B-2017-2007 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-2007
19960 STEVENS CREEK BLVD CUPERTINO,CA 95014-2306(369 05 008) KEITH ROOFING CO
INC
SAN JOSE,CA 95126
OWNER'S NAME: ERIC HOFFMAN FMLY LTD PTSP DATE ISSUED:'11/21/2017
OWNER'S PHONE:408-293-3500 PHONE NO:(408)295-8616
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-39 Lic.#554786
Contractor KEITH ROOFING CO INC Date 01/31/2019, X BLDG _ELECT _PLUMB
MECH RESIDENTIAL X 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:
FIRST TECH FEDERAL CREDIT UNION-ROOF REPAIR;TEAR OFF;
I hereby affirm under penalty of perjury one of the following two declarations: INSTALL CLASS B WODD SHINGLES;CAP SHEETS(9 SQ)
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.
�Mf `fi`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:$10500.00
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 05 008
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 regula' s per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
0a4A,.. _ Date 11/21/2017 Issued by:AbbyAyende
Date: 11/21/2017
0 R-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
i. I,as owner of the property,or my employees with wages as their sole installed without first obtaininl 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)
z. I,as owner of the property,am exclusively contracting with licensed . gnature ofAppl'-
contractors to construct the project(Sec.7044,Business&Professions Code). Date:11/21/201
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
i. 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
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 Cuperti o.Municipal Code,Chapter 9.12 and
' exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code, ns 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. I, „,,
,,h r or authorized age
,APPLICANT CERTIFICATION I i ate:11/21/2017
I certify that I have read this application and state that the above information is CO UCTION 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 11/21/2017 Licensed
Professional ,
„ , 'z-” CONSTRUCTION PERMIT APPLICATION
� COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
. 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 •
��' 201 '.
��' �s (408) 777-3228 • building��cupeTtino.org PEMIT�B- '
CUPERTINO REV S DEF E
❑ NEW CONSTRUCTION ❑ADDITION ❑ ALTERATION ❑T.I. ❑MEP OOF ❑SWIMMING POOL/SPA
PROJECT ADDRESS / /)(
901 / ,....;:on,1 ev�I�c f � � APNA 0(OWNER NAME .---2)1.\
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STREET ADDRESS .7CITY, STAT ZIP
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CONTRACTOR NAME '❑OWNER-BUILDER
COMPANY AME LICENSE NUMBER LICENSE TYPE
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0 ARCHITECT ❑OWNERNER AGENT 0 CONTRACTOR AGENT❑ENGINEER 0 DEVELOPER 0 TENANT
CONTACT N•, E-MAIL
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STREET ADDRESS CITY,STATE,ZIP PHONE '
DECRIPTON, )
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❑SINGLE-FAMILY/DUPLEX 0 MULTI-FAMILY• 0 INDUSTRIA6 .l .QeMMERCIAL I
EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES A TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION(5)
REMODEL REMODEL KITCHEN REMODEL,OTHR GARAGE ❑ATTACHED •
BATHROOM SF SF SF SF 0 DETACHED
EXISING ❑YES EICHLER 0 YES SECOND STORY ADDITION ❑YES
FIRE SPRINKLERS 0 NO ❑ NO •❑NO
DWELLING SECOND DWELLING ❑YES 0 ATTACHED DETACHED OTHER
UNrTS A UNIT ADDITON: ❑NO S F
POOLS ❑ FIBERGLASS 0 VINYL-LINED ❑GUNITE 0 PREFABRICATED
POOL-SF SPA-SF I SPA ATTACHED❑YES 0 NO I TOTAL-SF Environmental RECEI Y0444........... 3 o v
Commercial or Multi-Familu Buildings with Public Swimming Pools requires Department of Enviroental Heath approval
RE-ROOF EXISTING ROOF TYPE: ❑BUILT-UP ROOF❑ASPHALT SHINGLES WOOD SHAKES 000 SHINTILE OTHER(SPECIFY)•
/
REMOVE/REPLACE❑NO IF NO PLYWOOD ❑VI ❑3/8" PLYWOOD TYPE: PITCH:�/J� ROOF CLASS
1=1 YES A OF LAYERS THICKNESS❑S/8" OTHER_ ❑OSB E CDX OTHER / •12 A
PROPOSED ROOF TYPE:OBUILT-UP ROOF ❑ASPHALT SHINGLES 0 WOOD SHAKEA2OD SHINGLES 0 OTHER
*Provide a signed copy of the Cupertino's Tear-Off Policy SF9X A01 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 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 or.•-.nces and state laws relating to building construction. I authorize representatives of Cupertino to
enter the above-identified proper • inspection purposes. I acknowledge and authorize all information c itaineddon this application form
to be made available for publi ec.-• / j'
Signature of Applicant/Ag- t: Date: -
SUPPLEMENTAL INFORYTON 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.
