B-2016-2518 CITY OF CUPERTINO BUILDING PERMIT
BUH INGADDRESS: CONTRACTOR: PERMIT NO:B-2016-2518
6059 BOLLINGER RD CUPERTINO,CA 95014-4629(375 38 005) DURA FOAM INC
NMNLO PARK,CA
94025
OWNER'S NAME: LISTER PATRICK M ET AL DATE ISSUED:08/15/2016
OWNER'S PHONE:818-530-6567 PHONE NO:(650)327-3200
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class ELECTRICAL tic.#435836
Contractor DURA FOAM INC Date 47/31/2018 X BLDG —ELECT _PLUMB
MECH X RESIDENTIAL COMMERCLAL
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:
I hereby affirm under penalty of perjury one of the following two declarations: RE-ROOF;TEAR OFF/REMOVE T&G;INSTALL FOAM ROOFSYSTEM(24 SQ'S)
i. 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.
2 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:$10000.00
APPLICANT CERTIFICATION
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 APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 375 38 005
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 Cu in Municipal Code,Section 9.18. 180 DAYS FROM LAST C �ECTION.
Signature Date 08/15/2016 Issued by:MELISSA
Date:08/15/2016//'LERDECLARATIO
-
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,au inspection,I a to remove all new materials for
compensation,will do the work,and the structure is not intended or offered for % mspcc
sale(Scc.7044,Business&Professions Code) / /
2. I,as owner of the propertM am exclusively contracting with licensed Signature of App'eahY
contractors to construct the project(Sec.7044,Business&Professions Code). Date:08115/296
I hereby affirm under penalty of perjury one of the following three declarations: L11 COVERINGS TO BE CLASS"A"OR BETTER
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. HAZARDOUS MATERIALS DISCLOSURE
2. l 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
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
3. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store or handle hazardous
shall not employ any person in any manner so as to become subject to the material.Additionally,should I use equipment or devices which emit hazardous
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 Co etions V 533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
16;2—
be deemed revoked. Owner or authorized a t:,-, l
APPLICANT CERTIFICATION I hereby affirm that t, a Is a construction lending 4
Date:08/15/2016
I certify that I have read this application and state that the above information is 1V N NDV A Y
correct.I agree to comply with all city and county ordinances and state laws 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,Civ 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 Municipal ARCHITECT'S DECLARATION
Code,Section 9.18. I understand my plans shall be used as public records.
Licensed
Signature Date 08/15/2016 Professional
REROOF PERMIT APPLICATION'
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE CUPERTINO,CA 95014-3255
CLtPERTtNO (408)777-3228• FAX(408)777-3333•buildingft—cupertino.org
PROJECT ADDRESS ---F77-
PN;: _
OWNER NAMEPHip r®py�� p �z p
C3 3 4,—
STREET ADDRESS `f FAX
CONTACT NAME
PHONE
S3Z7 3
STREET ADDRESS CITY,STATE,ZIP F
❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTORAGENT ❑ ARCHITECT ❑ENGINEER ❑' DEVELOPER ❑ TENANT
CONTRACTOR NAME LICENSE LICENSE TYPE Bi .L C.
53 d - / a l
COMPANY NAME E_ L
STREET ADDRESS r' ® CITY,STATE Z� A � � 9?�7Z
j C^s
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC.#
COMPANY NAME E-MAIL
FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF KSFD or Duplex ❑ Multi-Family ROOF AREA: VALUATION:
STRUCTURE: ❑ Commercial AD,
EXISTING ROOF TYPE: ABUILT-UP ROOF El ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY)
REMOVE/REPLACE El YES IF NO, PLYWOOD ❑'w, ❑ PLYWD ❑ OSB PITCH: ROOF
09–NO Y LAYERS: THICKNESS: ❑ 5/8" TYPE: ❑ CDX 12 CLASS: A
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES MOTHER '1M� ICC-ES REPORT'
DESCRIPTION OF WORK:
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 141ding construe' , uthorize representatives of Cupertino to enter the above-iderpified property for inspection purposes.
Signature of Applicant/Agem: Date:
SUPPLEM AL INFORMATION REQUIRED a `
if building is associated with a Home Owner's Association,provide letter KT3�E RouTmc sL P
of approval from HOA. ovEu=TiE coulvER aulLDmcPr Ar RI >.E�i Y "
Provide Planning approval to verify if there any restrictions. ss z v
E�PRE ❑ &ANNING P.W RBN1j
—Provide copy of Manufacturer's Installation Specifications.
❑ STAI�`DARD % ❑ F3RE DEPT.;, ., c
�y ayY
Provide signed copy of Cupertino's Tear-Off Policy. ❑ ISTHER
.
ReroofApp_2011.doc revised 03/16111
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-building(aacupertino.org
PROJECT ADDRESS APN#
OWNER NAME
PHO
STREET ADDRESS ,+ P CITY, STATE,ZIPS FAX
CONTRACTOR NAME 5J LICE E �B�ER LICENSE BUS.LIC.
COMPANY NAME E-MAIL
s q2, 7-c>2.3
STREET ADDRESS
0�X CI Y AT Id Cn/1' Film&j, Z - :3e
I UNDERSTAND AND AGREE TO THE FOLLOWING:
1. The re-roof project shall comply with all applicable provisions of the 2013 California Codes.
2e 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 7:30-3:30pim(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 mails/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 i/"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 monoxidiQ detectors are re fired to be installed in accordance witli Sections R314 and R315 of
the 2013 California Residential C
Signature of Applicant/Agent: Date: / ' ��
ReroofPolicp 2014.doc revised 01/15/14