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14010073 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1166 SCOTLAND DR CONTRACTOR:q9 -Tn BE PERMIT NO: 14010073 DF'I'ER MThrP OWNER'S NAME: 1 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL ❑ /� RE-ROOF 23 SQUARES,REMOVE EXISTING INSTALL License Class C Li..# ��qq0 NEW Contractor A01 K LNC.. Date ( 30B FELT CLASS A 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 ompensation,as provided for by Section 3700 of the Labor Code,for the erformance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$7715 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 APN Number:36228006.1166 Occupancy Type: 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 building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DA ROM L, ST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,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: Date: with all non-point source regulations per the Cupertino Municipal Code,Section 918. RE-ROOFS: Sign Date t—A All roofs shall be inspected prior to any roofing material being installed.If a roof is installed without first obtaining an inspection,I a e to remove all new materials for inspection. 13OWNER-BUILDERDECLARATION - Signature of App Date: t 3 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TOB ASS"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 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 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. 1 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 Munic' de,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized Date: 3 y 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 Compensation laws of California. If,after making this certificate of exemption,I 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. 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 indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION 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 918. Signature Date ' REROOF PERMIT APPLICATION �� COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION ,� 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408)777-3228• FAX(408)777-3333•buildinp(Mcupertino.org t CUPERTINO. PROJECT ADDRESS /�(� C M cAN 0 1 F,G APN# -2 28- 050,W OWNERNAME �� E-MAIL STREET ADDRESS • CITY, STATE,ZIP RT')N O I FAX CONTACT NAME O • PE�2cz. PHONE 538`11 EMAILRtIV(MEINOOAT.0 TREET ADDRESS ` C ST.•77ATE,ZIP `7 FAX S 9q 3 A Rwd e R 0. ❑ OWNER ❑ OWNER-BUILDER ❑.OWNERAGENT .rJ CONTRACTOR ❑CONIRACTORAGENT ❑ ARCHIIECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME n�✓1 O ' Pe LICENSE NUMBS$799990 9 n 0 LICENSE TYPE BUS.LIC.# COMPANY NAME E-MAIL FAX C 1` r E-MAFAX • STREET ADDRESS T�-w n�A C n J�' CITY,STATE,ZIP W A U CA 'Q% W1 �10NE Q)538-104-3 C 3,n� 1 l 4-3 ARCHrrECT/ENGINEERNAME l r` K v �r �LIICENSENUM3ER ` V f BUS.LIC.#`7`+�+ COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑ SFD or Duplex ❑ Multi-Family ROOF AREA: VALU ON: (3 Co G q STRUCTURE: ❑ CommeIcial J , EXISTING ROOF TYPE: ❑BUILT-UP ROOF JU ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY) REMOVE/REPLACE YES I IF NO. PLYWOOD ❑ 'h" ❑ PLYWD ❑ OSB PITCH: ROOF ElNO #LAYERS: THICKNESS, ❑ 5/8" TYPE: ❑ CDX '12 CLASS: A PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHNGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT# DESCRIPTION OF WORK Ter �otl� N 0�.0 QooF /NST�yc.t_ NGW 30 Fc�' ANO 1,16 w CuAss AsPahuT f4lm► l t S- 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 ead the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state lama's relating to onstruction I h ize representatives of Cupertino to enter the aboveidentifiedproperty for inspection purposes. Signature of Applicant/ Date: 3 '.r. r ga . SUPPLEMENTAL INFORMATION REQUI - _ b SEOI.L 0_ ``MRM-, _If building is associated with a Home Owner's Association,provide letter CKI MOPEN, MONISM of approval from HOA. � � BIJII _Provide Planning approval to verify if there any restrictions. =��'xPR'ass �' PyAiv GP.LANREVSE. _Provide copy of Manufacturer's Installation Specifications. . A — _ DTA a _ Provide signed copy of Cupertino's Tear-Off Policy. ReroofApp_2011.doc revised 03116111 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 1160 Scotland Dr DATE: 01/13/2014 REVIEWED BY: Mendez APN: BP#: "VALUATION: 1$7,715 *PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof PRIMARY PENTAMATION USE: SFD or Duplex PERMIT TYPE: 1SFDWLR00 i WORK re-roof 23 squares, remove existing install new 30b felt class a SCOPE FEE H) ROOF AREA s.f. 1REROOFFRES 2,300 101 IUZ, � tech.flan Check Plumb. Plant Check Elec.Plan C:h:?ck Vlech.Permit Fee: Plumb. Permit Tee: Elec. Permit Fee: Other,tlech.Insp. Other Plumb Insp. L Other Elec.Insp, E171- Allech.Insp,Fe.. Plumb. Insp.Fee: Elec.Insp.Fee: NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,eta). Theseees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff. 711/132 FEE QTY/FEE MISC ITEMS Plan Cheek Fee: Suppl. PC Fee Plumh./Mech./Elec Permit Fee: $368.00 Suppl. Inst,Fee Plumb.iMech.lElee P1umb.A4&.-h.1E1ec Permit lee Construction Tax: T-7 Administrative.F e=e: Work Without Permit? ®,Yes E) No $0.00 Advanced Planning Fees: Travel Documentation Fees: � Strong Motion.Fee: IBSEISMICR $0.77 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 $369.77 $0.00 6 $369.77 Revised: 01/01/2014 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 a(�cupertino.org PROJECT ADDRESS APN� O f o OVJNERNAME �� FAX N 'D 1L. c U (&T No CONTFACTORNAMEky"�A h new LICENSENUMBER� rt(je LICENSE TYPE BUS.LIC. COMPANY NAMEE-MAIL FAX G STREET ADDRESS ktor C STALE,ZIP PHONE SrAp 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. 00fin,g 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 r Ir to be installed in accordance with Sections R314 and R315 of the 2010 California Residential Cod Signature of Applicant/Agent- Date: 1 ReroolPolicy_2012.doc revised 10/7/12