B-2017-1575 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1575
10251 MILLER AVE CUPERTINO,CA 95014-3465(369 42 002) SHADOWFAX
ROOFING INC
CAMPBELL,CA 95008
OWNER'S NAME: ZOEY HUANG DATE ISSUED:09/13/2017
OWNER'S PHONE:650-319-5709 PHONE NO:(408)628-0065
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-39:B Lic.#894247
Contractor SHADOWFAX ROOFING INC Date 04/30/2019 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(16 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 forwhich this permit is issued.
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. 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 369 42 002
representatives of this city to enter upon the above mentioned property for
inspection purposes. (We)agree tosave 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 regulati•ns per the C rtino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
*turf/ Date 9/13/2017 Issued by:Abby Ayende
Date:09/13/2017
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the I2.E-ROOFSt
following two reasons: All roofs shall be inspected prior to any roofmg 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
g44.4e
compensation,will do'the work,and the structure is not intended or offered for :spectio
sale(Sec.7044,Business&Professions Code)
2. I,as owner of the property,am exclusively contracting with licensed rs 'e of Applicant
contractors to construct the project(Sec.7044,Business&Professions Code). D. :9/13/2017
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
z. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materialslrequirements 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 •ctions 25505/' 533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. '
Owne_ ,70 thorized age• L«/1 %L✓.%�_�
APPLICANT CERTIFICATION Da.a 4 . ! I/
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.
Signature Date 9/13/2017 Licensed
Si
g Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION B .
fii.:p
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
SY.1,- 45
:4,..„,4., (408) 777-3228 • building �cupertin.o.org PEMIT#B- 40 -
CUPERTINO REV# DEF F
❑ NEW CONSTRUCTION ❑ADDITION ❑ALTERATION ❑T.I. ❑MEP OE-ROOF ❑SWIMMING POOL/SPA
PROJECT ADDRESS /
1 0`• St I InL11 `// APN a alq} (42, 2.
OWN AME PHONE c E-MAIL-} /0,02.STREE D SS a 65v SIT'11 >-7a1
CITY,
'].CONTRACTOR NAME 0 OWNER-BUILDER COMPANY NAME LICENSE NUMBER 'LICENSE TYPE
�`l 3
STREET ADORE . CTATE, ZIP I
E-MAIL PHONEBUS.LIC t,
❑ARCHITECT ❑OWNER ❑OWNER AGENT ❑CONTRACTOR AGENT❑ENGINEER❑DEVELOPER 0 TENANT
CONTACT jCr�vy SLL(ie __
E-MAIL
STREET ADDRESS� / CITY,STATE,ZIP PH E
401'G2 g-ov65-
DECRIPTON I.. 114 i` +4..:4,../.60,0-
[w0.G �1 "6/4..t. ,_ ' /�•/# / O- Q
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/ Ins 7J�T
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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($)
i
REMODEL REMODEL KITCHEN REMODELOTHR (GARAGE 0 ATTACHED
BATHROOM SF SF SF SF 0 DETACHED
EXISING ❑YES EICHLER ❑ YES SECOND STORY ADDITION ❑YES
FIRE SPRINKLERS 0 NO 0 NO 0 NO
DWELLING SECOND DWELLING ❑YES ❑ATTACHED❑DETACHED OTHER
UNITS a UNIT ADDITON: ' ❑NO S F
POOLS' ❑FIBERGLASS 0 VINYL-LINED ❑GUNITE ❑PREFABRICATED
POOL-SF SPA-SF ; I SPA ATTACHED OYES ❑ NO I TOTAL-SF
REMN:: e TOTAL VA- L I TION:
Commercial or Multi-Family Buildings with Public Swimming Pools requires Department of Environmental Heath aupronal ((WWet-F i ►WQ'�"n1r i1 1k+litJ'IV1
RE-ROOF EXISTING ROOF,TYPE: ❑BUILT-UP ROOF❑ASPHALT SHINGLESIIWOOD SHAKES❑WOOD SHINGLES❑TILE OTHER(SPECIFY)
REMOVE/REPLACE 0 NO IIF NO PLYWOOD " ❑3/S" PLYWOOD TYPE: ' PITCIe ROOF CLASS
IR YES 1LAYERS THICKNESS OF LAYERTHICKNESS❑5/8" OTHER �oss ❑CDX OTHER `Z—'12 A
PROPOSED ROOF TYPE:❑BUILT-UP ROOF ❑ASPHALT SHINGLES 0 WOOD SHAKES DWOOD SHINGLES ❑OTHER
*Provide a signed copy of,the Cupertino's Tear-Off Policy SF �n Rot SQUARES ��.F'
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 laws relating to building construction. I authorize representatives of Cupertino to
enter the above-identified property for '. spection pur;..ses. I acknowledge and authorize all information c ntaine on this application form
to be made available for,Ipublic recd .
