13040141CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:: 21544 CONRADIA CT
CONTRACTOR: BLACK DIAMOND
PERMIT NO: 13040141 ,.
DESIGNS
OWNER'S NAME: RENATE SWANSON
3481 DEL NORTE DR
DATE ISSUED: 04/18/2013
OWNER'S PHONE- 5597790700
SAN JOSE, CA 95132
PHONE NO: (408)272-5959
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIALL]
❑ LIC LASED CONTRACTOR'S DECLARATION
License Class Lic. # %
TEAR OFF (E) WOOD SHAKE, INSTALL 40 YR COMP (28,00
SQ FT)
Contractor ate
I hereby affirm thatI 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:
Valuation: $12000
performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance, as provided for by
APN Number: 35623052.00
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
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to buildingconstruction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
180 DAYS + ST CALLED INSPECTION.
indemnify and keep harmles City of Cupertino against liabilities, judgments,
costs, and, xpenses,,. ich i accrue against said City in consequence of the
Date: to l 3
granting of this permit: 'A ' ionall ; the, applican nderstands and will comply
Y
with all non point source gulatio s pe a ino Municipal Code, Section
OFS.
9.18.
Signature Date J
All roofs shall be inspected prior to oofiOng material installed: If a roof is
installed without first obtaining an ' ectio I ee t ove all new materials for
inspection. i
❑ OWNER -BUILDER DECLARATION
% f
Signature of Applic Date: O
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
ALL OF VE GS 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 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 a ment or devices which emit hazardous
Compensation, as provided for by Section 3700 of the Labor Code, for the
air contaminants as defined by th ay rea Air Quali M agement District I
performance of the work for which this permit is issued.
will maintain compliance with e C rtino Municip e, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health &Safety Code, S tions 505, 53 2 4.
Section 3700 of the Labor Code for the performance of the work for which this
Date.
Owner or authorized ag t:
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
NSTRUCTION LENDING AGENCY
Compensation laws of California. It after making this certificate of exemption, I
become subject to the Worker's Coprovisions of the Labor Code, I must
I hereby affirm that there is a construction lending agency for the performance of
1 1.mpensation
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
,
ARCHITECTS DECLARATION
indemriify 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 permi . Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
Licensed Professional
9.18.
SignatureDate
ReroofApp_2011.doc revised 03/16/11
CITY OF CUPERTINO
FF,F. F,STIMATOR — BUILDING DIVISION
Llech.. Plan Check Plumb, Plan Check Dec, Plan Check
klec.•h. Permit Fee: Plumb. lo—mit Fee: Elec. Permit Fee:
Other !llech. Insp., Other Plumb Insp.Li
Other Elee. Insp.
;taech. Insp. Fee: Plumb. Insp. Fee: Elec. Insp Fee:
NOTE: This estimate does not include fees due to other uepartments (Le. manning, runic worKs, Tire, aanetarynewer liiszriu, acnuuc
District eta). These fees are based on the prelimina information available and are only an estimate Contact the De t or addn'1 info,
ADDRESS: 21544 CONRADIA CT
DATE: 04/18/2013
REVIEWED BY: MELISSA
QTY/FEE
APN: 35623 052 1
BP#:
*VALUATION: 1$12,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARYPENTAMATION
SFD or Duplex
USE:
0.0
1 SFDWLROOF
PERMIT TYPE: �
WORK
TEAR OFF E WOOD SHAKE INSTALL 40 YR COMP 2800 SQ FT
SCOPE
$0.00
Llech.. Plan Check Plumb, Plan Check Dec, Plan Check
klec.•h. Permit Fee: Plumb. lo—mit Fee: Elec. Permit Fee:
Other !llech. Insp., Other Plumb Insp.Li
Other Elee. Insp.
;taech. Insp. Fee: Plumb. Insp. Fee: Elec. Insp Fee:
NOTE: This estimate does not include fees due to other uepartments (Le. manning, runic worKs, Tire, aanetarynewer liiszriu, acnuuc
District eta). These fees are based on the prelimina information available and are only an estimate Contact the De t or addn'1 info,
FEE ITEMS,(Fee Resolution']1-053 E . 711112)
FEE
QTY/FEE
MISC ITEMS
Plan .Check Fee:
$0.00
F2,800 s.f. Re -roof
$420.00 IREROOFRES
Suppl. PC Fee:` (j) Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee -0 Reg. ® OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
ConstxziclionTire:
Administrative :F'ee:
Work Without Permit. ® Yes (E) No
$0.00
Advanced Planning Fee.
$0.00
Select a Non -Residential 0
Building or Structure;
Travel Domnentation Fees:
Strong Motion Fee: IBSEISMICR
$1.20
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
$1.00
$2.201 $420.00 • $422.20
Revised: 04/01/2013
n r
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 aC�cupertino.orQ
PROJECT ADDRESS /�
APN # Z, 3 b
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PHONE
E-MAIL
STREET ADDRESS
C STATE, ZIP A
FAX
CONTRACTOR NAW
LICENSE NUMBER
LICENSE TYPE
BUS. LIC. #
COMPANY N •
E-MAIL
FAX
ME
STREET AD S
CITY, STATE, oT�.
PHONE
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'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 2010 California Residential Code.
of Applicant/Agent: Date:
ReroofPo1icy_2012.doc revised 10/7/12