14110147 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22215 RAE LN CONTRACTOR:A-1 ROOF PERMIT NO: 14110147
MANAGEMENT AND
OWNER'S NAME: CHANG JONATHAN AND WEILIN TRUSTEE 14100 DOOLITTLE DR DATE ISSUED: 11/26/2014
OWNER'S PHONE: 4082185063 SAN LEANDRO,CA 94577 PHONE NO:(510)347-5400
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL E]
DECK RE-ROOF 10 SQ
License Class 0 C-39,C-!.3 Lic.# `a2_ 394
Contractor A-1 9-01� Date 1K
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:$4000
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:35607063 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 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 F T 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
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
9 18.
RE-ROOFS:
Signature R Date i 1/n.f/If 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.
❑ OWNER-BUILDER DECLARATION
Signature of Applicant:/2 T Date:
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
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 25505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: RR V:// " Date: ii 124/ r
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 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 PERMIT APPLICATION a�
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 0\
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 \\
(408)777-3228- FAX(408)777-3333-building0kupertino.org \
CUPERTINO
PROJECT ADDRESS222 I Rao,—R�. Lchne APN# 35 L,p U-7 .0(03- '
OWNER NAME Sc91)nCvtV\0vy, PHONE/1,0V` P.I t, L)o 0 2 Wim;A;
STREET ADDRESS CITY, STATE,ZIP J Q •7 FAX
',2221 5 Rq_ C_Ipr 01 S,O 111
CONTACT NAME PH NE E-MAIL
13r;an q,r a►S 51o)31K�'-IIIZ iP, rvu- /1`11A cow
STREET ADDRESS CITY,STATE,ZIP FAX .
mloo b -off`•*1tk- br. Sqn L&,~,r o C-A O"S-77
❑OWNER ❑ OWNER-BUILDER ❑"OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME LICENSE NUMBER 17LICENSETYPE BUS.LIC.#,a- p-( (L.lot tNla .,1 17-13`6V3 c-
COMPANY NAME E-MAILf- k 5AX
1 I?.-oar 1Y��1rw ,ro.., Ir)-/� rvr rt'T�Iv+a c�,v, 7
STREET ADDRESS CITY,STATE,ZIP PHONE
`i l vc�I. N (: T• n CA2,^_Ot-v-b C-10, 9 Cr s-7 7 (GSI a) 3,-1 T-S-1
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC.#
NIA
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF �[ SFD or Duplex ❑ Multi-Family ROOF AREA: VALU ON:
STRUCTURE: ❑ Commercial
EXISTING ROOF TYPE: 11BUILT-UPROOF ]LjASPHALT IHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY)
REMOVE/REPLACE ,OYES IF NO, PLYWOOD ❑ 'w, ❑ pLYWD ❑ OSB PITCH. ROOF
❑ NO 1 #LAYERS: THICK--NESS: 13 -,/8" TYPE: ElCDX :12 CLASS: A/�
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF HI
ASPHALT SNGLES El WOOD SHAKES WOOD SHINGLES ❑OTHER ICC-ES REPORT#
DESCRIPTION OF WORK: ``
�� +o d.� 1 h 1 1 1
S4-, .A • SCC'f lan avl 1 /c)
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 buildi onstruc.on. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: `1 Date: // "d1 (e
SUPPLEM TAI,INFOPVAATION REQUIRED oFFICEUSEONLY
If building is associated with a Home Owner's Association,provide letter rAx caECTc TYPE ROUTING SLIP
Of approval from HOA. C�UNTER r,P; UiLDINGPLAN$EViEW
Provide Planningapproval t0 Veil If there an restrictions. R ❑ LANNING PLANxEEVIEw
PP verify Y EXPRESS3 tz a
� � a
Provide copy of Manufacturer's Installation Specifications. tys � f ❑ DEP
Provide signed copy of Cupertino's Tear-Off Policy. ❑ oxHER¢
ReroofApp_2011.doc revised 03/16/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 22215 rae In DATE: 11/26/2014 REVIEWED BY: mendez
APN: BP#: *VALUATION: 1$4,000
*PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD or Duplex PENTAMATION 1 SFDWLROO
USE: PERMIT TYPE: i
WORK [qggLre-roof 10 s
SCOPE
FEE ID ROOF AREA
s.f.
1REROOFFRES 1,000
1',:o t i't."ck Phwih. Plan C/u,"c`!;
fee: F'lu nf;. P rtnit Pec. ( < Per/ j<<
ot!'i er Plvn2b 7risrz
L1
P/dtwb, hlv). Fee:
NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc. . Thesefees are based on the prelimina information available and are only an estimate. Contact the De t or addn'1 info.
FEE ITEMS (Fee Resolution 11-053 Eff. 711/13) FEE QTY/FEE MISC ITEMS
7t E
Permit Fee: $170.00
',!unita. Per n it Fee:
Colzsir u.ction Y'a :
IJ,ninistralive Fce.
Work Without Permit? ® Yes (j) No $0.00
�ili�ti tt,7 fL,`e'C?�I",trmUrll:;Fees:
fZt.tt'('C'7�, L7f'L7FM.<'.�ZfGbdIC'IYt fees.
Strong;Motion Fee: IBSEISMICR $0.52 Select an Administrative Item
Bldg,Stds Commission Fee: IBCBSC $1.00
��� $171.52
S, A - $171.52 $0.00 TOTALFEE
xT
Revised: 10/01/2014
i 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
CUPERTlNO
(408)777-3228• FAX(408)777-3333•building(d-)cupertino.ong
PROJECT ADDRESS �,�t A 7PN#
OWNER NAME X81 n PHO E E-MAIL
STREET ADDRESS CITY, STATE,ZIP FAX
�-2Z 1 S �r-c. ;Y•.a G� al�l
CONTRACTOR NAME LICENSE NUMBER LICENSETYPE BUS.LIC.#
T :�- -IRF 92r'f38 (3C -37c -33
COMPANY NAME E-MAIL FA
A-( a Mn ?r f n s r zsu Fvr,q r uvti. 5I c� 3 y-7-3-1-f
STREET ADDRESS CITY,STATE,ZIP PHO E
1 0 D 0-l_.4- �- ,(-• 5,1- L�n.1oX—r�J � � 1 s"_7-7 5i -)3`17—TV0-6
I UNDERSTAND AND AGREE TO THE FOLLOWING:
1. The re-roof project shall comply with all applicable provisions of the 2013 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 monoxide detectors are required to be installed in accordance with Sections R314 and R315 of
the 2013 California Residential Code.
Signature of Applicant/Agent: Date:
ce ^I c, ReroofPolicy_2014.doc revised 01/15/14