B-2016-1525 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1525
19132 MURIELLN CUPERTINO,CA 95014-3540(375 08 013) LICO'S ROOFING
COMPANY
GILROY,CA 95020
OWNER'S NAME: LIN WEI LI AND LEE JEN HUEI DATE ISSUED:03/15/2016
OWNER'S PHONE:408-680-7996 PHONE NO:(408)337-1352
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-39 Lic.#272074
Contractor LICO'S ROOFING COMPANY Date 05/31/2016 X BLDG —ELECT —PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing MECH X RESIDENTIAL_COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
REPLACE(E)ROOF WITH ASPHALT SHINGLE ROOF 4,000 SQ FT
I hereby affirm under penalty of perjury one of the following two declarations:
i. I have and will maintain a certificate of consent to self-insure for Worker's
�7 Compensation, p
rovided 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. Sq.Ft Floor Area: Valuation:$14000.00'
APPLICANT CERTIFICATION
Tpertify that I have read this application and state that the above
information is correct.I agree to comply with all city and county ordinances APN Number: Occupancy Type:
and state taws relating to building construction,and hereby authorize 375 08 013
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 PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands and will comply with all non-point
source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
GSignature— Date 03/15/2016 Issued by:ABBY AYENDE
Date:03/15/2016 A
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
1. I,as owner of the property,or my employees with Wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for
compensation,will do the work,and the structure is not intended or offered for inspection.
sale(Sec.7044,Business&Professions Code)
2. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:0311512016
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1. 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. HAZARDOUS MATERIALS DISCLOSURE
2. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. I will
permit is issued, maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
3. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(x)should I store or handle hazardous
shall not employ any person in any manner so as to become subject to the material. Additionally,should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent:
&:CERTIFICATION C,pate:03/15/2016
I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C.)
to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments,costs,and expenses which may accrue against said City in Lender's Address
consequence of the granting of this permit. Additionally,the applicant understands
and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION
Code,Section 9,18. I understand my plans shall be used as public records.
Licensed
Signature Date 03/15/2016 Professional
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE-'CUPERTINO,CA 95014-3255
(408)777-3228• FAX(408)777-3333•building(cDcupertino.org
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OWNERNAME �( Z PHO a o (,O E-MAIL
STREET ADDRESS CITY,STATE,ZIP FAX
CONTACT NAME` PHONE E-MAIL
STREET ADDRESS CITY,STATE,ZIP FAX
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❑OWNER ID OWNER-BUILDER ❑OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME LICENSE NUMBER f LICENSE TYPE BUS.LIC.# Cy S
COMPANY NAME ��'�(•, �.5 �3 ( 1 FAX ! pC
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STREET ADDRESS /� / � CITY,STATE,ZIP ` D®yr PHO 41eg 3-f2-370
ARCHITECT/ENGINEERNAME ( jI LICENSE NUMBER L BUS.LIC.# (J'
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF VSFD or Duplex ❑ Multi-Family ROOF AREA: VALUATION:
STRUCTURE: ❑ Commercial t-eDj �',r, ZL , '15,�_ - C &
EXISTING ROOF TYPE: 11 ,BUILT-UP ROOF ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER{SPECIFY)
REMOVE/REPLACE ES I IF NO, PLYWOOD ❑ %1: ❑ PLYWD ❑ OSB PITCH: ROOF
❑NO #LAYERS`. THICKNESS: El5/8" TYPE: 11CDX 12 CLASS: A
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES []OTHER ICC-ES REPORT
DESCRIPTION OF WORK If7 ` e
all I
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 building construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date:
ear '.
SUPPLEMENTAL INFORMATION REQUIRED
If building is associated with a Home Owner's Association,provide letter rLArcl�cx?YP� ROTI7INcsiTe� r ':
k
of approval from HOA. ovviozfivTs> ���rr A v iu �'i
p,- " s
_Provide Planning approval to verify if there any restrictions.
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Provide copy o£Manufacturer'S Installation Specifications. ' �' x C3 �`
Provide signed copy of Cupertino's Tear-Off Policy. b
ReroofApp_20 11.doc revised 03/16/11
.µ_ 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-buildingQcupertino.otg
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OWNER NAME TA C�®�� �i��
PHONE
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STREET ADDRESS .Ia 1 M`,jjtj La^„e, CITU,ST E,ZtIP� "y� �° ( j FAX
CONTRACTOR NAME ede i i w ba LICENSE NUMBER � LIce-E YP� BUS.LIC.#
COMPANYNAME " vV -MAIL ((' ��tt FAX
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STREET ADDRESS jqq _ CITY,STATE,ZIP �� �+ � PHONE f��a �
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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 8314 and R315 of
the 2013 California Residential Code. fi J
Signature of ApplicanVAgent: / Dater—f
ReroofPolicy 2014.doc revised 01/15/14