14080112CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22607 ROYAL OAK WAY
CONTRACTOR: IQV CONSTRUCTION
PERMIT NO: 14080112
INC
OWNER'S NAME: POLSON THATTIL J AND JOSE MERCY C
820 CHARCOT AVE
DATE ISSUED: 08/15/2014
OWNER'S PHONE: 4085591977
SAN JOSE, CA 95131
PHONE NO: (408) 582-9200
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
CARPORT - TEAR OFF (E) SHAKE, INSTALL (N) CLASS A
License Class C_- 3 Lic. # ?15'3 ?,/Q
COMP ROOF SYSTEM (7 SQ'S)
Contractor Date 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
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: $1858
I have and will maintain Worker's Compensation Insurance, as provided for by
APN Number: 34232010 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 building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
180 DAYS MLA T CALLED INSP CT ON.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
City in consequence of the
`
I/
costs, and expenses which may accrue against said
Issued by: Date: �
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
9 18.
c
Signature % Date�V W��
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
Signature of Applicant: Date:
❑ OWNER -BUILDER DECLARATION
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
1, 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 25505, 25533, n 2534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent:
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
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
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
REROOF P TCATFON
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION112-s .
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • bulldingacupertino.org
CUPERTINO. \
PROIECfADDRESS
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❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTORAGENT ❑ ARCHrmCT ❑ ENGINEL•R ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
LICENSENUMBER
TYPE
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COMPANY NAME
E-MAIL
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ARCHTCECT/E•NGINEERNAME
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USE or ❑ SFD or Duplex ❑ Multi -Family Rr--1 S VALUATION:
❑ Commercial
STRUCTURE:
EXISTING ROOF TYPE: • : -BUILT-UP ROOF ❑ ASPHALT SHINGLES WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER (SPECIFY)
R-MOVE/REPLACE ®YES
❑
IF NO.
PLYWOOD ❑ w, ❑
PLYWD ❑ OSB
PITCH:
ROOF
NO
U LAYERS:
THICKNESS• ❑ 5/8"
TYPE: ❑ CDX
—�• ' � 2
CI..ASS: A
PROPOSED ROOF TYPE: BUILT-UP ROOT- ❑ ASPHALT SHINGLES 11 WOOD SHAKES ❑ROOD SHINGLES OTHER 16C -Es Rff6ffii
DESCRIPTION OF WORK: -� C-' + ) (�In ( �•-� j
r\ P rvl�?✓ �? (� X I�i��V C t<1 b] Lt +� �' -- �' �<> `S �%i-1 J �Ci � 1 � '��''sS �
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By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property ov mer's behalf. I have read this
application and the information I have provide 's 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 t9 u I nss/ttruction. I authorize representatives of Cupertino to enter the above-iid/entified property for inspection purposes.
�
S ignature of Applicant/AgenC Date:
SUPPLEMENTAL ITTFORMATION REQUIRED
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us�:on4� ?S ; � �ll
If building is associated wm
with a Horne O��ner's Association, provide letter
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of approval from HOA.
_ Provide Planning approval to verify if there any restrictions.
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Provide copy of Manufacturer's Installation Specifications..
Provide signed copy of Cupertino's Tear -Off Policy.
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Reyoof-4pp 2011.docrevised03/16/11
CITY OF CUPERTINO
r m FEE ESTIMATOR - BUILDING DIVISION
191
ADDRESS: 22607 ROYAL OAK WAY
DATE: 08/13/2014
REVIEWED BY: MELISSA
Plan Che -,-k Fee"
APN: 342 32 010 ---FBP#:
*VALUATION: 1$1,858
*PERMIT TYPE: Minor Building Permit
PLAN CHECK TYPE: Re -roof
or Duplex
USE:
PENTAMATION
PERT TYPE: 1SFDWLR0PERMITPRIMARYSFD
'A
WORK
CARPORT - TEAR OFF (E) SHAKE, INSTALL (N) CLASS A COMP ROOF SYSTEM (7 SQ'S)
SCOPE
.'Wef,h. Pian (74,."Ck
17. his'p,
0117er Al,,ir,-ib 1r p.
FT
Mwr,b. Inspe. Fee;
.Vll I I I
Dec . ht tp,
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.). inese-jees are oasea on me preliminary information available and are only an estimate. contact the Deptlorailan-1 into.
FEE ITEMS (Fee Resolution 11-053 Eff. 711113
FEE
QTY/FEE
MISC ITEMS
Plan Che -,-k Fee"
5�,'zvpj.,,L Pk/7 P'ee
F
Permit Fee:
$119.00
Permil P'ee:
4d" inisZraiivv Fec".
Work Without Permit? 0 Yes (F) No
$0.00
7'Favel l')OCIonewadon Fek:w:
Strong Motion Fee: 1BSEISAffCR
$0.50
Select an Administrative Item
Bld&Stds Commission Fee: IBCBSC
$1.0
`A
M20.50
M "M t worm"
$120.50
$0.00 TOTAL, FEE.-�',�,]
$1
Revised: 07/10/2014
CUPERTINO
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(alcuoertino.org
PROJECT ADDRESSAPN
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OWNER�!(
NAME
PHONE
E-MAIL
STREET ADDRESS
'17QUcor 10n) �o
CITY, STATE, ZIP
FAX
CONTRACTOR NAME
LICENSENUMBER�632/�•
7
LICENSE T E
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BUS. LIC.#
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
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 un to one business day before the requested inspection date.
Please schedule inspections online or 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. The hours for this service are: 7:30-10:30am and 12:30-3:30 (Mon-Thurs)
and 7:30-10:30am and 12:30-2:30 (Friday). 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 monoxid d tectors are required to be installed in accordance with Sections R314 and R315 of
the 2010 California Residential e7-7 .
Signature of Applicant/Agent:Y14--- Date:
Reroo)71olicy_2013.doc revised 10/20/13
August 11, 2014
City of Cupertino
Building Department
10300 Torre Avenue
Cupertino, CA 95014
Re: Westridge Country Club Homes Association
Gentlemen:
This office is the management company for the above homeowners association and the
Board of Directors requests your assistance in obtaining a Permit for the installation of
new roofs at this complex in Cupertino, CA 95014.
Please be advised that IQV Construction, Inc. or Jim Lyons of Construction Services, Inc.
will be obtaining the permits on behalf of the Board of Directors.
Thank you for your anticipated cooperation.
Sincerely,
COMMUNITY MANAGEMENT SERVICES
Pauline M. A. Moore, Senior Association Manager
Westridge Country Club Homes Association
cc: IQV
CSI
Board of Directors