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12100125 CITY OF CUPERTINO BUILDING PERMIT BUILDING AIIDRESS: 18964 PENDERGAST AVE CONTRACI'OR:ROSSETTAS ROOFING PFRAIIT NO: 12100125 ON'NIiR'SNAME: MELLENDAVIDM 401 LINCOLNAVF. DA'Z'E ISSUED: 10/162012 ��,�OWNER'S PIIONF,: 4088651987 SAN JOSE,CA 95126 PHONE NO:(408)2944400 /�LICENSSED CON*fRA—C7I*0R'''SS DECLARATION BUILDING PER INFO: BLDG r ELECT r PLUMB r License Class l a-1 Lick `�l J OIY�I pIECFI rRESIDENTIAL F� COMMERCIAL r ContracloriZLA/�� by1S Dale1p1\S1a 1 hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: REMOVE EXISTING COMP,INSTALL NEW 30 YR COMP (commencing with Section 7000)of Division 3 of the Business& Professions CLASS Code and that my license is in full force and effect. A 24 SQ hereby affirm under penalty of perjury our of the following ton 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. I have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of One work for which this permit is issued Sq.Ft Floor Area: Valuation:$7884 ArPI.ICA�N'I'CF.R'I'IFICA'I'ION I certify that 1 have read this application and slate that the above information is MIN Number:37534042.00 Occupancy Type: 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, PERMIT EXPIRES IF WORD IS NOT STARTED costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non-point source regulations per the Cupertino Municipal Code,Section 180 D YS FROM LCALLED INSPECTION. 9.18. Signature Date u S�l'a Issued be +'� ��AlWq �Date: ❑ OWNER-MIILDER DECLARATION hereby affirm that I am exempt from the Contractor's License La% for one of RE-ROOFS: the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is I,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I agree to remove all new materials for will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection. Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to Signature of Appliame Date: construct the project(Sec.7044,Business&Professions Code). - hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BE; FER declarations: I have and will maintain a Certificate ofConsem to self-insure far Worker's Ih\'L,U(DOI1S M.\TIiRI,\I ti DISCI.OSl1Rli Compensation,as provided for by Section 3700 of the Labor Code,for the perfomance of the work for which this permit is issued I have read the hazardous materials requirements under Chapter 6.95 of the I have and will mainmin Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. I mill maintain Section 3700 of the Labor Code,for the performance of the work for which this compliance with the Cupertino\municipal Code.Chapter 9.12 and the I lealth& Safety Code,Section 25532(a)should I store or handle hazardous material. permit is issued Additionally,should I use equipment or devices which emit hazardous air I certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area,tie Quality Management District m mill not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Compensation laws of California. IL ager making this certificate of exemption,I Health&Safety Code,Sections 25505.2.5533,and 25534. become subject to the Worker's Compensation provisions of the Labor Code,I must O' ��auth�orized,a nt: fonMvith comply with such provisions or this permit shall be deemed revoked - �y7)�f,VL-1-C.�'l Date: � Jl API'I-IC,N'I'CF-R'1'IFIC,\'PION CONSTRUCTION LENDING AGENCY 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 I hereby acorn that there is a constmction lending agency for the performance of work's to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.) upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accme against said City in consequence of the Lender's Address granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section ARCII ITF("1"S DECLARATION 9.18. 