B-2017-1554 CITY OF CUPERTINO BUILDING PERMIT
BUILDING,ADDRESS: • CONTRACTOR: PERMIT NO:B-2017-1554
22306 RANCHO DEEP CLIFF DR CUPERTINO,CA 95014-3928(356 02 044) LEGACY ROOFING&
WATERPROOFING INC
SAN JOSE,CA 95712
OWNER'S NAME: WELSH MICHAEL S TRUSTEE DATE ISSUED:09/12/2017
OWNER'S PHONE:408-226-3300 PHONE NO:(408)467-0150
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class CC=39 Lic.#802656
Contractor LEGACY ROOFING&WATERPROOFING INC Date 01/31/2018 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;OVERLAY EXISTING CAPSHEET ROOF;3/8 DERAFOLD;
I hereby affirm under penalty of perjury one of the following two declarations: 50 MIL WHITE DUROLAST PVC
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
erformance of the work for which this permit is issued.
i14211.1111/Khave 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:$25310.00
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 02 044
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.
O
Sig -'e 1 e, Date 9/12/2017 Issued by:Jasmine Archbold
the e:09/12/2017
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 Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:9/12/2017
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 torollib
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 haveand 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 Section's 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall I
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIFICATION Date:9/12/2017 j
I certify that I have read this application and state that the above information is CONSTRUCTION LEND GA ENCY
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 9/12/2017 Licensed
Si
9 Professional
CONSTRUCTION PERMIT APPLICATION
\i " / COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
r 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 S
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r (408)777-3228 • building(tIcupertino.orfy PEMIT#B- /�
CUPERTINO REV# DEF#
❑ NEW CONSTRUCTION ❑ADDITION ❑ALTERATION ❑T.I. ❑MEP NI
Z 1' Rot" 1FF RE-ROOF ❑SWIMMING POOL/SPA
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[CONTRACTOR NAME ❑OWNER-BUILDER COMPANY NAME LICENSE NUMBER LICENSE TYPE '
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❑ARCHITECT ❑OWNER ❑OWNER AGENT CONTRACTOR AGENT 0 ENGINEER 0 DEVELOPER 0 TENANT
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SINGLEIFAMILY/DUPLEX ❑MULTI-FAMILY ❑INDUSTRIAL ❑COMMERCIAL I
EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES 0 TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION($)
REMODEL .1 i REMODEL KITCHEN REMODELOTHR GARAGE ❑ATTACHED
BATHROOM SF SF SF SF 0 DETACHED
EXiSI ib ❑YES EICHLER 0 YES SECOND STORY ADDITION ❑YES
, FIRE SPRINKLERS 0 ANO 0 NO 0 NO
DWELLING i'SECOND DWELLING ❑YES ❑ATTACHED❑DETACHED OTHER
UNITS p 'UNITADDITON: : ; 0 NO S F
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767/7 4 i,❑FIBERGLASS ❑VINYL-LINED 0 GUNITE ❑PREFABRICATED
POOL SF ,' SPA:-SF I SPA ATTACHED OYES 0 NO I TOTAL-SF
II I II REC ED TOTAL VALUATION:
Commercial or Multi Family Buildings with Public Swimming Pools requires Department of Environmental Heath approval _ •2_$) 3 O
REiROOFI;'EXISTING ROOF TYPE: BUILT-UP ROOF❑ASPHALT SHINGLES❑WOOD SHAKES❑WOOD SHINGLES❑TILE OTHER(SPECIFY)
REMOVE/REPLACE NO IF* PLYWOOD nw' ❑3/8" PLYWOOD TYPE: PITCHaROOF CLASS
❑YES #OF LAYERS THICKNESS I:1 Sir OTHER 1:OSB IACDX OTHER i' :12 A
PROPOSED'ROOF TYPE:❑BUILT-UP ROOF ❑ASPHALT SHINGLES El WOOD SHAKES❑WOOD SHINGLES 1:1 OTHER P V C
*Provide aligned copy of the Cupertino's Tear-Off Policy SF'1500 ttof SQUARES ?S
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'nspection purposes. I acknowledge authorize all information contained on this application form
to be made available for public record
Signature of Applicant/Agent: �}•t� Date: 1(12)11
SUPPLEMENTAL INFORMATION REQUIRED
*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 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 approval from the Home Owner's Association
BldgApp_2017.doc revised 08/01/17
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT 4 BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O.,BUILDING OFFICIAL
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERtik0 1 5L\ •
(408) 777-3228 4 FAX(408)777-3333•building@cupertinworq
RWCr ADDRESS
22.10 eglet t API
8661 02' 0116L-/
OWNER NAME I'IONE E-MAIL
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STREET ADDRESS CITY, STATE.ZIP FAX
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CONTRACIOR NAMEA A LICENSE NUMBER LICE SR TYPE BUS.LIE.
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I UNDERSTAND 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 beforethe requested inspection.date.
To schedule inspections Call (408) 777-3228 from 7:30:30Pin(Mon-thurs) oi 1:30-2:30pm (Friday) to
schedule insPection. for Tear-Off and Nailing InspectidpS,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: I:AO-10;30am and 12:30f-3:30 (Mon-Thurs)
and fr;3O-10;:30ant and 12:30-2:30 (Friday). Final Inspections will be given a two hour window.
3. Tear-Off ectioris tired. Any and all dry-rotted,wood shall be replaced prior to this inspection.
Unless new plywdod 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, aplywood NLajlinginipssthiLiii:aidred.
5. Roofing shall not he applied without first obtaining all.prior inspection and written approvals from the
building insPector.. Anytroofing which is applied without first obtaining an approved inspection will
require the rernoval of all new material down to the sheathing's° a proper inspection can be performed.
6. A Final Insneetion and,'approval shall be obtained:fronithebuildina inspector when the re-roofing is
•
completed.':1fareeeiVe arra sign-:Off.,the following iteMs*ill be verified:
a. Flat roofs shall!have a minimum of I/4" per foot of Slope and demonstrate there is no ponding.
i
b. Listings,from approved testing agencies for all pre-manufactured products used shall be
available on-site;to review at the time of the inspeetion.
c. Proper spark arrestor installation, vents painted, gutter/downspouts installed, debris removed.
7. NOTE: If you call for atear-off or plywood nailing inspection and the work is not complete, you will be
charged a re-inSpeetion tee. The re-inspection fee shall be said before another ins ection can be
scheduled. '
„ -
By my signing below,I certify each of the following is true: ram 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 aceordance with Sections R314 and R3,15 of
the 2016 California Residentia de.
Signature ofApplicant/Agent J> _ _ Date: [12"1
Reroeolicy, 2014.doc revised 06/017