13040016CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22047 CLEARCREEK CT
CONTRACTOR: AMERICAN TEAR OFF
PERMIT NO: 13040016
SERVICES
OWNER'S NAME: FAIRCHILD RONALD S AND PATRICI
861 BRITTANY CIR
DATE ISSUED: 04/02/2013
OWNER'S PHONE: 4082534611
HOLLISTER, CA 95023
PHONE NO: (408) 690-7173
JOB DESCRIPTION: RESIDENTIAL COMMERCIALE]
Is LICENSED CONTRACTOR'S DECLARATION
L'`� #
TEAR OFF (E) WOOD SHAKE, INSTALL (1) OSB 30LBS
License Class Li,.
FELT & LIFETIME COMP (2800 SQ FT)
Contractor Date_L'�-z 3
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: $13000
Ihave and will maintain Worker's. Compensation Insurance, as provided for by
APN Number: 32618014.00
Occupancy Type:
Section 3700 of the Labor Code, for the performance of the work, for which this
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 DA RNIIT ISSUANCE OR
to building construction, and hereby authorize representatives of this city to enter
180 DAYS CALLED INSPECTION.
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 may accrue .against said City in consequence of the
Issue by Date: 2
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
2'-1
RE -ROOFS:
installed. If is
Signature Date
All roofs shall be inspected prior to any roofing material being a roof
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
if _Z - 15
❑ OWNER -BUILDER DECLARATION
Signature of Applicant: Date:
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 isnot 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. I 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 Cupertino Municipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sections 25505, 25533, and 25534.
—z"1
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: Date:
permit is issued.
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
CONSTRUCTION LENDING AGENCY
Compensation laws of California. If, after making this certificate of exemption, I
Code, I
I hereby affirm that there is a construction lending agency for the performance of
become subject to the Worker's Compensation provisions of the Labor must
work's for which this permit is issued (Sec. 3097, Civ C.)
forthwith comply with such provisions or this permit shall be deemed revoked.
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 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
CITY OF CUPERTINO
.�
IVU 1V FCTTMATnR—RIT11,11INf DIV14RION
-Ch. Plan Check
F111.), Perinit Fee:
then Alech. Awry.
Tech. Inch. Fee:
NOTE. This estimate does not include
Phimb. Plan Check Elec. Plan Check
Plumb. Permit Fee: Elec. Permit Fee:
Other- Plumb Insp.0_L_ Cather Elec. Insp, Li
Plumb. Insli. Fee: Elec. Insp, Fete:
due to other Departments (La Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.). These fees are based on the preliminary
ADDRESS: 22047 CLEARCREEK CT
DATE: 04/02/2013
REVIEWED BY: MELISSA
Suppl. PC Fee:' (F)Reg. 0 OT
APN: 326 18 020
BP#:
*VALUATION: 1$13,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Du lex
p
Suppl. Insp. Fee -.0 Reg. Q OT
PENTAMATION 1SFDWLR00F
PERMIT TYPE: i
USE:
PME Unit Fee:
WORK
TEAR OFF E WOOD SHAKE INSTALL N OSB 30LBS FELT & LIFETIME COMP 2800 SQ FT
Consiruction Tax:
SCOPE
A.dninistrcative .Fee:
-Ch. Plan Check
F111.), Perinit Fee:
then Alech. Awry.
Tech. Inch. Fee:
NOTE. This estimate does not include
Phimb. Plan Check Elec. Plan Check
Plumb. Permit Fee: Elec. Permit Fee:
Other- Plumb Insp.0_L_ Cather Elec. Insp, Li
Plumb. Insli. Fee: Elec. Insp, Fete:
due to other Departments (La Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.). These fees are based on the preliminary
FEE ITEMS (Fee Resolution.]1-053 E :.711/12)
Plan Check Fee:
Suppl. PC Fee:' (F)Reg. 0 OT
0.0
hrs
PME Plan Check:
E
Permit Fee:
$0.00
Suppl. Insp. Fee -.0 Reg. Q OT
0,0
hrs
PME Unit Fee:
PME Permit Fee:
Consiruction Tax:
$1.30
A.dninistrcative .Fee:
Select an Administrative Item
Work Without Permit? 0 Yes (E) No
Advanced PlanningFee.
Travel Doeumentao.on Fees:
Strong Motion Fee: 1BSEISWCR
Bldg Stds Commission Fee: 1BCBSC
oration available and are only an estimate. contact the wept for aaan z
FEE QTY/FEE MISC ITEMS
$0.00 2,800 s.f. Re -roof
$0.00 $420.00 IREROOFRES
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
E
$0.00
Select a Non -Residential E)
Building or Structure_
$1.30
Select an Administrative Item
$1.00
$2.301
$420.00
._ym $422.30
Revised: 04/01/2013
h
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 cupertino.org
PRO DRyE S
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APN #
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BUS. LIC. #
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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
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 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 R314 and R3 f5 of
the 2010 California Residential Code.
Sienature of ADDlicandAaent: Date.
ReroofPolicy_2012.doc revised 10/7/12