B-2017-1481 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1481
10571 CYPRESS CT CUPERTINO,CA 95014-2423(316 30 056) ATHK
CONSTRUCTION INC
MILPITAS,CA 95035
OWNER'S NAME: BOREL PRIVATE BANK&TRUST COMPANY TTEE DATE ISSUED:09/06/2017
OWNER'S PHONE:,408-367-9788 . PHONE NO:(408)569-5890
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C39 Lic.#941248
Contractor ATHK CONSTRUCTION INC Date 12/31/2017 X BLDG _ELECT _PLUMB
MECH XC 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;INSTALL OSB;COMP SHINGLES-(22 SQ)
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.
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
I
permit is issued. Sq.Ft Floor Area: Valuation:$8000.00 •
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 316 30 056
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..
Signature Date 09/06/2017 Issued by:)(im Dunbar
Date:09/06/2017
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 of Applican. -
contractors to construct the project(Sec.7044,Business&Professions Code). Date:09/06/2017
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
i 1. ,I have and will maintain a Certificate of Consent to self-insure for Worker's
Compensation,,as provided for b'y 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
"' Health&Safety Code,Section 25532(a)should I store or handle hazardous
3. I certify that in'the performative of the work for which this permit is issued,I
material. Additionally,should I use equipment or devices which emit hazardous
shall not'employ any person in any manner so as to become subject to the air'contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of,Califomia. 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
,I APPLICANT CERTIFICATION Date:09/06/2017
I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY
correct.I agree to,comply with allwcity and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance
relating to building construction;i'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 ttiis,permit. Additionally,the applicant understands ;:
and will comply with all non-point source regulations per the Cupertino Municipal , ARCIIITECT'SD CLARATION
Code,Section 9.18. .I understand my plans shall be used as public records.
•
Licensed
Signature Date 09/06/2017 Professional
/ CONSTRUCTION PERMIT APPLICATION
• '\. / COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
-;.I.P.:/ 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
"�K`�9ss (408)777-3228 • building@cupertino.org PEMIT#B- [C 19 - / la/
CUPERTINO REV# DEF#
• ❑ NEW CONSTRUCTION ❑ADDITION ❑ALTERATION ❑T.I. ❑MEP RE-ROOF ❑SWIMMING POOL/SPA
PROJECT ADDRESS o S -7 1 . G Y' ' R.t-,---ss S cif- �N# /^ - 30 - 05- 6 w
OWNER N 1J( G f A R-&- N C 4'023 ) 7PHONE O 3 o 7 ✓.7 d E-MAIL ..
STREET ADDRESS CITY, STATE,ZIP
3 Am - A 6 0 L1& ' ,
134 CONTRACTOR NAME ❑OWNER-BUILDER COMPANY NAME LICENSE NUMBER LICENSE TYPE
�' �� (COIN 9 et- ( 02 q e. 3-1
•
I STREET ADDRESS CITY,STATE, ZIP '
l 9 #�v� or✓ r2 M i f�P( i s .
E-MAIL PHONE BUS.LIC# •
❑ARCHITECT ❑OWNER ❑OWNER AGENT D CONTRACTOR AGENT❑ENGINEER❑DEVELOPER 0 TENANT
CONTACT NAMEE-MAIL
STREET ADDRESS CITY,STATE,ZIP PHONE
DECRIPTON
T IL O -/ /- I,L d o •g S K ik IL—f—. i N S 1 A L L 6-c a
•
. A r\-) D . S 0 y f2-S le_ 0 e oLf F 0 S ,� r r o w . .
•
' ❑SINGLE-FAMILY/DUPLEX, 0 MULTI-FAMILY 0 INDUSTRIAL 0 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 0 ATTACHED
, BATHROOM SF 'SFI SF SF ❑DETACHED
EXISING ❑YES EICHLER'f❑�YES SECOND STORY ADDITION 0 NO
FIRE SPRINKLERS'❑NO 1 0 NO
DWELLING SECOND'DWELLING ',0 YES ❑ATTACHED❑DETACHED OTHER
UNITS# (UNITADDITON: 1 I,❑NO SF
POOLS' ❑FIBERGLASS ❑VINYL LINED ❑GUNITE ❑PREFABRICATED
POOL-SF ' SPA-SF Ii:SPA ATTACHED ❑YES _. NO TOTAL-SF
1 REC4 44: VALUATION:
ALUATION:
Commercial or Multi-Fmnilp Buildings with Public Swimmm, Pools requires Deportment of Environmental Heath approval 4.
