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15070185�1 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 6471 BOLLINGER RD CONTRACTOR: DAN ELLIOTT'S PERMIT NO: 15070185 ROOFING CO OWNER'S NAME: PRIVETTE FRANKLIN M P O BOX 26878 DATE ISSUED: 07/27/2015 OWNER'S PHONE: 4085541818 SAN JOSE, CA 95159 PHONE NO: (408)559-7327 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL F] DUPLEX (6469 & 6471) TEAR OFF (E) ROOF, INSTALL License Class ic. # 49 `l 3 d (N) OSB, 30# FELT, & 50 YR CLASS A COMP ROOF &- 7-27- / J SYSTEM (34 SQ'S) Contract Date 1 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 Sq. Ft Floor Area: Va I uatiun: k 1 ; 311 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 APN Number: 36920033.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION 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 WITIIIN 180 DAYS OF ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DA D 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—/-, bZ=-3- granting of this permit. Additionally, the applicant understands and will corn a te: with all non- o' source regulations p r the Cupertino Municipal Code, I 9.18. Signature Date -7- 7" 5 RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. ❑ OWNER -BUILDER DECLARATION ^ 7 Signature Date: 7"A / -/,5 1 hereby affirm that I am exempt from the Contractor's License Law for one of ofApplican the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 1, 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(x) should I store or handle hazardous 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 Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, ec 'ons 255Q5, 25533, au d 25534. Section 3700 of the Labor Code, for the performance of the work for which thisOw 7 2 7 �.3 permit is issued. ner or authorized agen Date: I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any 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 or this permit shall be 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, ARCHITECT'S DECLARATION costs, and expenses which may 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 CVPERTINO REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 •FAX (408) 777-3333 • buildina0cuaertino.ora / " 7 PROJECT ADDRESS OWNER NAMF��" PHONE \g,$ 'E-M.4II. STREET ADDRESS /p /� � CITE � �/ (i1(// FAX CONTACT NAMEW'd �S PHO r% �Z -MAIL 1 0 ��► f COW\ STREET ADDRESS CITY, ` q 1 ` FAX ss ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ® CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR N 1 �Qe LICENSE NUMBER LICENSE TYPE �^ BUS. LIC. # COMPANY NAME Is Q EMAIL FAX STREET ADDRESS m / \ I `` n (-� 'T ,f ` CITY, STATE ZIP S �� z G� 12�I 1 O ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC. # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ® SFD or Duplex ❑ Multi -Family STRUCTURE: ❑ Commercial ROOF AREA: ;� 4,0 Q VALUATION: 1 _�) 3) I EXISTING ROOF TYPE: ❑ BUU T -UP ROOF ❑ ASPHALT SHINGLES M WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER (SPECIFY) REMOVE /REPLACE W YES ❑ IF N #LO PLYWOOD 11 S PLYwD 13 OSBPITCH: '12 ROOF AS PROPOSED ROOF TYPE: ❑ BUILT-UP ROOF 10 ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER ICC -ES REPORT # DESCRIPTION OF WORK:I�Mo�r, n 1 1 'v 1 �, 1_ I �G (� h, Z t l fff»i ` 0 5 V �/©dam all � -��6, r -4 Mk-tS VYveY\S11 hai_(vk W SIS'l V,4S AaLs ` m I �e. By my signature below, I certify to each of the following: I am the property owner or authorized agent to ac property er s be e read s application and the information I have provided is correct. I e read the Description of Work and verify it is accurate. I gree to th all a cab 1 ordinances and state laws relating t con tion. I a rite repre tatives of Cupertino to enter the aboc�idenbfi pe rty for in t' urposes. r ^� Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION QUI D _ If building is associated with a Home Owner's Association, provide letter of approval from HOA. 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. OFFICE USE ONLY PLAN CHECK TYPE ROUTING SLIP VER -THE -COUNTER ❑ EXPRESS ❑ STANDARD ❑ BUILDING PLAN REVIEW ❑ PLANNING PLAN REVIEW ❑ FIREDEPT ❑ OTHER: ReroofApp_2011.doe revised 03/16/11 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION FEE ID ROOF AREA s.f. 1 REROOFFRES 3,400 ADDRESS: 6471 BOLLINGER RD DATE: 07/27/2015 APN: 369 20 033 BP#: REVIEWED BY: MELISSA *VALUATION: 1$13,311 PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re -roof PRIMARY USE: SFD or Duplex !Flee. Permit Fee: PENTAMATION 1 SFDWLROOF PERMIT TYPE. 14 WORK DUPLEX 6469 & 6471 TEAR OFF E ROOF INSTALL N OSB 30# FELT & 50 YR CLASS A SCOPE COMP ROOF SYSTEM (34 SQ'S) FEE ID ROOF AREA s.f. 1 REROOFFRES 3,400 NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 E . 