B-2017-1186CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:.
CONTRACTOR:
PERMIT NO: B-2017_-1186
21134 HAZELBROOK DR CUPERTINO, CA 95014-1663 (326 55 028)
LIBERTY ROOFING
SAN JOSE, CA 95133
OWNER'S NAME: SU HUNG I TRUSTEE
DATE ISSUED: 07/21/2017
OWNER'S PHONE: 408-603-7885
PHONE NO: (408) 786-3177
LICENSED CONTRAC'TOR'S DECL RATION
BUILDING PERMIT INFO:
License Class ROOFING Lic. #.Q -M
Contractor LIBERTY ROOFING Date 03/31/2018
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:
RE -ROOF; TEAR OFF; COMP SHINGLES- (31 SQ)
I hereby affirm under penalty of perjury one of the following two declarations:
m. 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.
Ci ,Performance
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: $14200.00
APPLICANT CERTIFICATION
I 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 55 028
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.
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.
Signatur' e , –^--Daate 7/21/2017
Issued by: Jasmine Archbold
Date: 07/21/2017
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
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)
2. I, as owner of the property, am exclusively contracting with licensed
Signature ofAp�ilicant:
contractors to construct the project (Sec.7044, Business & Professions Code).
Date: 7/21-/201"7
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
a. 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, 25 33, and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
r
be deemed revoked.
Owner oratithoFized agent:
APPLICANT CERTIFICATION
Dat 7/21/2017
C7
I certify that I have read this application and state that the above information is
CONS CTIOXLENDINGA!��
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.
1 understand my plans shall be used as public records.
Licensed
Signature Date 7121/2017
Professional
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(c)cupetno.org
CUPERTtN
n— I(R(,
/
PROJECT ADDRESS2-11
lid`C
aze� rj2o)) Jr
APN n �'
�?
OWNERNAME / r j PHOv
E-AJR
M
�9 `
STREET ADDRESS CITY, ATE, ZIP
FAX
CONTTACT NAME �q p ' 1 pgON
ST_REETADDRESS
CITY, STATE, ZIP
FAX
❑ ow,�'ER ❑ owiuR-BUILDER ❑ OMIERAGENTI' ❑ CONTRACTOR ❑ CON-MACTORAGENT ❑ ARCHITECT ❑ ENGATEER ❑ DEVELOPER ❑ TENANT
� LICENSE NUMBER y�
CONTRACTOR NAME + � elC
f
�
LICENTSE TYPE
BUS. LIC. - [� /ry
(�(O
COMPANY NAME v
E-A4AII
STREET ADDRESS B
f CITY, STATE, ZIP
PHOI TE
ARCHITECT/ENGL'vtER Iv AA2E I LICENSE- N*.;MBER
BUS, LIC. r
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF SFD or Duplex L"] Multi -Family
ROOF AREA:
VALUATION:
$TRliCTURE>^.J COITiIllerCial
5r
2—
EXISTING
EXISTING ROOF TYPE: ❑ BUILT -IIP ROOF KSPI-IAL�T SINGLES ❑ A'001) SILAXES
❑ WOOD SHLNTGLES ❑ OTHER (SPECIFl,)
REMOVE /REPLACE KS
NO, PLYWOOD ❑ w, ❑
PLYWD ❑ OSB
PITCH:
ROOF
_ ❑ NO
IF I�
: LAS'ERS: I THICIG ESS: ❑ 5/S"
TYPE: ❑ CDX
' 12
CLASS: A
PROPOSED ROOF TYPE: ❑ BUILT-UP ROOF dASPFIAi.T SHINGLES ❑ WOOD SHAKES
❑ WOOD SHINGLES ❑ OTHER
ICC -ES REPORT
DESCRIPTION OF \YORK �
1 n R
P F
r C�'� S1 •
oaF
_)CO)ev Vo tie? y1' <-Li'v/
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 lases relating to bqdigg constractio - authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent:
Date: C- �'
SUPPLF,MENT II& FORMATIO SQUIRED
of ICE:I sE QN
_ If building is associated with a Home Owner's Association, provide letter
PLA -N, cx> cx ryPE -
_ RovTInG STIP
O ER THE-COUNTER-Jq
BUILDIAGPL3n REVIEI3
of approval from HOA.
Provide Planning ' roal to verify if there an restrictions.
—.. - . ..P _..> .. Y res
ak�y. _ ,. _.. , .
�nni�G P� An IiEt IE«T
_rI
Provide copy of Manufacturer's Installation Specifications.
L7sTAND Rn --
0 TIRE .
Provide signed copy of Cupertino's Tear -Off Policy.
oTHEx
h
ReroofXpp_2011.doc revised 03116/11
717
REROOF TEAR -OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
CUPERTINO 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333 - building cupertino org
PROTECT ADDRESS 20 J� APN # 6 _
- �a zeLA ro
OWNER NAME
f J 1"CITYSOTATE,
E-MAIL
Ct/A STREET ADDRESS l FAX
CONTRACTOR NAME n fJ% LICENSE NUMBER/' LICENSE TYPES ' BUS. LIC. #
r i
�ry
COMPANY NAME ?I d E-MAILp
AX
STREET ADDRESS ('Yj � � p � CITY, STATE, ZIP � 1 ��� P00 (13? PHONE q ,y�p
�j
I &DERSTAND 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.
To schedule inspections 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 out to the
job site 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 1/" 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 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 2016 California Residential Code. . I
of Applicant/Agent.&''�%.��� Date:
ReroofPolicy_2014.doc revised 06/01/7