❑ ['ASPHALT ❑ 00 � P V A Jam/
RE-ROOF'EXISTING ROOF TYPE: BUILT-UP ROOF ASPHALT SHINGLES WOOD SHAKES SHINGLES❑TILE OTHER(SPECIFY)`,
REMOVE/REPLACE 0 N IF NO ' PLYWODD rich„ ID3/8" PLYWOOD TYPE: PITCH:5 ROOF CLASS
EryES #OF LAYERS A THICKNESS.5/8" OTHER �bSB CDX OTHER J 12 A
PROPOSED ROOF TYPE:❑BUILT-UP'ROOF,*SPHALT SHINGLES 0 WOOD SHAKES OWOOD El
SHINGLES 0 OTHER
*Provide a signed copy of the Cupertino's Tear-Off Policy SF wog.. #of SQUARES
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 ar d!,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 ilocal ordinances and state laws relating to building construction. I authorize representatives of Cupertino to
. enter the above-identified property for inspectio purposes. I acknowledge and authorize all information contained on this application form
. to be made available for pubh¢'record. /
Signature of Applicant'/Agent ' / Date: &I .S1 ,I 1
SUPPLEMENTAL INFORMATION REQUIRED I ( '
*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: Providea completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project.
*Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. • •
*HOA-Provide a'letter of approval from the Home Owner's Association
1 1' , ,
B1dgApp_2017.doc revised 08/01/17
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REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION -
. ..
„ .
ALBERT SALVADOR,P.E.,C.B.O.,BUILDING OFFIOIAL
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
COP;EFOINCIt /-4...—
/ Vil/
(408)777-3228•FAX(408)777-3333*building@cupertinoorq t t '
b-20
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PROJECT ADDRESS
4 p 6-7 I C. P R -S'S c___-t- API*: 3 ,...... 30 .._6 0 s ,
i
OWNER NAME . • I PHONE E-MAIL .
ti I e. k_ -F f-- E iv C.PA
STREET ADDRESS CITY, STATE,ZIP I FAX
10
CONIR,TFOR NAME LICENSE NUMBER , LICENSE TYPE BUS.LIE.P
i-i i< t.--0 ill C__ s5 ef i,e Q_ 1 c.- 3 g 1
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COMPANY NAME E-MAIL FAX
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STREET ADDRESS CITY,STATE,ZIP , • PHONE
• 1,1AV/ ion/ _D i'e..... Am t- p 1 'T,1--.< , . 2S i 22s-1,
I UNDERSTAND AND AGREE TO THE FOLLOWING:
1. The re-roof project shall comply with all applicable provisions of the 2016 C.alifornia,codes.
, .
2. An inspection request can be scheduled on to one busirtess'da before:the requeSted insnettion date.
.
To schedule inspectio4s call (408) 777-3228 firm 7:30;-3.:. ()pin.(Mbri-tfiurs) ór.7:302.2:3Opm (Frida))to
schedule inspection. For Tear-Off and Nailing Inspectionyou must also callIon the day of the
inspection,only after that phase of the work is completedE The building inspector Will be out to the
job site within,one hour. The hours for this service are: 730-10:30am and 12:304:30(Mon-Thurs)
and 7:30-10:30am and 12:30-2:30 (Friday). Final Inspectionwill:be given ia to 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/fastenershall be either
completely knocked-dOwn or removed prior to this inspection. . .
4. If plywood is installed, a plywood Lialljaghpas Inspection is l'_._, ..vt!.i .
5. Roofing shall not beapl plied 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.
l
6. A Final Inspection and approval shall be obtained from the building inspector when the re-roofing is
completed, To receive a finataign-Off,.the followinglieffiss:VN,Till•be verified:
I
a. Flat roofs shall have a minimum of'/4"per foot ofSlope and demonStrate there is no ponding.
b. Listings from approved testing agencies for all pre4nanufactured products Used shall be
available on-site to review at the time of the inspection. . . .
c. Proper sparki 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 shalkbenahlbefore 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., 1alsO',understand that
smoke detectors and carbon,monoxide detectors are required to he installed in accordance with Sections R31.4 and R315 of
the 2016 California Residential Code
j 1/4s-
''Signature ofApplieanvAgera: ._,. ,. . Date: ! . 1 i ..'. .
or , --7
1 .
Rerogq'olicy_.20,14.doc revised 06/01/7
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