B-2018-0689 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0689
10221 STONYDALE DR CUPERTINO,CA 95014-1029(326 37 018) JIREH INC
LOS GATOS,CA 95031
OWNER'S NAME:WEINBERG RICHARD AND TARA DATE ISSUED:04/26/2018
OWNER'S PHONE:408-313-3655 PHONE NO:(408)298-9399
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C_39 Lia#800707
Contractor JIREH INC Date 10/31/2019 X BLDG—ELECT—PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing —MECH X RESIDENTIAL—COMMERCIAL
with Section 7000)of Division 3 attire Business&Professions Code and that my
license is in fail force and effect. JOB DESCRIPTION:
TEAR-OFF;RE-ROOF;INSTALL OSB;COMP SHINGLES-(42 SQ)
I hereby affirm under penalty of perjury one of the following two declarations:
u I have and will maintain a certificate of consent to self-insure for Workers
Compensation,as provided for by Section 3700 of the Labor Code,for the
erformance of the work for which this permit is issued.
e. 1 have and will maintain Worker's Compensation Insurance,is 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:$14279.00
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above AVIS Number: Occupancy Type;
information is correct.I agree to comply with all city and county ordinances
and state laws relating to building construction,and hereby authorize 32637 018
represenlallves 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�no Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
i
Signature ,at 04-26-2018 Issued by:Kim Dunbar
Date:04/26/2018
OWNER-BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS:
following two reasons: All root's shall be inspected prior to any roofing material being installed.If a roof is
r. 1,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 °t1O0'
sale(Sec,7044,Business&Professions Code)
a. I,as owner of the property,am exclusively contracting with licensed Signature ofApl icaut
contractors to construct the project.(Sce.7044,Business&Professions Code). Date 04-26-2018
1 hereby affirm under penalty of perjury one of the following three declarations:
1. I have cad will maintain a Certificate of Consent t°selfn-Iime for WorkCY's ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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
1, I have and will maintain Worker's Compensation Insurance,as provided far by I have,cad the hazardous materials requirements under Chapter 6.95 of the
Section 3700°f'the Labor Code,for the performance of the work for which this California Health&Safety Code,Sectlons 25505,25533,and 25534.1 will
permit is Issued. midirum n complbmcewith the Cupertino Mmt illail Code,Chapter 9.12 and Bre
3. 1 certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Sectloo 25532(x)should 1 store or handle hazardous
shall not employ any person in any manner so as to becoutc subject to the material.Additionally,should 1 use equipment or devices which emit hazardous
ontaminants as defined by the Bay Area Air Quality Management District 1
Worker's Compensation laws of Califomia,If,after making this certificate of wit-ill maintain compliance with the Capin Unit Munidpal Code,Chapter 9.12 and
exemption,l become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections '5505,25533,smd 25 4.
Lobe,Code,l must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent��
APPLICANTCERT Date:04-26-2018
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,ON 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 MunicipalARCHITECT'S DECLARIION
Code,Section 9.18. understand my plans shall be used as public records.
Licensed
Signature Data 04-26-2018 Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 Q
(408)777-3228• building@cupertirto.org PEIVIIT#13,-
4CIJPERTINO REVq DEFN
❑NEW CONSTRUCTION El ADDITION❑AIPRATION❑T.I. ❑MEP RE-ROOF ❑SWIMIdING POOL/SPA
PROJECTADDRESSZO
APN tl �..
