13030138 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21390 VAI AVE. CONTRACTOR:ECONOMY ROOFING PERMIT NO: 13030138
INC
OWNER'S NAME: BOLANDER RICHARD B AND PATRICI 2988 NEAL AVE DATE ISSUED:03/26/2013
OWNER'S PHONE: 4088914129 SAN JOSE,CA 95128 PHONE NO:(408)615-7200
13 LICENSED CONTRACTOR'S DECL TION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL❑
License Class `"" Lie.# I/ $ 3 TEAR OFF(E)WOOD SHAKE,INSTALL(N)OSB,30LBS
FELT,PREMIUM CLASS A COMP
Contractor Jla-Z > O/e5 9-�� Date -3,.006) S^`�(
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.
I hereby affirm under penalty of perjury one of the following two declarations:
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. Sq.Ft Floor Area: Valuation:$12000
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 APN Number:36205027.00 Occupancy Type:
permit is issued.
APPLICANTCERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct:I agree to comply with all city and county.ordinances and state laws relating WITfIIN 180 D + T ISSUANCE OR
to building construction,and hereby authorize repesentatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 D + OM CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the �Z 6
granting of this permit. Addition y,the applicant understands and will compl s Date:
with all non-poin urce re ons per the Cupertino Municipal Code,Section
9.18.
2 of -aj RE-ROOFS:
Signature Date All roofs shall be inspected prior to any ofing material being installed.If a roof is
installed without first obtaining an m ction,I agree to remove all new materials for
inspection.
❑1. OWNER-BUILDER DECLARATION
Signature of Applicant: Date: 6
I hereby affirm that I am exempt from:the Contractor's License Law for one of
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534.1 will
I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the Cupertigo Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sec' s 255W25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this di
permit is issued. Owner or authorized agent: Dates
I certify that in the performance of the work for which this permit is issued,I shall
not employ any person iwany manner so as to become subject to the Worker's
Compensation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions of this permit shall he deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANT CERTIFICATION Lender's Address
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 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 ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which3nay accrue against said City in consequence of the I understand my plans shall be used as public records.
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
y
REROOF PERMIT APPLICATION O�
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 O
(408)777-3228•FAX(408)777-3333•building(a)-cupertino.org
CUERTI'NO'
PROJECT ADDRESS APN#V.
OWNERNAME L r G ®/� PHONE A+r g C�/'1/I 7-7 &MA,II/
CITY,STATE,ZIP(J ` [r (�� / FAX
STREET ADDRESS
CONTACT.NAME �5, PHONE D9 -7 f� ._..UO�.j /`C (i�I'•
STREET ADDRESS (i A0/ /� CITY,STATE,ZIP 2, k FAX
❑OWNER ❑ OWNER-BUILDER Jam❑ OWNER/AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARGCHITEcT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME G�! /fe ev LICENSE NUMBER r(�Q Z b LICENSE TYPE BUS.LIC.#
MPANY NAME
-MAIL
M-MAIL
�' G,d I►//� l� K/ B G f7/1��J G d• .C FAX
CO
STREET ADDRESS CITY,STATE,ZIP C! J S PHONE
ARCHITECf/ENGINEERNAME LICENSE NUMBER BUS.LIC.#
COMPANY NAME E-MAIL FAX
.STREET ADDRESS CITY,STATE,ZIP PHONE
�
USE OF El Or Duplex ' Multi-Family ROOF AREA: VALUATION:
sTxuciuRE: . ❑ Commercial .. 3
EXISTING ROOF,TYPE: .❑BUILT-UP ROOF '❑ASPHALT SHINGLES XWOOD SHAKES ❑WOOD SSHrIN�GLES ❑OTHER(SPECIFY)
REMOVE/REPLACE;;SYES IF NO, PLYWOOD ''/:" ❑ PLYWD w�{�SB PITCH: ROOF
❑NO #LA THICKNESS: ❑5/8" TYPE: ❑CDX '12 CLASS: A
ICC-ES REPORT#
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF' xASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHQNGLES ❑OTHER
DESCRIPTION OF WORK-
ALe
Q� W
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 corre 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 buildin cons n. I authorize renresentatives of Cupertino to enter the above-iden'ri�fled p��rty forinsp ection purposes...
gent: Date:
Signature ofApplicandAqc- gr
SUPPLETAL INFORMATION REQUIRED -
If building is asso ted with a Home Owner's Association,provide letter
of approval from OA.
Provide Planning approval to verify if there any restrictions.
Provide copy of Manufacturer's Installation Specifications.
Provide signed copy of Cupertino's Tear-Off Policy.
ReroofApp_2011.doc revised 03/16/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 21390 VAI AVE DATE: 03/26/2013 REVIEWED BY: MELISSA
its APN: 362 05 027 BP#: *VALUATION: 1$12,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY SFD or Du lex PENTAMATION 1SFDWLROOF
USE: p PERMIT TYPE:
wORK TEAR OFF E WOOD SHAKE INSTALL N OSB 30LBS FELT PREMIUM CLASS A COMP
SCOPE
6i
o
Jvfe'.h.flan Cheek Plumb.Plan('heck F_lec.Plan(..,heck
'Wch.Permit Fee; Plumb.Permit t ee: LYec.Permit Fee:
[Mlre'ch.
Mech.Insp. Other Plumb Insp. Other Elec.Insp.
Insl).Fee: Plumb. Insp.Fee: Elee.Insp.Fee.-
NOTE.
ee:NOTE.This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). These fees are based on the prelimina information available and are only an estimate- Contact the Dept for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 E . 7fi`/1/12) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 3,000 s.f. Re-roof
Suppl.PC Fee: (E) Reg. 0 OTT0.0 hrs $0.00 $450.00 IREROOFRES
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl.Insp.Fee-.0 Reg. Q.OT 0,0 hrs $0.00
PME Unit Feer $0.00
PME Permit Fee: $0.00
t:onstr-uction :Tax:
Administrative.Fee:
Work Without Permit? ®Yes JE) No $0.00
Advanced Planning Fee: $0.00 Select a Non-Residential G
Building or Structure -®
Travel Doc:ume station Fees: i
Strong Motion Fee: 1BSEISMICR $1.20 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
$2.201 $450.00 '�� , $452.20
Revised: 01/01/2013
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O.,BUILDING OFFICIAL
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERTINO
(408)777-3228•FAX(408)777-3333•buildinga-cupertino.ora
PRomcr ADDRESS 7NJ1 �J ' 0
OWNERNA2viE � �/1 O / �y� PHONE�e n /Z E-MAIL
STREET ADDRESS Com,STATE,ZIP 7 V� FAX
CONTRACTOR NAME � LICENSE TYPEr1'„2 BUS.LIC.# A z?
4P LICENSE NUMBER/
COMPANY NAME E-MAIL
l• / FAX rf�/ / G
STREET ADDRESS CITY,STATE,ZIP PHONE
I UNDERSTAND AND AGREE TO THE FOLLOWING:
1. The re-roof project shall comply with all applicable provisions of the 2010 California Codes.
2. An inspection request can be scheduled up to one business day before the requested inspection date.
Please 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 available within one hour.
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
new material down to the sheathing so a proper inspection can be performed.
require the removal of all
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 I/4"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 ori-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 monoxide detectors are required to be installed in accordance with Sections 8314 and R315 of
the 2010 California Residential Code.
Signature of Applicant/Agent: Date:
ReroofPo1icy_2012.doc revised 10/7/12