12090262 CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRESS: 10321 S DE ANZA BLVD CONTR,yCI'OR:TNT ROOFING CO PERMITNO: 12090262
OWNER'S NAME: 1031 I S DE ANZA LLC 1610 BLOSSOM HILL RD STE 6C DATE ISSUED:09282012
OWNER'S PIIONE: 4086210602 SAN JOSE,CA 95124 11IIONE NO:(408)277-0800
❑ LICENSED CONTRACT'OR'S DECLARATION 3OB DESCRIPTION: RESIDFN PIAL CONINIERCIAL11
LicenseClusC Lic.k Sa Lp Z RE-ROOF IJ SQ- REMOVE AND REPLACE COMP
L ROOFING
Cont art SIG" Date �� AND INSTALL NEW 30# FELT UNDERLAYMENT
I hereby affirm that I an,licensed under the provisions of Chapter 9
(commencing"illi Seclion 7000)of Division 3 of the Business& Professions
Code and that my license is in.fall force and effect.
I hereby affirm underpenaltyof perjury one of the follo"ing hyo declarations:
I have and will maintain o 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.FI Floor,Area: Valuation:$5494
1 have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 ofthe Labor Code,.for the performance of the work for which this ,CPN Number:35917004.10321 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application mid state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct. I agree to comply with all city and county ordinances mid state laws relating WITHIN 180 DAYS OF PERMIT 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 DAYS FROM LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against Iiabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply Issued by: Dale:
with all non-paint source regulations per the Cupertino Municipal Code,Section
9.18.
Rb:ROOFS:
Signature Date Zee Z All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed without first obtaining an mspectJo I agree to remove all new materials for
inspection.
❑ O\VNFR-BUILDER DECLARATION
Signature of ica Date:
1 hereby affirm(hat I am exempt from(he Contractor's License Law for one of
the following two reasons: ALL ROOF COVERINGS TO RE CLASS"A"OR BEI-ITR
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 IIAZARDOUS MATE..RIAIS DISCLOSURE.
construct the project(Sec.7044,Business&Professions Code). 1 have read the hazardous materials requirements under Chapter 6.95 of the
California Ilealth&Safer) Cade,Sections 25505,25533,and 25534. 1 will
1 hereby affirm under penalty of perjure one of the fallowing three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Ilealth&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 Fuse 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 Ray Area Air Quality Management District
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&SafetyCode,Se bus 25505.25533 rfd 25534, S/ n
Section 3700 of the Labor Code,for the performance of the work for which this p��
Owner or authorized a n(: Dal
permit is issued:
1 cenify that in the performance of the work for which this permit is issued,1 shall
not employ any person in any manner so as to became subject to the Worker's
Compensation laws of California. If,after making this certificate of exemption,1 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. w'ork's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANT CER'1'IEIC,\TION 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,mid hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes.(We)agree to save ARGIII'I'FCI"S DECLARATIONindemnify and keep harmless the City of Cupertino against liabilities,judgments,
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
T
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION lD2
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 07/
CUPERTINO (408)777-3228• FAX(408)777-3333•buildinG(cbcupertino.ort ��
PROTECT ADDRESS " O U
OWNER NANO: Ory,1` .P , C S/ /T ,PHONE \ / ✓�r /� E-MAIL
STREETADDRESS 'O / J V VP �Iu �j CITY, STATE,ZIP v C�L1 V/V
FAX
CONTACT NAME „/ /j/`//✓j G� PHONE / Q E/
STREET ADDRESS / ' 1 /, CITV.�/.t E•`U/ ` !� (J I[ FAX V
❑OWNER ❑ O%VER- UILDER ❑ OWNER AGENT ❑ CONTRACTOR �I CONIRACIOORR AGENT ❑ ARCNr ECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTORNANIE LICENSE NUMB LICENr j - BUS.LIC.I
COMPANY NAMErr� l E-NL1R FAX
Iokx` La =
sTREEr.ADDRESSt CITY,STATE,ZIP PHONE
-- i2 ��eu 1er �I - - Z?�'G�O°
ARCHITEC(ENGINEER NAME ICENSE NUMBER BUS.LIC.M
COMPANY NAME E-NIAIL FAX
STREEr.ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑ SSF��FD or Duplex ❑ Mulb-Family ROOFAREA: VALUATION:
STRUcrURE: .21- ontmercial I / 5'ao F S S�9�r
EXISTING ROOF TYPE: ❑BUILT-UP ROOF P1151HAIT SHINGLES ❑WOOD SHAKES ❑WOODSHINGLFS ❑OTHER(SPECIFYT
B IOVEIREPLACE Q<ms I IF NO. PLYWOOD ❑ l5' ❑ PLYWD ❑OSB PITCH: ROOF
❑ N S ICKNEI 11 <B" ❑ AX 4=:12 LASS
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ASPHALT SHINGLES ❑WOOD SHARES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT tl
DESCRIPTION OF WORK: Ski Tau 6A(
1 Li c �i)c �s �trr
� N
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. 1 have read this
application and die 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 slate laws relating In building construction. I authorize representatives of Cupertino to enter the above-identified ropeny for inspection purposes.
