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14030025l�1 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10122 AMADOR OAK CT CONTRACTOR: IQV CONSTRUCTION PERMIT NO: 14030025 INC OWNER'S NAME: CHANG HONG SHUN AND MARY MAILI 820 CHARCOT AVE DATE ISSUED: 03/10/2014 OWNER'S PHONE: 4084483080 SAN JOSE, CA 95131 PHONE NO: (408) 582-9200 PK LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ �� ) License Class Lic. # ` REMOVE EXISTING BUILT UP ROOF AND INSTALL SECURE � �� 3— d ` �– ROCK AND 60 MIL CARLISLE ROOFING SYSTEM (400 SQ Contractor Date FT). 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 Sq. Ft Floor Area: Valuation: $2417 erformance 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 the work for which this APN Number: 34232018.00 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 RMIT 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 M L 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 Date: a with all non -point source re ulations per the Cupertino Municipal Code, Section 9 18. Signature Date RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first oAani, I agree to remove all new materials for inspection. OWNER -BUILDER DECLARATION _X�Signature of Applicant:Date: I hereby affirm that I am exempt from the Contractor's License Law for one ofthe following two reasons: ALL ROOFBE 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 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. 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 25 5 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner _d Date:_ permit is issued. or authorized agent: 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 9 18. Signature Date REROOF PERMIT APPLICATION [a COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION V 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 0� (408) 777-3228 •FAX (408) 777-3333 • build ing ancupertino.org CUPERTINO. PROJECT ADDRESS I APN # 412 L-32- 6) 19' OVVNERNAMF Q V J STREET ADDRESS CITY, STATE, ZIP FAX CONTACT NAMEtt PH0N E-MAIL 7`�'�� Zips - �' 7 Z,. i STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ .OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LIC. k COMPANY NAME E-MAIL FAX STREET ADDRESS �- CITY STATE, ZI r A //0 PHONE 4, 7 5� to ,: c .5 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC. # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFD or Duplex ❑ Multi -Family ROOF AREA: VALUATION: STRUCTURE: ❑ Commercial EXISTING ROOF TYPE: • 'R BUILT -IJP ROOF ❑ ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER (SPECIFY) REMOVE /REPLACE M YES Jr. NO, PLYWOOD ❑ %- ❑ PLYWD ❑ OSB PITCH: ROOF A ❑ NO # LAYERS: THICKNESS: ❑ sn- TYPE: ❑ CDX -1—:12 CLASS PROPOSED ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES OTHER ICC ES R1-POtL9' f! DESCRIPTION OF WORK:.? is 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 of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to bui h struction. I authorize representatives of Cupertino to enter the ab o e -identified property for inspection purposes. Date: Signature of ApplicandAgent: SUPPLEMENT4L WFOWATION REQUIREDci•U�sz }Ylit 5j PLAN"cI 'cx xYPE t{ = to 4-s"RJ W At $'FR .a �h� •: �/ 0K,*0 r .G SLii�� If building is associated with a Home Owners Association, provide letter �'Nj+f�F 4 f 'k(1�"Y} r, O' VER THI; CQ LR � +y5 k'aSt 4 srA y�eyyfif'^��f y'$ Nthis, Atk` ❑+BUILDINGILREVIL - of approval from HOA, Provide Planning approval to verify if there any restrictions. -Y,poi p ' �"� >F� x i �a-r',' E i S✓ r pz uT — Provide copy of Manufacturer's Installation Specifications.. signed copy of Cupertino's Tear -Off Policy, We � � U r R ora�R -��t�• �; —Provide a� s€r , �� Reroof,4pp_2011. doc revised 0311,6/11 CUPS11TING REROOF TEAR -OFF POLICY COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION ALBERT SALVADOR, RE., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 - building 5cupertino.ora PROJECT ADDRESS ` !J �J - - V C� v O K I APN R / Q OWA'ERNAME h PH 0 I O ob 1 D D p MAIL STREET ADDRESS CITY, STATE, ZIP I FAXS �S CONMALCrORNAME 61t F?N LXENISENUMBER.SETYPE ZI J L -3I BUS. LIC. n COMPANY N I E-MAIL FAX Q /`J ADDRESS F;" 7 C l�tesi � tr S t CITY STATE, ZIP S�v s� �� `_ U I 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 inspedtiori. 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 J/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 Daid 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 det tors are required to be installed in accordance with Sections R314 and R315 of the 2010 California Residential Code. _ Signature of Applicant/Agent: Date: / ReroojTo1icy_2012.doc revised 1017/12