPE: ❑ CDX 12 CLASS: A
PROPOSED ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES _2 OTHER
ICC -ES REPORT n
DESCRIPTION OF WORK: n
'�. ^�J- 1 1 ti I i) IJf/�t ".�'LW.�d •� n �.l "T' C �? '� �i.� r_ L7 �� ' .�' «T/�3�
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 ofWork
and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building consswti.0n. authorize representatives of
Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: %d(�1/G�
Date:
SUPPLEMENTAL INFORIAATION REQUIRED
OMCE USE O\ , ..:'
_ If building is associated with a Home Owner's Association, provide letter
P� �N''cHi cK PE , .. ,
,._ . RoUTI TG size ,
of approval from HOA.
a
❑ OY ER TFLE-COUNTER
❑
BLTILDING�LAI� REY'IEW
_ Provide Planning approval to verify if there any restrictions.
❑;.
❑ �I�ni
EaPREsS W
pi �G PI Ar. RE\ IE\i
Provide copy of Manufacturer's Installation Specifications.
❑ sTALVAizD
❑ FIRE DEPT.
Provide signed copy of Cupertino's Tear -Off Policy.
_ ,,,,
❑:..OTHER.
Reroof4pp_2011.doC revised 03116/11
GZ��1
CUPERTINO
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(alcupertino.org
PROJECT ADDRESS/
12&V
J
!/
,
APN
OW'N'ER NAME
PHoNTE
E-MAIL
STREET ADDRESS
CITY, STATE, ZIP
FAX
CONTRACTOR NAME�� A „ f
/ �i A
JLL Le
LICENSE NUMBER �
LICENSE -11PE� ✓
BUS. LIC.
COMPANT' NAME ^
_'
E-Mkm
FAX
STREET ADDRESS/` )p
;'
CITY, STATE, ZIP � �
-
*
PHoNTE �ry 07 1
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 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 fi-om 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.
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 ani 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 R3 15 of
the 2016 California Residential Code. �^ l
Signature of Applicant/Agent: Date: �7 ` 7 ^ 1
Re7-00fP01icy_2014.doc rel,ised 12/15/16
R