WHOA-Provide a letter of approval from the Home Owner's Association
•
Bldg,4pp_20/7.doc revised 08/01/17
./ REROOF TEAR-OFF POLICY
VCOMMUNITY DEVELOPMENT DEPARTMENT.•BUILDING DIVISION
ass. ALBERT SALVADOR, P.E., C.B.O.,BUILDING OFFICIAL
I.
CUPERTthiC} 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•• FAX(408)777-3333••buildincl cupertino.ora r
PROJECT ADDRESS 79f, ,..o L(/G/ D FJ l 6•Lf/ APN#E ( ( ^ OC 00 lJ
OWNER NAME 4* l v /� O 74, — E-MAIL
(t) STREET ADDRESS AirA../J� 6 lady_ CrrY TAT L /�n 190J y" / FAX
CONTRACTOR NAME 'Y! '(� LIC .S I� R"
C/J/ LI SE '�C/ B
COMPANY N• E-MAIL FAX
STREEliAj}T�E�S Ldl{����C/+�1�1 / / 4 . C A' ZIPie". e (.; -/ )"71Z e
( 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 before the requested inspection date.
To schedule inspections call'(408) 777-3228 from 7:30-3:30pm(Mon-Thurs) or 7:30-2:30pin(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 work 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 12:30-3:30 (Mon-Thurs)
and 7:30-10:30am and 12:30-2:30 (Friday). Final Inspections will be given a two hour window.
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 all new material down to the sheathing so a proper inspection can be performed.
6. A Final Inspection and approval shall be obtained from the building inspector when the re-roofing is
completed. Tp receive a final sign-off, the following items will be verified:
a. Flat roofs shall have a minimum of 1/"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.
c. Proper spark 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 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 mono '.0detectors are required to be installed in accordance with Sections R314 and R315 of
the 2016 California Resident'- o,-. --de—k
Signature of Applicant/Age- : % ,� Date:
ReroofPolicy_2014.doc revised 06/01/7
CALIFORNIA DEPARTMENT OF FORESTRY &FIRE PROTECTION "
CAL
OFFICE OF THE STATE FIRE MARSHAL FIRE
FIRE ENGINEERING - BUILDING MATERIALS LISTING PROGRAM sir=e
./LISLTSTING SERVICE ..,-
LISTING
TING No. 4150-1450:100 Page 1 of 1
•
CATEGORY: Roof Covering,Wood Shakes/Shingles
LISTEE: Chemco, Inc.,4191 Grandview Road, Ferndale,WA 98248
Contact: Philip Favro (916)962-1066 FAX(916)965-9357
DESIGN: Model FTX and CedarPlus, and Chemco pressure treated, No. 1 Grade Western Red
Cedar shakes and shingles. Shakes and shingles, having a maximum moisture content
of 25%, are pressured treated with Chemco's proprietary FTX fire retardant chemical.
. Refer to*ICC Evaluation Services, Inc. ES Report No. ESR-1410 Reissued June 1, 2006
for additional detailed product description and installation considerations.
RATING: Class B and C
INSTALLATION: In accordance with listee's printed installation instructions,applicable codes&ordinances and
in a manner acceptable to the authority having jurisdiction.
Class B and C shakes and shingles are applied over 1/2"thick CDX plywood with exterior
glue*or spaced sheathing of 1"x 4"lumber,and a listed asphalt-saturated felt underlayment
and interlayment. Spacing between shakes and shingles shall notbe less than 3/8" nor
more than 5/8". The roof valley flashing shall be fabricated of not less than No. 28 Ga.
galvanized sheet corrosion-resistant metal applied over at least Type 15 felt. Hot-dipped
zinc-coated*fasteners shall be used.
For Class A assemblies,Class B shakes and shingles shall be applied over 1A4"Dens-Deck(a
glass-faced gypsum roof board),or a minimum approved and listed 72-lb mineral surface
fiberglass cap sheet,*complying with ASTM D3909,installed over solid or spaced sheathing
as described for Class B and C. The Dens-Deck shall be fastened with a minimum four
fasteners per board and the cap sheet shall be installed with a 2-inch overlap on sides and
ends.The use of the Class A assembly is subject to the final approval of the authority having
jurisdiction.
MARKING: Listee's.name, model number, classification, and CSFM label.
APPROVAL: Listed as Class B and C, pressure treated red cedar shakes and shingles when installed on
• minimum roof slopes of 4:12 and when used as part of a Class A assembly as described
under Installation Section above. Class B shingles may be usedon minimum roof slopes of
3:12 when at least listed Type 15 felt underlayment is used and the installation is approved by
the authority having jurisdiction.
l
*Rev.10-11-2006jw
1.4:
c
This listing is based upon technical data submitted by the applicant. CSFM Fire Engineering staff has reviewed the test results
and/or other data but does not make an independent verification of any claims. This listing is not an endorsement or
4s:•,',.;;+ recommendation of the item listed. This listing should not be used to verify correct operational requirements or installation
criteria. Refer to listee's data sheet, installation instructions and/or other suitable information sources.
Date Issued: MAY 29, 2008 Listing Expires June 30,2009
Authorized By: BEN HO, Chief
Fire Engineering Division