1 understand my plans shall be used as public records. Signature Date Licensed Professional REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 CU PERTI NO (408)777-3228• FAX(408)777-3333•buildinll ftupertino.00rrg 1 PROJECT ADDRESS 1r\, ULA �� c— r �_ I APN 0 2(J�/ (� / OWNER NA �r� , PIIONE E-MAIL —I STR"'.TADD R�S q1- pQ y)�� ,L`I o cl •.sTnns.zir n�Dl FAX CONTACT NAME lY l- M PHONE �"1 E-MAIL STREET ADDRESS CITY.STATE, ZIP FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRAQUR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CO AC700.NAME LICE�`1.5)y MBE R LICf,.,NSE TYPE I BUS.LIC. L OT COMPANYNAME EMAIL FX STREET ADDRESS CI ,G�,ZI Lh aAX y ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC.p COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF SFD or Duplex ❑ Niulli-Family ROOFAREA: VALUATION: STRUCTURE ❑ Commercial yo)y •1�$y— F-X13TING ROOF TYPE ❑RUILT-UPROOT IOVSPHALTSFIINGLE:S ❑WOODSHAKPS ❑W'OODSHINGLES ❑OTHER(SPECIFY) REMOVE/REPLACE &YES IFNO. PLYWOOD ❑ %" ❑ PLYR'D ❑OSB PITCH: ROOF ❑ NO M LAYERS: I'Ky TIIICKNESS: ❑ 5B" TYPE: ❑ DX '5 (� CLASS: A PROPOSEDROOFTYPE ❑BUILT-UPROOF p.4SPHALTSHINGLPS ❑WOOD SHAKrs ❑WOOD SHINGLES ❑OTHER ICC-FS REPORT DESCRIPTION OF WORK: l 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 ofWork and verify it is accurate. 1 agree to comply with all applicable local ordinances and state laws.relating to building constru�ctio_n.,�I.rauythorize representatives of Cupertino to enter the above-idemified property for inspection purposes. Signature of Applican✓Agent: `1�) Date: 1 C)1 Iu\Ii-,)- SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY _ If building is associated with a I tome Owners Association,provide letter PLAN CHECK TYPE ROMIN'GSLIP Ofapproval.from HOA. ❑ OVER-TIIF.COUSrER ❑ BUILDINGPLANRF-YIEW Provide Planning approval to verify if there any restrictions. ❑ r;Xrur'ss ❑ PL.\NN'ING PL.\NRF:\'I f:\Y Provide copy of Manufacturer's Installation Specifications. ❑ STANDARD ❑ F'IRF.DEPI' Provide signed copy of Cupertinos Tear-O Cf Policy. ❑ OTHER: ReroojApp_2011.doc revised 03/16111 CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION ADDRESS: 18964 pendergast ave DA'Z'E: 10/16/2012 REVIEN1'ED BY: larrys \ APN: BP#: 'VALUATION: $7,884 *PERMIT'1'YPE: Minor Building Permit PLAN CIIECK'I'YPE: Re-roof PRIMARY PENI'AiNIATION 1SFDWLROOF USE: SFD Or Duplex PFRMITTYPE: WORK remove exist comp, install new 30 yr. comp SCOPE FEEID ROOFAREA (s.L) 1REROOFFRES 2,400 ,ileeh. Plan Check Hood, Halt Chrrk Ore.flat Chet k ,Nrrh. Permit Iye. Pbatib.Permit Fee.: En F.-lo,Pe, Fee- Other:1 hrh.lay. Oihrr Plumb last, Other h7ee / pt. Alrclt.Imp.Fee Phonh. hap. Fee: E/w.lap.Fee: NOTE: This estimate does not inchidejees(lite to other Departments(i.e. Planning,Public Works, Fire,Sanitary Sewer District,School District,etc). These ee.v are ba.cerl on the trelindnary in ornuaion available anti are onli'an estimate. Contact the De I or athln'I in t. FEE ITEMS fLe Kesolutlon 11-053 L•' : 7:1112) FEE QTl'/FEE MISC ITEII7S Plan Check Fee: Suppl. PC F,ve Plumb./il4ec•h.4i ler• Permit Fee: $360.00 Stipp/. Insp Fee Phonh.4fech.tElec Plumh.hNech.`Flec. Permit Fee: Concuructimn Tew Administrative Fee: Work Without Permit? O Yes (E) No $0.00 Arh•unced Planning Fees: Travel Documentation Fees: Strome Motion Fee: IBSEISd-IICR $0.79 Select an Administrative Item Uld¢ Sids Commission Fee: IBCBSC $1.00 SUBTOTALS: $361.79 $O.Ool TOTAL FEE: $361.79 Revised: 10/01/2012 REROOF TEAR-OFF POLICY s COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL C U P E RT I N O 10300 TORRE AVENUE•CUPERTI NO, CA 95014-3255 (408)777-3228 • FAX(408)777-3333 • buildinc0cuoertino.oro PROJECT ADDRESS !1� I .UN M O\VNER NhME mL��-tl PHO , E-MAIL STREET i DRESS ITY,ST _I DH FAX CONTRACTOR NAME LICENSE N111,1BER LICENSETYPE I BUS.LICA CO ANY NAME E-MAIL STREET ADDRESS�^ CITY,STATE, P �1.� Pxt SNE_ "T1" Ob w 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 (late. Please call (408) 777-3225 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 Nailin„ 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 there-roofing is completed. To receive a final sign-off, the following items will be verified: a. Flat roofs shall have a minimum of'A" 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 raid 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 owners 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 2010 California Residential Code. Signature of Applicant/Agent: Date: KAAS.11Z, ReroofPolicy_2012.doc revised 10/7/12