OWNERNAME PHONH &MAIL
STREET ADDRESS CrPY,S TE,
11 a
CONTRACTOR NAME ❑OW -BUILDER CO ANY NANfB LICENSI NUMBER LICENSE TYPH
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Il /I� OSG(�(/'�C SU(/�7�� Y PHOJ✓1 .,I U cl/ BUS.L]C0o 3/
0 ARRC/HITS 0 owpE ❑OWNERAGENT❑co—WmcPoRAGENTE1 ENGINEER❑DEVELOPER❑TENANT
CONTACT NAME E-MAIL
STREET ADDRESS CITY,STATE,ZIP PHONE
DBCRII'TO
Un ho
Yl A a S
[]SINGLE-FAMILY/DUPLEX ❑MULTPFAMILY ❑INDUSTRIAL ❑COMMERCIAL
70DEL
ING USE EXISTWGBP NEW FLOOR SP PORCH SP DECK SA DEMOSF 'TORIE5NTOTALNCTSF USE TYPE OCCQ.FT. VALUATIONREI,IODEL KrCCHEN REMODELOTHR GARAGE []pTTACHEO
HROOM SP SF SF SP ❑DETACHED
EMSING ❑YES EICHLER 0 YES I SECOND STORY ADDPHON 0 NO
FIRE SPRINKLERS NO 0 NO
DWELLNG SRCONDDWELLWG []YES[]ATTACHED[]DETACHED OTHER
UNPTS# UNITADDITON: ❑NO SF
POOLS ❑FIBERGLASS[]VINYGLINED❑GUNITE []PREFABRICATED
POOL-SF _ SPA-SP I sPAATTACHED[]yss 0 NO TOTAL-SP (/!
RE EI B T A ALUATTON:
Co dal.,Mrdti-Fa rilu Buildin¢s rvitlr PuAiie Smimnrin¢Ponls rennins D—rM1nnrl o(Envirom rmrtnl HentN o,,—1 —
RE-ROOF EXLSTINGROOFTYPE: []BUILT-UPROOF[_]ASPHALT SHINGLES El WOOD SHAKES F]W006SIHNGLES❑TILE OTHER(SPECIFY)
REMOVH/REPLACE❑NO IF NO /I PLYWOOD❑11" ❑S/8" PLA�Y,,-/-TYPE: PITCH: -01 CLASS
gyps &OFLAYERS,—(� THICKNESS❑5/8•' OTHER 'ZOSB ❑COX OTHER •12 A
PROPOSED ROOF TYPE:❑BUILT-UPROOF❑ASPHALTSHENGLEs[]WOODSHAKES[]WOODSHINGLES[]OTHER ,,//,���
"Provide a signed copy of the Cupertino's Tear-Off Policy SFtof 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 mid the information I have provided is correct.I have read the Description of WE*mid verify it is accurate.I agree
to comply with all applicable local ordinances and state laws relating to building construction. I authorize repres ntatives of Cuperthm to
enter the above-identified property for inspecfio pup es.I arlmowkd e and authorize all information�onation form
tobe made available for public record.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORMAT REQUIR 6
*New SFD/Second Dwelling Units/Multifamily Dwellings:A Demolition permit is required prior to issuance of a buildnng permit for all new construction.
*Ccsrunercial Buildings:Provides 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 O Woer's Association
BldgApp_2017.doe revised 08/01117
502.Sl0
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
ALBERT SALVADOR,RE„C.B.O.,BUILDING OFFICIAL
CUPERTINO 10300TORREAVENUE•CUPERTINO,CA95014-3255
(408)777-32/28•FAX(408)777-3333-bulldina(obcupertino.ora Ik'f) l�
PROJECT ADDRESS'
O /
OWNER NAME /// LCG�Q PHON ���- o"YJ c/-'AIL 6
STREETADDRES D 0A I` CRY,S ,ZiP
T I F.4X
CONTRACTORNAMB LICENSE EL]C NSE T]'E I BUS,
COMPANY NAA E-MAIL -.
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 7:30-2:30pm(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 12:30-2:3.0(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. To receive a final sign-off,the following items will be verified:
a. Flat roofs shall have a minimum of/"per foot of slope and demonstrate there is no ponding.
b. Listings from approved testing agencies for all pre-manufactured product,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 are-inspection fee. The re-inspection fee shall be paid before another luospection can be
scheduled.
By my signing below,I certify each of the following is hue: 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 4.'so understand that
smoke detectors and carbon monoxide detectors are required to be installed in accordance with Sections R314 and R315 of
the 2016 California Residential Code.
Signature of Applicant/Agent: Date:
ReroolPold`nv.2014.doe revised 0610117