B-2017-2189 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR. PERMIT NO:B-2017 2189
874 BROOKGROVE LN CUPERTINO,CA 95014-4634(375 39 042) N I R WEST COAST
INC
VACAVILLE,CA 95688
OWNER'S NAME. MOGULMOUSE HOLDINGS LLC DATE ISSUED' 12/20/2017
OWNER'S PHONE.650-464-5209 PHONE NO (707)447-5655
1
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO' 1
License Class B:C-39 Lic.#593448 X BLDG _ELECT _PLUMB
Contractor N I R WEST COAST INC Date 07/31/2019
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 TPO ROOFING SYSTEM(32 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 for which 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:$31692.00
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above APN Number Occupancy Type:
information is correct.I agree to comply with all city and county ordinances 375 39 042
and state laws relating to building construction,and hereby authorize
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 12/20/2017 Issued by.AbbyAyende
/' Date: 12/20/2017
I t-: D_' D_ Ant• II
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
i o
compensation,will do the work,and the structure is not intended or offered for
sale(Sec.7044,Business&Professions Code) "
2. I,as owner of the property,am exclusively contracting with licensed -Signature ofApplic •
-_
contractors to construct the project(Sec.7044,Business&Professions Code),(--- Date:12/20/2017
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVER1''g. OBE CLASS"A"OR BETTER
1. I have and will maintain a Certificate of Consent to self-insure for Worker's 5---
Compensation,
Compensation,as provided for by Section 3700 of the Labor Code,for the HAZARDOUS MATERIALS DISCLOSURE
performance of the work for which this permit is issued.
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
maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
permit is issued. Health&Safety Code,Section 25532(a)should I store or handle hazardous
s. I certify that in the performance of the work for which this permit is issued,I material. Additionally,should I use equipment or devices which emit hazardous
shall not employ any person in 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 25505,255 ..e 5534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Y-Owner or authorized agent:
APPLICANT CERTIFICATION Date:12/20/2017
I T' I _►: •G-dY
I certify that I have read this application and state that the above information is I hereby affirm that there is a constructso i
lendng�-Igfor the performance
correct.I agree to comply with all city and county ordinances and state laws of work's for which this permit is issued(Sendn37 Civ C.)
relating to building construction,and hereby authorize representatives of this city Lender's Name
to enter upon the above mentioned property for inspection purposes. (We)agree
to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Address
judgments,costs,and expenses which may accrue against said City in
consequence of the granting of this permit. Additionally,the applicant understands ARCHITECT'S DECLARATION
and will comply with all non-point source regulations per the Cupertino Municipal I understand my plans shall be used as public records.
Code,Section 9.18.
Licensed
Signature Date 12/20/2017 Professional -
/ CONSTRUCTION PERMIT APPLICATION
1:\ !4sx COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
(4' B ,
10300 TORRE AVENUE • CUPERTINO,CA 95014-3255
yK.tu, o Z 1 7
(408)777-3228 • building@cupertino.org PEMIT#B-
CUPERTINO
El NEW CONSTRUC 1'ION!❑ADDmON ❑ALTERATION ❑T.I. ❑MEP ❑RE-ROOF ❑SWIMMING POOL/SPA
PROJECT ADDRESS
ji®�3 < 672-00C" A_4,3 I APN# `Z15- 39_044
OWNER NAME PHONE J E-MAIL
Ai!A)A �"_ � C�J Adc1 CoSo "44-52-0 7
STREET ADDRESS CITY, STATE,ZIP ���
�7 '
1; 6 ia 006- 1-nl e,1 pati,,0.0 j
CONTRACTOR NAME 0 OWNER-BUILDER COMPANYNAME (XX 11 LICENSE NUEN�BERR` LICENSE TYPE j
ISTREET ADDRESS 9O 77S3 c� „---ft.-.--/ A �/1-1), //L G� /4- 7 564< I
fb� 9
y l ^� 1 BUS.LIC#
E-MAILPH'�C� 9- ti"7 ! ° 5655
0 ARCHITECT 0 OWNER ❑OWNER AGENT [ CONTRACTORAGENT❑ENGINEER 0 DEVELOPER 0 TENANT
CONTACT NAME E-MAIL
STREET ADDRESS CITY,STATE,ZIP PHONE
7 49 o /s.l7-5'4 5.5
DECRIPTON
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`7 5/ 7C-74 .
