B-2017-1215CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-1215
21928 OAKDELL PL CUPERTINO, CA 95014-1161 (326 18 048)
DAN ELLIOTT'S
ROOFING COMPANY
SAN JOSE, CA 95159 -
OWNER'S NAME: LAM CHRIS C AND COLLEEN
DATE ISSUED: 07/25/2017
OWNER'S PHONE: 408-807-7986
PHONE NO: (408) 559-7327
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
i
License Class SSS Lic. #611338
Contractor DAN ELLICITT'S ROOFING COMPANY Date 01/31/2019
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:
REROOF; TEAR-OFF; INSTALL OSB; COMP SHINGLES (25 SQ)
I hereby affirm under penalty of perjury one of the following, two declarations:
t. 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
erformance of the work for which this permit is issued.
have and `,'will maintain Worker's Compensation Insurance, as provided for by
Section •3700 the Labor Code, for the of the work for which this
of performance
permit is issued.
Sq. Ft Floor Area:
Valuation: $12427.00
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 18 048
representatives of thiscity enter upon the above mentioned property for
,°
inspection purposes;'(We),agree to save indemnify and keep harmless the
City of Cupertinq'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.
iAJSi u.r Date 7/25/2017
Issued by; Abby Ayende
Date: 07/25/2017
OWNER-B UILDER'DECLARATION
I hereby, affirnr�6at 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 I has 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
corripensatron, will do the work and the structure is not intended or offered for
inspection.
sale (Sec 7044, Business & Professions Code)
2: I, as oaner',of the property; am exclusively contracting with licensed
afore ofApplic v
(Date:
contractorsto constrnct the project (Sec.7044, Business & Professions Codt
7/25/20 it
I hereby affirm urider, penalty of perjury one of the following three declarations:
"A"
J! I have and swill maintain a Certificate of Consent to self-insure for Worker's
ATT ROOF COVERINGS TO BE CLASS OR BETTER
f I I
i � `Compensaa-tion, as provided for by Section 3700 of the Labor Code, for the
,
perforriiance',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 13700 of the Labor Code, for the performance of the work for which this
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
;, ;.I
permit'ig issued.
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
is.,
_3. I certify that the performance of the work for which this permit is issued, I
Health & Safety Code, Section 25532(a) should I store or handle hazardous
sliall;not employ any person in any manner so as ito become subject to the
i
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 Coinpensation laws of California. If, after making this certificate of
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
exemption,lbecome 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.
mer or authorized ager
j. APPLICANT CERTIFICATION
Date: 7/25/2017
I certifythat: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
of
Lender's Address
consequence the granting of this permit. Additionally, the applicant understands
and will comply with';`ali non-point source regulations per the Cupertino Municipal
ARCHITECT'S DECLARATION
Code, Section 9:18,2'
1 understand my plans shall be used as public records.
Licensed
Signature Date 7/25/2017
Si 9
Professional
NAME'N 6Irl jt 1-'-',IAII-
\ JCL YY\ --S
FAN
SaAW
NANIFU B-NiAll.
STWE rl-�'
TJADUIMS�,� Ck L _._O... .. . . . . ..........
0 ovvm'A 0 lmuYER ❑0 OWNM�� AGENr CONTRI"'C"Ok OCONTKACTMAGEN-r CJARCIM7.(.,, n ;Notmmm u rxv-m-om,� L M It; NA
LAMM Y BUS IAC
*V,SS�- 734-7
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s i"RPIE'.1— IT RF*11'1�
BU'S LIC
NAMP
FAX
"IRM, ADDRESS
PHONE
st; OF (k] S -FD or Duplex [I Multi -Family
VALU'Alla"';
FJ Commercial
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M�Ii\O ROOF TYPE' BUILT-Ul R(WJr LIASMAMASPINGLA'S 6WOODSFIAKI-S, D At 0 1 111 NG11, li S al'IIFI
REMOVE ilu'-TLACE YES
IF NO, N.YlIM001) CI �,o
MICH:
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KH�OR 4
PROPOSEDROOFTYPE' ASPHAL ;MINGLE i WOODAIARES 13W00JM1TmA---:i El amr.R
OPSCM71"KANOF
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By my 5ign1tufe beta Y. I certify to each or the foil Gwing: lam the prollertYowi 'rorniitborizvd aged illoact on ale ProprrIyom"ller'sbehall"
�� I � omplywillallappl; IALJO'Cal
application and the irdbiTrat I i 's C-olrect. I has the De.iz p[iott of and vefjf� it k necumu". I agree to
: : ' '
I ficd
-ordirtance-sandslate law, dalingEOlUild lim" lal, rig rei)MS• ma, W , cay, fpr in5p"V pjrpo.��.
e, liveziorcullerlillo to ell rtheabove-idenW prop
Agent:_ .... ....... . .. . . . .. .....
SUPPLEN11'XIAL IN FORMATION REQ
Provide letter Me, j W'; t�" 7--
o= approval from HOA. -W
Pix Je Planning ap rova) to verii'v irthere any mstricfious..1NINCTCAIN ENN-,
Provide copy oCA'Aarimflacturer's histallation Specifications,
..........