Signature of Applicant/Agent: s.//y/ it , Date: g I.3 %)-1V-3----
SUPPLEMENTAL INFORI%IATIO EQUIR i '
*New SFD/Second Dwellirig Units/Multifamily Dwellings:A Demolition permit is required prior to issuance of a building permit for all new construction.
*Commercial Buildings: Piovide a 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 aipproval from the Home Owner's Association
13
1
1 BldgApp_2017.doc revised 08/01/17
Ia
1
iv,:Tog REROOF TEAR-OFF POLICY .
COMMUNITY DEVELOPMENT DEPARTMENT*BUILDING DIVISION •
•.;,<'* --!:,,.1'..- ALBERT SALVADOR, RE., C.B.O.,BUILDING OFFICIAL
AVIN.,,B;
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
t U PERI";4 o
' (408) 777-3228* FAX(408)777-3333*building@curertino.org
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• ntoJEcr ADDRESS ,/
Oe.767 ///itGr- ”" -6L,4 442-0
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OWNER NAME • I. HONE E-MAIL
ile, .____Lo- V q-57 07
• mull'ADDRESS i , 2 / CITY, STATE,ZIP , 1 FAX
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CON I- ;10R:',;A,.. • jee 1,10ENSE NUNIBER,,. .... LX'NSi.4 t P..46 BUS.Ur.9z ç' 4' .... .
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CO° A,' NAME • , - E-MAIL FAX
STREET ADM'''. e. .0,446‘r • i _rj CITY,ST,. E,ZIP / .a.e.? e„. PHON.
A ;, Azi.4 -d --a OF--e5taa •-
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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 110jiigie tujklesslia ',tp_Ie re ested ins eetion.date.
To schedule inspections call (408) 777-3228 from 7:30j.-330pirt( 6n-,Thurs) or 7:302:30pm (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 l'iiiork 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 1.2:30-3:30 (Mon-Thurs)'
and 7:30-10:30am and 12:30-2:30 (Friday). Final Inspections will be given a tWo,hour window.
6,
i Tear-Off Inspection:is required. Any and all thy-rotted wood shall be rep this this inspectipn.
Unless new plywood:roof sheathing is prdposed throughout, all the nails/fasteners,shall.be either
completely knocked'-down or removed1prior to this inspection.
. I:
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 sheathings° a proper inspection;Can be performed.
6., A Final Inspection and approval shall be obtained from thebuilding inspector req.00fing is
, ,
completed. To receive a final sign-off,the following itents,Will be verified:
a. Flat roofs shall have a minimum of 1/4" per foot of slope and demonstrate there isno ponding.
b. Listings from approved testing agencies for all pre-manufactured products luSed shall be
available onsite to review at the time of the inspectibn.
c. Proper spark arrestor installation, vents painted, gutter/downspouts installed,:debrisremoved.
. i hi; d"
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. '
..
I3y my sioling below, I certify each of the following is true:• I am the property o or atithorieltigint to acton the
property owner's behalf. I understand and agree to comply with the re-roof policy stated abbve: 14s,61itnderitand that .
smoke detectors and carbon mo - 'ide detectors a required to be installed in accordance with Seetid4'R31,i•and R315 of
the 2016 California Resident', . de.
#
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