Signature of Applicant/Agenc
SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY
_if building is associated with a Home Owners Association,provide letter - PLAII CHECK rVPE ROUTING SUP
of approval from HOA. \OVER-111 COUNTER BUILDING PLM'.REVIEW
_Provide Planning approval to verify if there any restrictions. d_exraEss PundlNr,PLAN xeYlew
_Provide copy of Malmfacmrer's Installation Specifications. p crANI)ARD ❑' Inxr oral'
Provide signed copy of Cupertino's Tear-Off Policy. ❑ OTiti:R: - -
Reroojdpp_2011.doc revised 03116/11
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
ALBERT SALVADOR. P.E., C.B.O.. BUILDING OFFICIAL
CUPERTINO 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255
(408)777-3228• FAX(408)777-3333•buildino okupertino.oro
PROJECT ADDRESS O3Z / APN0
OWNER NAME ( Pt10NE /�� �/.' 0 ? E-MAIL
STREETADDRESS ` CITY,STAT IP 1C (_ FAX
/U30 eL 7i�4-- r
CONIAACI'OR NAME LICENSE NUMBER LICENSE'IYPau
S.LIC.Y
COMPANYNAME E- FAX
/.S
STREET ADDRESS JI .J� r( P(L( I`r` CITY.STATFL ,` C P //r PHONE rf 7
1 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 the day before the inspection date. Please call (408)777-
3228 from 7:30 - 3:30pm (Mon-Thurs) or 7:30 - 2:30pm (Friday) to schedule the next day 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. Progress
and 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. Progress Inspection is required when approximately 50% of roof covering is installed.
7. 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.
8. 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 of$126.00. 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 requi d to be installed in accordance with Sections R314 and R315 of
the 2010 California Residential Code//
Signature of ApplicanUAgent: , ��_�'!F'6 Date:
ReroofPolicv_20/Like reviser/0211611 l
kEROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 02
10300 TORRE AVENUE -CUPERTINO,CA 95014-3255 O<fj
CUPERTINO (408)777-3228• FAX(408)777-3333•buildina(ftuoertino.ora
}� 1
FROIECT ADDRESS /0 z/� /1 4 A AP/N p 2/C/ c, 1-1
O 0
OWNER NAME C•• O2,` _P ^A[C /1 �PHOONE \ O�iJI '✓"`�� E MAR. V
qog
STREET ADDRESS 'D V I'V/P/Wil• ( lV (�
r.'� CITY, STATE,ZIP S 9 1 FAX
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CONTACT NAME Q�1 `✓� ryl GL PNONE �••O/ / �� E�<L _fi"//a-r^V - �. � Lr�
STREET ADDRESS //`QIP/ FAX
leliq
❑ OWNER 11OUNER-B IURDDER ❑ OWNERAGENLT E3 CONTRACTOR Be 50 RACiORAGFNT ❑ Attcn T cr ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTORNAME LICENSE NIR.f . LICENr BUS.LIC.0
COMPANY NAME E-MAIL - FAX
STREET.ADDRESS 1- n CITY,STATE,ZIPPHONE
— ZZ/6e0v
ARCHITECDENGINEER NAME 'CENSE NUMBER BUS,LIC.0
COMPANY NAME E-MAIL FAX
STREET ADDRESS CRI',STATE,ZIP PHONE
USE OF ❑❑ SSFFD or Duplex ❑ Multi-Family. ROor.AREA: VALUATION: _
/ , �J
srRucruRE:
EXISTING ROOF TYPE: ❑BUILT-UP ROOF ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTRER(SPECIFT)
REMOVE MEPLACE IFS IF NO. PLYWOOD ❑ 15" ❑ PLYWD ❑OSB PITCH: ROOF
❑ ND e o rmGKNEcs ❑ sm,^ ❑ 'i� CLASS
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-FS REPORT M
DESCRIPTION OF WORK:
Ll t 61 01
' rN
By my signs Lure below,I certify m each ofthe following: I am die property owner or audiorized agent to act on die propene 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 in comply with all applicable local
ordinances and state laws relating w building eonstmuion. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agen[ 1 — Date: Z 1_
SUPPLEMENTAL INFORMATION REQUIRED - OFFICEUSLONLV
_If building is associated with a Home Ovvnees Association,provide letter PLASCHECK TYPE - ROU TING SLIP
of approval from HOA. \,ot,ER.THC-COUNTER'. BUILDING PLAN REY'Cn'
_Provide Planning approval to verify if there any restrictions. LLLd1JJJ__KvrRe_cs � rLANnTINc rL'A;v iteYteW
_Provide copy of Manufacturer's Installation Specifications. ❑ sTANDARn ❑ riREDCrer
Provide signed copy of Cupertino's Tear-Off Polic7. ❑ OTHER:
Reroojdpp_101 Witic reviser(03116111