3-2- 56 titi- 5 ---(4/a
r
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(5)
REMODEL REMODEL KITCHEN REMODEL OTHR GARAGE ❑ATTACHED
BATHROOM SF SF SF SF 0 DETACHED
EXISING
0 YES EICHLER 0 YES SECOND STORY ADDITION ❑YES
FIRE SPRINKLERS 0 NO 0 NO ❑NO
DWELLING SECOND DWELLING ❑yES.0 ATTACHED CI DETACHED OTHER
UNITS it UNIT ADDITON: ❑NO S F
POOLS 0 FIBERGLASS 0 VINYL-LINED ❑GUNIi'E ❑PREFABRICATED
POOL-SF SPA-SF SPA ATTACHED❑YES ❑NO TOTAL-SF
REC.WED BY: TOTAL
L VALUATION:
Commercial or Multi-Family Buildings with Public Swimming Pools requires Department of Environmental Heath approval GJ`/"""1 ""`�14/1,1641L 1��lWC)'z co q�l )
RE-ROOF EXISTING ROOF TYPE: BUILT-UP ROOF❑ASPHALT SHINGLES❑WOOD SHAKES❑WOOD SHINGLES❑TILE OTHER(SPECIFY)
REMOVE/REPLACE❑NOI IF NO PLYWOOD ❑w 1113/8" PLYWOOD TYPE: PITCH: ROOF CLASS
m YES #OF LAYERS THICKNESS 5/8" OTHER IX OSB ❑CDX OTHER :12 A
PROPOSED ROOF TYPE:QBUILT-UP ROOF ❑ASPHALT SHINGLES 0 WOOD SHAKES❑WOOD SHINGLES 0 OTHER
*Provide a signed copy of the Cupertino's Tear-Off Policy SF'2L #of SQUARES 3?----
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 inspection purposes. I a ii•. --i:• -,d authorize all information contained on this application form
to be made available for public record. , 2-49/l
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFO QUIRED
*New SFD/Second Dwelling nits/Multifamily Dwellings: r-... tion permit is required prior to issuance of a building permit for all new construction.
*Commercial Buildings: Provide a completed Hazard() ' aterials Disclosure form if any Hazardous Materials are being used as part of this project.
*Copy of Planning Approval Letter or Meeting with arming 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
f REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
e.Is ALBERT SALVADOR, RE., C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE•CUPERTINO, CA 950143255
CUPERTINO (408) 777-3228•FAX(408)777-3333•buildinq(a cupertino.orq
404
PROJECT ADDRESS "-?6 4 I 'o,K 6 ! APN OW ,
/qm l 1r gyp- C.�/ ,, 6
OWNER NAME ( I ,!V f T J g PHONE V 50 ` c 5 20 ( EMAIL
STREET ADDRESS// ) h CITY, S ATE,ZIP 2'TP FAX f <� FAX
CONTRACTOR NAME} LICENSE NUMBER LICENSE Y ` BUS.LIC.#
FiJ R-rke-r2-r2 +J C-frLi�G€ ai-h I`. )- reJ t 5 cl �'
6-3
COMPANYNAME G/1Z_ li° 1f f'`^ IA E-MAIL FAX
STREET ADDRESS CI STATE,ZIP PHONE
I UNDERSTAND AND AGREE TO THE FOLLOWING:
1. The re-roof project shall comply with all applicable provisions of the 2007 California Building Code.
2. You must schedule all needed inspections a minimum of one day before the requested inspection date.
Please schedule inspections online or call(408)777-3228 between 7:30-3:30 (Mon-Fri).
3. Tear-off roof inspection is required. Please call for tear-off inspection after the roof is torn off and all
the nails/fasteners have been removed. Any and all dry-rotted wood shall be replaced prior to this
inspection. A building inspector will be available within one hour.
There are special hours for this service: 7:30 — 10:30am and 1:00—3:30pm(Mon—Thurs);
7:30 — 10:30am and 1:00—2:30pm(Friday).
4. If plywood is installed,a plywood nailing inspection is required.
5. In-Progress roof inspection is required. Call for an in-progress roof inspection to verify building is
weather tight after installation of approximately 25% of the roofing material.
6. New roof coverings shall not be applied without first obtaining all inspections and written approvals
from the building inspector. Any roofmg 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.
7. A fmal inspection and approval shall be obtained from the building inspector when the re-roofmg is
complete. To receive a final sign-off,the following items will be verified:
a. Flat roofs shall have a minimum of IA"per foot of slope and must 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.
8. 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 of$126.00. 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 a_ e- • e•• - with the re-roof•olic stated above.
Signature of Applicant/Agent:', Date: /7--
40111•P'
Z{ ( I
ReroofPolicy_2010.doe revised 05/17/10