7/1/132 "ch. Plan Check I'lrtnab, Plan Check 1i1ec. Pleas Check Ile, %. Plumb. ; ' !Flee. Permit Fee: ether Meeh..hi.%p, Other Plumb /rash.Li I Other B1ec. 1111: D L . ,'_- Imp. Vice: Plumb. Insp. Fee: 14ec Fee: NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 E . 7/1/132 FEE QTY/FEE MISC ITEMS Plan Check Pee. �'uppl. PC Fee 1'I arntb. /,A-1eelt. !Flee Permit Fee: .00 �trhpl. 1nvp Fie e 1'lumb.7Mech./Elec "lumb./Mech./Flec• Pertuit Fee: Construction Tax: I rlministrative Fee: Work Without Permit? o Yes O No $0.00 I(1vaneed Planning fees: i rctvel Doeurnenlation Fees: Stronfz Motion Fee: IBSEISMICR $1.73 Select an Administrative Itteem Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: F$580.731 $0.00 TOTAL FEE: 1 $580.73 Revised: 07/02/2015 CUPERTINO 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 (408) 777-3228 - FAX (408) 777-3333 - building(a)cuaertino.org PROJECT ADDRESS / /� APN # , Z OWNER NAME(/ et > t' IVe 7;kPHO(I -ay�y� \ - V �IG-• E-MAIL STREET AL Z LVI CI FAX CONTRACTOR NA t,SLICENSE�Ii Will LICE�J Ulq ` f BUS. LIC.# COMPANY NAME FAX STREET ADDRESS w ' / �1 _ / �! CITY, S�r, PHV I UNDERSTAND AND AGREE TO THE FOLLOWING: 1. The re -roof project shall comply with all applicable provisions of the 2013 California Codes. 2. An inspection request can be scheduled up to one business day before the requested inspection date. Please schedule inspections online or 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. 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 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 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 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 R314 and R315 of the 2013 California Residential Code.//# ,, I r Signature of Applicant/Agent: �/ �/v Date: 2 �// PA/v, 0 7--r ReroofPo1igLM4.doc revised 01/15/14 08/10/2015 10:10 4082468941 CAL -WESTERN PAGE 03/03 SMOKE 1 CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE CoMKIUIII:fY-Dp�LOPMeNT-,n�AART?,�F.,�IT • �U11pil�G pIV1SlON 10300 TORRE AVENUE'- CUPERIINO, CA 05014-3255 14M 777 -3"R .FAX 1dD81 T17 XT,3 , bulidirin nn roeRinn nm PURPO£fi This a fidavltis a self-cextdIcaiion for -the installation of all requae.45mohe and CazbonMoUO.Iddo Alarms for compliance with 2013 CRC o`'' ectzon M14,2013 CBC Sedio* m 420.6 aztid 9V.2.Ill where no interior access for inspection fire required. , GENTIltAIL WORAdATii9N , Existizhg sinec4arnt17 axtzl multi family'd'KTllings shall be provided with 9nioke Marnu aAd Caibon Monoxide alarpns- When the valuation of addition, alterations, ox repairs to existing dwelling uWu exceeds , $1000,00, CRCSection 1 14 and CBC Sections 907.1.11.5 and 420,6 regWm that Smoka Alturns and/or Carbon rMonoxide ala=s be iiip led to the foUowwing locations: AREA SMOKE ATARM CO ALARM bub (la of math separate sloping area in tlho iu►mediate vidzvt r 4f the bedroom !) X X M evay 1e%-Iefadwe3lnn tinitinciudin b.sements )C X Widiin eachsleepira room X Cuban Monoxide alarms fire not required in dwaIngs wlhiSh d0 not contain fuel -burning appliances and that do not have an attached gArne. _ -Carbon Monoxide alarms combined with Jsmoka- alarms shall comply with CBC Section 420.6 and shall be approved by the Office of tha Siate Pile Max®ha1. power Supply: in dwelliahg units svlth zto•copctmesdal power g apply, alamra(s) Bey be solely battrry operated. in existing &•welling unite, a mnris axe pw=iitted 1A be solely battery operated where repairs or alterations do not zeBult in the removal, of wall axed ceiling firniehes or thew i9 no access by Dncfins of attic basement or 'crawl space. Refer to CRC Sectdan 8.914 and CBC Sections 9072,11.4 and 420.6,2. AA electrical pemdt is requited fnx zalamhs which must ranneoted to the binding wiring. As owner of the above-ra%renced property,.1 Hereby certify that 6e alurn(s) referenced above has/have been installed in accordance with the manwfactazrer s instructions aid in�casonpXianae wa the California Buildixtg and CaWornia ResidenUtl Wes. The,alams.havebeen te4ted PA,�K.o�erationaL as of the dam signed - � ,, , ,.__.., .5•Awlaz aJid.CQ,�br�,dhC.�evtrtdO9II�Ii4 t7tVIVIYE715 10:10 4032468941 CAL -WESTERN BE/07/2015 12:16 1-616-679-1441 THE UPS STORE 3741,PAGE 02;0.2 WATER -CONSERVING I PLUMUINO FIXTURES OWNflRCriPTIPiCA,TE-OF COMPLIANCE 00ISR UN)TYnEvFyoPMSNYAEPat7M&T-6UpMdD4�t�t4t�. iMwTQRFtCNVRWF, •'CUPSRTtwd. CA W AMM (408)777-3 8 •PAX R d68� 777.9333 buflgWftMrttII e4IIffl h `Q L l�e� � ib �0 ca cs�a cods seotio� 'l 101.1 � 11 a1.a wLbob tee' i� ole ��. ��. �r>sa1 >v a re�t�8 bi�c� silo? G 9PI Cavil Cada0l-d;aa9110L16&agE 1101.8 do rotgply. S*b0nw rad ft thermof the bm owresr'stata eN0 too to ow4m 2. 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