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B-2017-2100
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-2100 10130 CRAFT DR CUPERTINO,CA 95014-3477(375 02 020) SIMON SAYS ROOFING SAN JOSE,CA 95135 OWNER'S NAME: PESIC YELENA DATE ISSUED:12/07/2017 OWNER'S PHONE:408-531-9700 PHONE NO:(408)531-9700 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C39 Lic.#784948 Contractor SIMON SAYS ROOFING Date 09/30/2018 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;TEAR-OFF;INSTALL OSB;COMP SHINGLE(33 SQ) I hereby affirm under penalty of perjury one of the following two declarations: t. I have and will maintain a certificate of consent to self-insure for Worker's Compensation,as providedfor by Section 3700 of the Labor Code,for the nC performance of the work for which this permit is issued. IF 2.V 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:$16000.00 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 375 02 020 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 12-07-2017 Issued by:Kim Dunbar Date: 12/07/2017 OWNER-BUILDER DECLARATION I hereby affirm that I ani 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 t. 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, s(Seowner of44,t]e es&Professions Code) L / �J . .4C.S 3'�t 2. I,as owner the property,am exclusively contracting with licensed Signature of Applicant: contractors to construct theproject(Sec.7044,Business&Professions Code). Date: 12-07-2017 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 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 material. Additionally,should I use equipment or devices which emit hazardous shall not employ any person Im 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 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 25505,25533,and 25534. Labor Code,I mustforthwitli comply with such provisions or this permit shall nnn be deemed revoked; Owner or authorized agent: 1,41117.461-€ .2ein ., I APPLICANT CERTIFICATION Date:12-07-2017 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 keepiharrrildae the City of Cupertino against liabilities, judgments,costs,and expenses wh'ich 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 12-07-2017 Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION .10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 . �,n 7.)c - z/DO `�S--s''�- (408) 777-3228 • hLlildingC?-cupertino.org PEMIT»B- CUPERTINO REVS DEFE • ❑ NEW CONSTRUCTION ❑ADDITION ❑ALTERATION ❑T.1. E MEP ❑RE-ROOF ❑SWIMMING POOL/SPA PROJECT ADDRESS I] ® l 3 6 c r 1 P APN a, Os-4-5--- O Z—f 2l� Y, OWNER NAME 1 "'1� iv ef) C PHONE r©S J J 3 I -1�Q STREET ADDRESS ' CITY, I E-MAIL ` , STATE,ZIP / •yl¢ p 40 qS ly CONTRACTOR NAME 0 W R-BUILDER�COMPPA Y NAMEL CENSE NI MBE I`� ` LICENSEYPE�I STRT ADS P1 s i�h�h s i'wlau x s C °A"J TE, ZIP 7Siiy S c 3q 1 E-MAIL Y PHONE S• �, BUS.LIC'ft CI- 513$ , ❑ARCHITECT ❑OWNER ❑OWNER AGENT 0 CONTRACTOR AGENT El ENGINEER 0 DEVELOPER❑TENANT CONTACT NAME I E-MAIL L, STREET ADDRESS CITY,STATE,ZIP PHONE • DECRIPTON Tear © ) ane )ay-ef1 cif uuoo9 sh . c,JJ ply - v,p00.64 - j n r}v1i c.JAnp -;ln .,IPf . ❑SINGLE-FAMILY/DUPLEX L�vtULTI-FAMILY 0 INDUSTRIAL 0 COMMERCIAL , " EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES I TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION(5) REMODEL _ REMODEL KITCHEN REMODEL OTHR GARAGE ❑ATTACHED BATHROOM SF SF SF SF ❑DETACHED EXISING DYES EICHLER 0 YES SECOND STORY ADDITION D ES FIRE SPRINKLERS 0 NO ❑ NO DWELLING SECOND DWELLING 'D YES 0 ATTACHED DETACHED OTHER UNITS a UNIT ADDITON: :❑NO S F _ , POOLS ❑ FIBERGLASS ❑VINYL-LINED 0 GUNITE D PREFABRICATED . POOL-SF SPA-SF I SPA ATTACHED El YES 0 NO I TOTAL-SF , RECEI TOTAL VALUATION: Commercial or Multi-Family Buildings with Public Swimming Pools requires Department orEnvironmenlal Heath approval I (J_jdd l' RE-ROOF EXISTING ROOF TYPE: ❑BUILT-UP ROOF E ASPHALLC+J�T SHINGLES❑WOOD SHAKES❑WOOD SHINGLES❑TILE OTHER(SPECIFY) 1 (� U REMOVE/REPLACE❑NO IF NO PLYWOOD 1/2" ❑3/8" PLYWOOD TYPE: PITCH: , ROOF CLASS yEs F OF LAYERS 1 THICKNESS❑5//8" OTHER 'SSB E CDX OTHER •12 i A PROPOSED ROOF TYPE:❑BUILT-UP ROOF ❑ASPHALT SHINGLES tai WOOD SHAKES❑WOOD SHINGLES 0 OTHER *Provide a signed copy of the Cupertino's Tear-Off Policy SF 7j 27 CIL,.of SQUARES By my signature below I certify to each of the following: I am the property owner or authorized agent to act on theproperty 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 repre'sen'tatives of Cupertino to enter the above-identified property for inspection purposes. I acknowledge and authorize all information contained on this application form to be made available for public record _, c2r Signature of Applicant/Agent: �AIJ Z/l4 4 ifr ( Date: ZI 7l / 7 - SUPPLEMENTAL INFORMATION REQUIRED V • H *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 1 Bldg,4pp_2Q/7.doc revised 08/01/17 . A , , \ REROOF TEAR-OFF POLICY f....0 COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION p ST;yyf. ALBERT SALVADOR, RE., C.B.O.,BUILDING OFFICIAL 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPERTINO -4_ 1 (408)777-3228•FAX(408)777-3333•buildino cupertino.orcpj _2/0( Zi 0 PROJECT ADDRESS . r� ? 0 f APN# V 5 F1 7 - D.--2._D OWNER NAME I PHONE E-MAIL k;d '�y fej: c STREET ADDRESS (la 1 3 d C^a.�+ r� l CITY, STATE,ZIP Vp e r 1 e) r� ^A,i I " FAX CONTRACTOR NAME / LICENSE NUMBER r� LICENSE TYP{jEY BUS.LIC.# Darryl 'gl 0 T8%1 i'1 G3 ' _ COMPANY NAMEE-MAIL FAX s ifro914 says ;k ) 5;A/1 dyi s-V5 TboRiHyeat)krAl STREET ADDRESS I CITY,STATE,ZIP PHONE 3617_ !r(ktley P( , 4M lash eA. qsi;5 wd8-53 I, 77001 1 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. ' 'I ' 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 I completely knoeked'downor 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 there-roofing is completed. To'receive a final sign-off, the following items will be verified: a. Flat roofs shall]have a minimum of I/"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. PI oper,spark arrestor installation, vents painted, gutter/downspouts installed, d'eb'ris removed. 7. NOTE I you call for a tear-off or plywood nailing inspection and the work is riot complete, you will be charged a re-inspection fee. The re-inspection fee shall be paid before another inspection can be scheduled. ; I ' By my signing below,I certify each of the following is true: I am the property owner or authonzed'agenttd 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$eedons;R314 and R315 of the 2016 California`Residential Code. j Signature of Applicant/Agent:; I PJM Date: 2 Re,oofPo,licy'_201,1 doc revised 06/01/7 ,I1