B-2018-1304 CITY OF CUPERTINO BUILDING PERMIT
BU ILDINGADDRESS: CONTRACTOR: PERMIT NO:B-2018-1304
11247 TERRA BELLA DR CUPERTINO,CA 95014-4805(356 25 006) LUNNEBORG
ROOFING INC
CAMPBELL,CA 95008
OWNER'S NAME:CHUC KIEN N AND DUONG JACQUELINE KTRUSTE DATE ISSUED:08/01/2018
OWNER'S PHONE:408-768-4551 PHONE NO:(408)369-9175
LICENSED CON'TRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C39 Lic.#6 79725
Contractor LUNNEBORG ROOFING INC Dale 04/30/2020 X BLDG—ELECT—PLUMB
I hereby aMru that I nm Recused under the provisions of Chapter 9(commencing —MECH X RESIDENTIAL_COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license Is in full force had effect. JOB DESCRIPTION:
RE-ROOF;TEAR-OFF;INSTALL METAL TILE ROOF SYSTEM-(26
I hereby affirm under penalty of perjury one of the following two declarations: SQ)
x. yhave and will maintain a certificate of emnsent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for Nie
performance of the work for which this permit is issued.
x. 1 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:.$17000.00
APPLICANT CERTiFICATTON
I certify that I have read this application and stale that the above
information Is correct.I agree to comply with all city and county ordinances AIN Number: Oceapaney'lype:
and state laws relating to building construction,and hereby authorize 35625 006
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.
Signatur Date 08/1/2018 Issued by:Haley McKee
Date:08/01/2018
OWNER-DILDER DECLA I
I hereby af'Brnr that I am ax npt f• the Contractor's License Law for one of the RE-ROOFS:
following two reasons: All roofs shall be inspected prim to any roofing material being installed.U a roof is
t. I,as owner orthe property,or my employees with wages as their sole installed without first obtaining an inspection,I agree fallen—all new materials for
ompensation,will do the work,and the structure is not intended or offered for inspection.
.,a(Sec.7044,Business&Professions Code)
e. I,as owner of the property,am exclusively contracting with licensed Signotme of Appli,a,,
contractors to construct the project(Seo 7044,Business&Profession Code). Date:09/l/2018
l hereby affirm ander penalty of perjury one of the following three declarations: ALL BOOP COVERINGS TO BE LASS"A"OR BETTOR
I I have and will maintain a Certificate of Consent to self-insure For Worker's
Compensation,as provided faby Section 3700 o£the Labor Code,for the
performance ofthe work Por which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
x. 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 thisCalifornia 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
s. 1 certify that in the performance of the work for which this permit is issued,1 Health&Safety Code,Sectlmr 25532(a)should I store or handle hazardous
shall not employ any person in any manner so as to become subject to the n,tarts.Additionally,should 1 use equipment or devices which craft hazardous
aft contaminants ns donned by the Bay Area At.-Quality Manngennart District 1
Worker's Compensation laws o£California.If,after making this certificate of will maintain compliance with the Cupertino Municipal Coda,Chapter 9.12 and
exemption,I became subject to the Worker's Compensation previsions of the file Health&Safety Code,Sections 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent,
APILICANT CERTIFICATION Date:08/1/2018
I certify that I have read this application and slate that the above information is N' i GE Y
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction nding goncy for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(S c.3097 iv C.)
to enter upon the above mentioned property for inspectlon 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.Addltionally,the applicant understands
and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION
Code, action 9.18, I understand my plans shall be used as public records.
