14080153CITY OF CUPERTINO BUILDING PERMIT I
BUILDING ADDRESS: 22706 ROYAL OAK WAY CONTRACTOR: IQV CONSTRUCTION PERMIT NO: 14080153
INC
OWNER'S NAME: KANDACE KLEMBA 820 CHARCOT AVE DATE ISSUED: 08/18/2014
OWNER'S PHONE: 4085591977 SAN JOSE, CA 95131 PHONE NO: (408) 582-9200
❑ LICENSED CONTRACTOR'S DECLARATION
License Class Lic. # 3 21
Contractor 4 Date
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.
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
permit is issued.
APPLICANT CERTIFICATION
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,
costs, and expenses which may accrue against said City in consequence of the
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.
Date �S `J y
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
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.
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
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
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION
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,
costs, and expenses which may accrue against said City in consequence of the
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.
Date
JOB DESCRIPTION: RESIDENTIAL [] COMMERCIAL ❑
CARPORT - TEAR OFF (E) SHAKE, INSTALL (N) CLASS A
COMP ROOF SYSTEM (7 SQ'S)
Sq. Ft Floor Area: I Valuation: $1858
APN Number: 34232127 00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS F CALLED INS EC ION.
Issued by: Date:
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection. / f
Signature of Applicant: Date: 0
ERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Sections 2 5, 25533, and 25534.
Owner or authorized age.. Date:
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
work's for which this permit is issued (Sec. 3097, Civ C )
Lender's Name
Lender's
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
r«�vvr rcmiv►I I HrrLIlAA I IUN O
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION.
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333 - buildin cu ertino.or
CUPERTINO. G(a o q
PROJECT ADDRESS
OVJTIER NAMFr L(/C 1� `U PH'6CJ ` S I T �� E-? LAIC
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STREET ADDRESS
CONTACT NAME PHONF� E-MAIL
STREET ADDRESS
CITY, STATE, ZIP
FAQ(
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGngE-L•R ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME LICENSE NUMBER
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LICENSE TYPE
BUS. LIC.
COMPANY NAME
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CITY, STATE, ZI _
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PHONE
ARCI-BTECT/E-NGINEER NAME
LICENSE NUMBER
BUS. LIC. it
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
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USE or ❑ SFD or Duplex ❑ hfulti-Fatnily Rr-- VALUATION:
STRUCTURE: ❑ Commercial
EXISTING ROOF TYPE: ' BUILT-UP ROOF ❑ ASPHALT SHINGLES F WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER (SPECIFY)
REMOVE/REPLACE M YES Efr�NO,��PLYWOOD, ❑ Iw. ❑ PLYWD ❑ OSB PITCH: ROOF
NO HICI03FS• _❑ S/S'— TYPE: ❑ CDX 2 _CLASS: A
-- - _- -
PROPOSED ROOF TYPE: ❑ BUILT-UP ROOT ❑ ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES OTHER ICC•ES ItEP02'I' 1!
DESCIUPTION OF WORK -� � f 1 r '
r �ti :./� �> (Ake- T100 �S
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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 owner's behalf, I have read this
application and the information I have provide's earrect. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
nstruction. I authorize representatives of Cupertino to enter the above-identified
ordinances and state laws relating Vt?uY prop" for inspection purposes.
SignatureofApplicantlAgent: t/i/ Date:
SUPPLEMENTAL INFORMATION REQUIRED����;�?
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_ If building is associated with a Home Owner's Association, provide letter
acr AN;cuLc,,t�lcxrl,� _
FROM
oiNT c;scl.�'s
of approval from HOA.
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_ Provide Plarming 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,
tax `,td
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Reroofdpp-2011. doc revised 03116111
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
imiADDRES:
FEE
DATE: 08/13/2014
REVIEWED BY: MELISSA
APN.
BP#:
*VALUATION:
1$1,858
*'PERMIT TYPE: Minor Building Permit
PLAN CHECK TYPE: Re -roof
PRIMARY
USE: SFD or Duplex
PENTAMATION
PERMIT TYPE: 1SFDWLR00
WORK
CARPORT - TEAR OFF E SHAKE INSTALL N CLASS A COMP ROOF SYSTEM 7 SQ'S
SCOPE
Me I
F2v.
Pl., nib..Pkat? (_7%'ck
FP,'7"pr'7.'
011ier Al.rrrib Imp,
Phe�nb, Insp. Fee:
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.). ihese_rees are basea on the preliminary information available and are only an estimate. Contact the Dept for aaan'l into.
FEE ITEMS (Fee Resolution 11-053 E . 711113)
FEE
QTY/FEE
MISC ITEMS
T_
Szip ) �p..P(7 P € e
Permit Fee:
$119.00
SLtppl, .IPIsp ee,
("'onstrucfio�i'Tax:
T
?att'� inz'sfr"Cal;Ve Fee
Work Without Permit? 0 Yes 0 No
$0.00
Strong Motion Fee: IBSEISMICR
$0.50
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
$1.00
10
_ "
$120.50
0 9 SAL E
$0.0 ..
$120.50
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 aalcupertino.org
PROJECT ADDRESS C APN #
(l (f/
OWNERNAME PHONE E-MAIL
STREET ADDRESS
CITY, STATE, ZIP
FAX
(� [CA) � 0
CONTRACTOR NAME
LICENSE NUMBER�,63 ?I C7
LICENSE TYPE
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 up 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 tectors are required to be installed in accordance with Sections R314 and R315 of
the 2010 California Residentia�ll � e.
Signature of Applicant/Agent: 3°G` �-' Date:
ReroofPolicy_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