Provide Aarted copy of (,upertinoVUar-OtT Policy.
rerised (1311&1 i
REROOF FFA POLICY
COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
CUPERTINO (408) 777-3228 - FAX (408) 777-3333 - 11L�cu�etLln_o_.O_rg
I UNDERSTIVIND AND AGF03TOITIE, FOLLOWING:
The re -roof projectshall. comply with all applicable provisions of the 20 1. 6 California Codes.
2. An inspection request can be scheduled to to one business day before the reguested. insL) ction date.
To schedule inspections call (408) 777-3228 from 7:30-3 ):50pni (Mon-Thurs) or. 7:30-2:30pm (Friday) to
schedule inspection. 'F or 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 wili be out to the
kala 1) site within one hour. The hours for this service are: 7:30,40.30am and 12-30-3:30 (Mon -
and 7.30-10-30am and 12:30-2:30 (Friday). Final Inspections will be given a two hour window.
3. Tear -Off Insi2ection is reguired. ' Any and all ch -y -rotted wood shall be replaced prior to this inspection
LInlessnew 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 Nailingjnsj)ection is reqUired,
5. Rooring shall not be applied without -first obtaining all prior inspection and written approvals fron'l the.
bUilding inspector. Any roofing which is applied without first obtabung 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 apprgyal shall be obtained ftoin. the building inspector when the re-rool'ing is
completed. TO receive a final sign -off. the follgk�v ing items will be verified,
a. Flat roof's shall have a minimum of per Boot of'slope and demonstrate there is no ponding.
b. Listings frot-n. approved testing agencies for all pre -manufactured products used shall be
available on-site to review at the tune of the inspection.
c 'Proper spark arrestor installation,
vents painted, gutten,"do,,vrispouts installed, debris removed.
7. NOTE: 'if vou call lbr a tear -off or plywood.nailing inspection and the work is not cornpleteYQU will be
W
charged a re -inspection. fee. The re -inspection fee small lac paid efcare araQtlaer insoection call be
scheduled.
Bymy signing below, I certify each of the following is tri.je: I aaaa the property owner or authorized agent to act on the
property ow'ner's behalf. I understand aiid agree to comply with the 1'0 -oof policy stated above. I also understand Chat
sanc)ke detectors and carbon rnonoxid o s are requiredX) lbel hast:
led in accordance xvith Sections . IZ314 and 8315 of'.
(",-' �Ctll S
the 201 6 California residential Codd X
Raraqlpohc.i 204 -doe revised 06'01/7
OWNER NAMF MHONE
....... ...
STREFY ADDPESS r AX
VONIRf",CTOR NAC41N
X_ Ay----Is11a,m�`
.. ....
('0',1PANY NAMIE E-MAIL
FAX
KY STATE 2111
I UNDERSTIVIND AND AGF03TOITIE, FOLLOWING:
The re -roof projectshall. comply with all applicable provisions of the 20 1. 6 California Codes.
2. An inspection request can be scheduled to to one business day before the reguested. insL) ction date.
To schedule inspections call (408) 777-3228 from 7:30-3 ):50pni (Mon-Thurs) or. 7:30-2:30pm (Friday) to
schedule inspection. 'F or 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 wili be out to the
kala 1) site within one hour. The hours for this service are: 7:30,40.30am and 12-30-3:30 (Mon -
and 7.30-10-30am and 12:30-2:30 (Friday). Final Inspections will be given a two hour window.
3. Tear -Off Insi2ection is reguired. ' Any and all ch -y -rotted wood shall be replaced prior to this inspection
LInlessnew 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 Nailingjnsj)ection is reqUired,
5. Rooring shall not be applied without -first obtaining all prior inspection and written approvals fron'l the.
bUilding inspector. Any roofing which is applied without first obtabung 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 apprgyal shall be obtained ftoin. the building inspector when the re-rool'ing is
completed. TO receive a final sign -off. the follgk�v ing items will be verified,
a. Flat roof's shall have a minimum of per Boot of'slope and demonstrate there is no ponding.
b. Listings frot-n. approved testing agencies for all pre -manufactured products used shall be
available on-site to review at the tune of the inspection.
c 'Proper spark arrestor installation,
vents painted, gutten,"do,,vrispouts installed, debris removed.
7. NOTE: 'if vou call lbr a tear -off or plywood.nailing inspection and the work is not cornpleteYQU will be
W
charged a re -inspection. fee. The re -inspection fee small lac paid efcare araQtlaer insoection call be
scheduled.
Bymy signing below, I certify each of the following is tri.je: I aaaa the property owner or authorized agent to act on the
property ow'ner's behalf. I understand aiid agree to comply with the 1'0 -oof policy stated above. I also understand Chat
sanc)ke detectors and carbon rnonoxid o s are requiredX) lbel hast:
led in accordance xvith Sections . IZ314 and 8315 of'.
(",-' �Ctll S
the 201 6 California residential Codd X
Raraqlpohc.i 204 -doe revised 06'01/7
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