B-2017-1459 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: . CONTRACTOR: PERMIT NO:B-2017-1459
10896 LINDA VISTA DR CUPERTINO,CA 95014-4749(356 14 045) CAMPBELL ROOFING
INC
CAMPBELL,CA 95011
OWNER'S NAME: PRADHAN FIROZ AND ZUBEDA DATE ISSUED:09/01/2017
OWNER'S PHONE:408-821-2051 PHONE NO:(408)326-2611
•
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-39 Lic.#963201
Contractor CAMPBELL ROOFING INC Date 07/31/2019 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:
RE-ROOF;TEAR-OFF;COMP SHINGLES(28 SQ)
I hereby affirm under penalty of perjury one of the following two declarations:
a. 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'-rformance of the work for which this permit is issued.
vI 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:$11000.00
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 356 14 045
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.
gnature Date 9/1/2.017 Issued by:Abby Ayende
Date:09/01/2017
OWNER-BUILDER DECLARATION.'.
I hereby affirm that I ant exempt from the Contractor's License Law for one ofthe RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
t, 1,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 _fuer; re ofApplicant
'.contractors to construct the project(Sec.7044,Business&Professions Code),'Fir ate:9/1/2017
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
LI 1 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:9/1/2017
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 9/1/2017
Professional
CONSTRUCTION PERMIT APPLICATION
\' / COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO,CA 95014-3255
y"{.19s.-
(408) 777-3228 • building@cupertino.or SDI
PEMIT#B- I
CUPERTINO REV# DEF#
❑ NEW CONSTRUCTION ❑ADDITION-❑ALTERATION ❑T.I. ❑MEp IRE-ROOF ❑SWIMMING POOL/SPA
PROJECT ADDRESS /_isiejet, 1 APN#l� Ts�rhv� r ' I4-0Ck�
OWNER NAMEP NE E-MAIL
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STREET ADDRESS CITY, STATE,ZIP
ZrCONTRACTORNAME ❑OWNER-BUILDER COMPANY NAME LICENSE NUMBER LICENSE TYPE
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[STREET ADDRE911 CITY,STATE I
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E-MAIL PHONE BUS.LIC# 131/
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❑ARCHITECT ❑OWNER ❑OWNER AGENT [f]CONTRACTORAGENT❑ENGINEER 0 DEVELOPER❑'TENANT
CONTACT NAME gapE-MAIL
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STREET ADDRESSF CITY,STATE,ZIP PHONE
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DECRIPTON '
2ewev-eSk i7p/eC C?14ti Aj 4ci/l 'fif
eSINGLE-FAMILY/DUPLEX , ❑MULTI-FAMILY ElINDUSTRIAL ❑COMMERCIAL I
EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF'STORIES# TOTAL NET SF USE TYPE OCC. SQ.FT. VALUATION($)
REMODEL REMODEL,KITCHEN REMODEL OTHR GARAGE ❑ATTACHED
BATHROOM SF SF ' '' !' SF SF ❑DETACHED
-
EXISING 1:1YES EICHLER j❑'YES' SECOND STORY ADDITION ❑YES
' FIRE SPRINKLERS❑NO ❑1 NO 0 NO
DWELLING SECOND DWELLING 0;YES�'ti ATTACHED❑DETACHED OTHER
UNITS# UNIT ADDITON: i ❑NO S F
POOLS ❑FIBERGLASS ❑VINYL-LINED 0 GUNITE 0 PREFABRICATED
POOL-SF SPA-SF ,II, SPA,ATFACHED DYES O NO TOTAL-SF
RECEIVED BY:
Ili;! T AL VALUATION:.
Commercial or Multi-Family Buildings with Public Swimming Pools requires Department of Environmental Heath approval /� p,/"l� �p,✓. J 0 \\II' 6.-in
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, RE-RO OF'EXISTING ROOF TYPE: ❑BUILT-UP ROOF❑ASPHALT SHINGLES❑WOOD SHAKES❑WOOD SHA GLES. LTIL`(/E�,OTHER(SPECIFY) ll 4Jl 1
REMOVE/REPLACE Q NO IF NO PLYWOOD
3/8" PLYWOOD TYPE:he n,i tef PITCH:
1214.h.'" ElROOF CLASS
YES #OF LAYERS I THICKNESS❑5/8" OTHER ElOSB ❑CDX - OTHER .12 A
PROPOSED ROOF TYPE:❑BUILT-UP ROOF GASPHALTSHINGLES U WOOD SHAKES❑WOOD SHINGLES ❑OTHER
*Provide a signed copy of the cupertino's Tear-Off Policy SF #of SQUARES Z
• By my signature below I certify to each of the following: I am the property owner or authorizedagent 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 building construction. I authorize representatives of Cupertino to
enter the above-identified property'for inspection purposes. I acknowled•e and authorize all information cont ' d on this application form
to be made available for public record. -
Signature of Applicant/Agent: _ - Date:
SUPPLEMENTAL INFO`do •.-;.: K D - ..
*New SFD/Second Dwelling Units/Multifamily Dwellings:A Demolition permit is required prior to issuance of a building permit for all new construction.•
'*Commercial Buildings: Provide la coiiipleted Hazardous Materials Disclosure form if any Hazardous Materials are being"used as part of this project.
*Copy of PlanninglApproval Letter or'Meeting with Planning prior to submittal of Building Permit application.
*HOA-Provide a letter of approioin al fithe Home Owner's Association
B1dgApp_2017.doc revised 08/01/17
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‘P'71ir REROOF TEAR-OFF POLICY
CQMMUNIrrY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
ALBERT SALVADOR,P.E.,C.B.O.,BUILDING-OFFiCIAL
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTI NO
(408) 777-3228•FAX(408)777-3333•building ocuoOrtino:org
. - . ' .. •
..PROJECT ADDRESS ,
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OWNER NAME Ftw_ i PHON Liao oz i /15.e.
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STREET ADDRESS CITY, STA' ',ZIP 1 FAX
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CONTRACTOR NAME 09C ve
CLICENSE NUMBER erg p, 1 i LICENSE TYPE BUS.LIE.g
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eompANy NAME E-MAIL FAX
STREET ADDRESS aCITY,STATE,ZIP I P110,''
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I UNDERSTAND AND AGREE TO THE FOLLOWING:
I. 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 businesSda* before'.the inspection date.
, .., .
To schedule inspections call (408)777-3228 from 7:304:3PMEMen!-Thurs) of 7:30-2 .30pm(Friday)to
schedule inspection. For tear-Off and Nailing InspeetionS,,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: 7304 ;30arn and.12:30-3:30,(Mon-Thur.$)
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 tothisinspection.
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 Lailinghaneetio .
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 sheathings° a proper inspectiOn can be performed.
NI 6. . A Final Inspection and.approval shall be obtained froiri the,building inspector when the re-roofing is
,
completed,. TO receive a final Sign-Off,the following,itena-,,ivill be'verified:.
a. Flat roofs shall have a minimum of'A" 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. . li
h
c. Proper spark arrestor installation, vents painted, gutter/downspouts inStalled. debris removed.
- I,
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 aid before anOthr ins oetion can be
11
scheduled. ' .1
. . . . . „
By my signing below, I certify each of the following is true: I am the property owner orauthOrized agdin 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 deteetors.are required to be installed in accordance with Sections R314 and•R315 of ', ...
the 2016 California Residential ,"....
‘, • _ma ,
Signature of Appheant/A0e411140/Paips --.-- Date.
" 1
Rerocyroticy_2014.doc revised 06/01.7