Sig urs
Data 08/ O8 Licensed
Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 n �f
(408)777-3228• bui]dingClcupertino.arg PEMITGB-
CUPERTIN0 REVa_ DEF#_
❑NEW CONSTRUCTION ❑ADDITION ❑ALTERATION❑T.I. ❑MEPRE-ROOF ❑SWIMMING POOL/SPA
PROJECT ADDR SS ® APN A a L=" ,S e» ()r
OWNER NAME PHOb �� �� U
STREEf ADD/5�'J' �� �r�✓/1� CITY�"-,TATHsZ7P
CONTRACTOR NAME O OWNER-BUILDER COMPANY NAh1E (' /•f— LICENSE NUMBER LICENSE TYPE
67
TREET ADDRES S QX/r,
E-MAIL C.J /�J/L ' 3G r'�l�r �y BUS.LIC A 6��
❑ARCHITECT []OWNER DOWNERAGENT O CONTRACTORAGENTO ENGINEER❑DEVELOPER❑TENANT
CONTACT NAME E-MAIL
STREET ADDRESS CITY,STATE,ZIP PHONE
DECRIPTON �a—
PAl`74 Gvvv� tli�ke /y,r�.�+s�� J�1e7i l 74/P fes! S �te�
1NGLE-FAMILY/DUPLEX D MULTI-FAMILY D INDUSTRIAL ❑COMMERCIAL
EXISIINGUSE EXISTINGSF NEWPLOOR SF PORCHSF DECXSP DEMOsF STORIESA TOTALNETSF USE TYPE OCC SQTT. VALUATIONS)
REMODEL REMODEL KITCHEN REMODELOTHR GARAGE D ATTACHED
BATHROOM SF �F, sF 5F O DETACHED
ET'ISING 0Y. EICHLER ED YES; SECOND STORY ADDITION L]YES
FIRESPRINKLER5 11NO O NO O NO
DWELLING SECOND DWELLING DYP,s DATTACHEDDDETACHED OTHER
UNITSn UNITADDTON: ONO SF
POOLS ❑FIBERGLASS D VINYL-LINED D GUNITE O PREFABRICATED
POOL SF _ SPA-SF SPA ATTACH ED OYES D NO I TOTAL-SF
RECEIVED HY: 1 A,(//M TOTAL VALUATION:
Camnieveiul or Mulli-Favil Bnildin swish Pnhli Smi nein Pools re ores Oe nrlmenla Envirmrmarlal Healhn aovnl /A\1It1 VFfYA"1!'
RE-RO OF EXI57TNG ROOF TYPE: BUILT-UP ROOF❑ASPHALT SHINGLES WOOD SHAKES E]WOOD SHINGLES E]TILE Q ER(SPECIFY)
MOVE EPLACE❑NO I IF NO PLYWOOD❑'A„ ❑3/s" PLYWOOD TYPE: PITCH: ROOF CLASS
S A OF LAYERSj= I THICKNESS❑5/B" OTHER ❑OSB ❑CDX OTHER •12
PROPOSED ROOF TYPE:OBUILT-L'PROOF❑ASPHALT SHINGLES OWOODSHAKESOWOODSHINCL OTHER �(�/1y�
*Provide a signed copy of the Cupertino's Tear-Off Policy SF_It w Ao11QUARES�
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 acknowledge and authorize all information contained on this application form
to be made available for public record r rte'
Signature of Applicant/Agent: Date:
SUPPLEMENTAL 1NFORMATI0RE 1RED
•New SPD/Second Dwelling Unit Multifamily Dwellings: emolftfon permit is required prior to issuance of a building permit for all new construction.
*Commercial Buildings:Provide a completed Hazardous erials 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
81dgApp2017.doc revised 08/01/17
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION
ALBERT SALVADOR,P.E.,C.B.O.,BUILDING OFFICIAL �odg--
CUPEftTINCY 10300 TORRE AVENUE-CUPERTINO,CA 95014-3255 1
(408)777-3228-FAX(408)777-3333-buildina(a cuoertino.ora (`
PROJECT ADDRESS R .. A"N /# ' S CO ,ZS
OWNER NAME J
/
fr+7 -H
STREET ADDRESS CITY,
FAX
CONTRACTOR NAME LICENNUMB UCSA PE BUS.
/'VI[�ltA( GWIA ` .�
COMPANY NAMJS , ,
STREET ADDRES�/ !
Z a /. /Jf YPr( CITY,$TATE, IP. LsaM.1� s�
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 Callon 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 fiom 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 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 sighing 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 Residen9d Co
Signature of Applicant/Ager• Date: &f/—/k
ReroofPolicy_20/4.doc revised 06/07/7