B-2017-1566 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1566
21045 FREEDOM DR CUPERTINO,CA 95014-5704(326 53 026) EASTMAN ROOFING
&WATERPROOFING
INC
SAN JOSE,CA 95126
OWNER'S NAME: YANAGISAWA NORIKO TRUSTEE DATE ISSUED:09/13/2017 •
OWNER'S PHONE:408-559-1977 PHONE NO:(408)971-9000
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class ROOFING. Lic.#525051
Contractor EASTMAN ROOFING&WATERPROOFING INC Date 02/28/2018. 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:
REROOF;TEAR-OFF;INSTALL SINGLE PLY SYSTEM OVER
I hereby affirm under penalty of perjury one of the following two declarations: EXISTING CAP SHEET ROOF(5 SQ)
t. [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
•erfonmance of the work for which this permit is issued.
'I}tave 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:$1708.00
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 53 026
representatives of this city to enter upon the above mentioned property for
inspection purposes. (We)agree to saveindemnify 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 1 SO DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands and will comply with all non-point
source regulations per the Cupe ino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
g ature\1\(' 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 RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
1. 11,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 ,ait sit re of Applicant: \C` V`
contractors to construct the project Sec.7044,Business&Professions Code Pate: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
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 1 store or handle hazardous
3. +1 certify that in the performance of the work for which this permit is issued,I
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 25505,2553 ,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall l
be'deetned revoked: ( ner or authorized agent: v
APPLICANT CERTIFICATION CERTIFICATION w Date:9/13/2017
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 9/13/2017
Professional
CONSTRUCTION PERMIT APPLICATION
4")
/� COMMUNITY DEVELOPMENT DEPARTMENT •
BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO,CA 95014-3255 ry
�ZS'1951, (408)777-3228 • building@cupertino.org PEMIT#B- ;2.0 `, - 1C
CUPERTINO REV# DEF#
❑ NEW CONSTRUCTION ❑ADDITION ❑ALTERATION ❑T.I. ❑MEP la<ROOF ❑SWIMMING POOL/SPA
PROJECT ADDRESS APN#
tAc 15 rr'e rl r 0� . Zu' .5 --0- t,
O NER N E CO(I/t("%J i i j�1\\ PHONE E-MAIL
5 rA�nM a. (5 11 Awl°, r,e,-,- - 9Oss-55°\- ke
STREET ADDRESS CITY,STATE,ZIP
153c Q(A (.r i - &Ark ;.1eAA 1a. °i Cog
Q'CONTRACTOR NAME- 0 OWNER-BUILDER
COMPANY NAME LICENSE NUMBER LICENSE TYPE
STREET ADDRESSI JM� t ' U(16-1'1.0\
C.PfY,STATE,ZIP
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v-1vg .0@ J' lnk-S �� • 5-.n `Tose, CQ- 01S ' Z b
E-MAIL V PHONED +y�" BUS.LIC#
110
0 ARCHITECT 0 OWNER DOWNER AGENT ' ONTRAC OR GENT❑ENGINEER EER 0 DEVELOPER❑TENANT ✓
`
COINII NE-MAIL
\ AC,16r Ai n ez-
STREET ADDRESS CITY,STATE,ZIP PHONE
DECRIPTON^1.r \ ‘
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-s\nee)r- 'rack— ex.`od�1\ S d ('.
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INGLE-FAMILY/DUPLEX ❑MULTI-FAMILY 0 INDUSTRIAL 0 COMMERCIAL I
EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES It TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION($)
REMODEL REMODEL KITCHEN REMODEL OTHR GARAGE 0 ATTACHED
BATHROOM SF SF SF SF 0 DETACHED
EXISING ❑YES EICHLER ❑YES SECOND STORYADDmON ❑YES •
FIRE SPRINKLERS❑NO 0 NO 0 NO
DWELLING SECOND DWELLING ❑YES ❑ATTACHED❑DETACHED OTHER
UNITS# UNIT ADDITON: 0 NO S F
PO OA 0 FIBERGLASS 0 VINYL-LINED 0 GUNITE 0 PREFABRICATED
POOL-SF SPA-SF I SPA ATTACHED 0 YES 0 NO I TOTAL-SF
REC TOTAL VALUATION:
Commercial or Multi-Family Buildings with Public S 'amtin-Pools re.uires D',artment o Environmental Heath a .roaal Ip,._ CI 61
RE-ROOF I EXISTING ROOF TYPE: 0,:UILT-UP ROOF 0 ASPHALT SHINGLES 0 WOOD SHAKES❑WOOD SHINGLES❑TIL OTHER(SPECIFY) `[ C7/4
REMOVE/REPLACE NO IF NO PLYWOOD 01 ❑3/8" PLYWOOD TYPE: PITCH: ROOF CLASS
OYES #OF LAYERS_ THICKNESS❑5/8" OTHER ❑OSB ❑,C�DXX OTHER b �,,"�{ '12 A
PROPOSED ROOF TYPE:❑BUILT-UP ROOF ❑ASPHALT SHINGLES 0 WOOD SHAKES MOOD SHINGLES Ix-lOTHER ,;/t rkP Q 1�
*Provide a signed copy of the Cupertino's Tear-Off Policy J S'F�5(h #of SQUARES .5
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 ordin ces and state laws relating to building construction. I authorize representatives of Cupertino to
enter the above-identified property for ins ection urposes. I ac wledge and authorize all information contained on this application form
toSi ben madeeavailableAplicfor public record. c A l ( 31 )'
Signature of Applicant/Agent: � Date:
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
r' REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O.,BUILDING OFFICIAL
C't3PEf3TIN0 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408) 777-3228•FAX(408)777-3333•building a(�,cupertino.orct
PROJECT ADDRESS - APN
2..109 S to r- '
{y�4'!.G\-' 701/41E �� PHONE 534_ E-MAIL
L• 0�.5 wtncT. �� i �` � T
STREET ADDRESS CTY, STATE,.-EP FAX
CONTRACTOR TOR NAME LICENSENNUM.BEY LICENSE TYPE DOS.LEC.#
5'2,5115.1
CO.:EPANS NAME E-MAIL FAX
STREET ADDRESS CITY,STATE.ZIP _ PHONE
OA r .4141 - C SVZ, k' ' 1`cib
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 business.dav before.the..requested inspection date.
To schedule inspections call (408) 777-3228 from 7 30 3 3Opm,(Moi,-Thurs} or 7:30-2:30pm (Friday)to
schedule inspection. For Tear-Off and Nailing Inspections;you must also call on the clay 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: 7:30-i030.arn;and 12:30-3:30 (Mon-Tours).
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 to this inspection.
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 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 new material down to thesheathiiig_so a proper inspection can be performed.
6. A Final Inspection_nd_approval shall be obtained from the:building inspector when the re-roofing is
completed. To receive a final:Sign off,the following-itel iswill be:verified:.
a. Flat roofs shall have a_minimum of'A"per foot of slope and demonstrate there is no ponding.
b. Listings fromapproved testing agencies for all pre-manufactured products used shall be
available on-site to review at the time of the inspdtioti.
c. Proper spark arrestor installation, vents painted,`gutter/downspouts installed, debris removed.
7. NOTE: If you call for a tear-off or plywood nailinginspeetion 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.
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. I also understand that
smoke-detectors and carbon monoxide detectors are required to be installed in accordance with Sections.R314 and R315 of
the 2016. California Resident' :l %de.
Si4;n azure of.ApplicantlA.gent
RerovfPolicv_201 .clot revised 06'01;7