B-2017-0906CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-0906
22444 RIVERSIDE DR CUPERTINO, CA 95014-3959 (356 02 003)
ABOVE ALL ROOFING
SAN JOSE, CA 95139
OWNER'S NAME: KABASINSKAS, DAVID & APRIL
DATE ISSUED: 06/07/2017
OWNER'S PHONE: 408-204-8991
PHONE NO: (408) 370-1056
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class C-_a Lic. #873582
Contractor ABOVE ALL ROOFING Date 03/31/2018
X BLDG —ELECT —PLUMB
—
MECH X RESIDENTIAL COMMERCIAL
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.
JOB DESCRIPTION:
RE-ROOF;TEAR-OFF; INSTALL OSB; COMP SHINGLES - (30 SQ)
I hereby affirm under penalty of perjury one of the following two declarations:
t. 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
"rformance of the work for which this permit is issued.
J 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
Sq. Ft Floor Area:
Valuation: $11000.00
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
APN Number:
Occupancy Type:
and state laws relating to building construction, and hereby authorize
356 02 003
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 regulationsbrr Cupertino Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signature✓1/ Date 06-07-2017
Issued by: Kim Dunbar
OWNER-BUILDER ,
Date: 06/07/2017
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
t. 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 (Scc.7044, Business & Professions Code).
Date: 06-07-2017
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
t. 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(a) 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: +-•-r-'
APPLICANT CERTIFICATION
Date: 06-07-2017
I certify that I have read this application and state that the above information is
CONSTRUCTION CENDING AGENCY
I hereby affirm that there is a constructiolt,l�nding agency for the performance
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
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.
1 understand my plans shall be used as public records.
Licensed
Signature Date 06-07-2017
professional
CUPERTINO
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 77773228 • FAX (408) 777-3333 • building(d)cupertino.org
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❑ OWNER ❑ OWNER -BUILDER ❑ O)NWERAGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
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USE OF SFDorDuplex ❑ Multi -Family ROOF AREA:
VALUATION:
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ST"RUCTURE: ❑ Commercial Nv v
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EXISTLNG ROOF TYPE. ✓I BUILT -L P ROOF ❑ ASPILA�� SFIPVGLES W OOD SILAKES ❑ROOD SHIlVGt.ES El nTHER (SPECIFY) - -
REMOVE /REPLACE. ❑ YES IF NO, TPLYWOOD ❑ !4" ❑
❑ NO I LAYERS: I THICKNESS: _'8"
PLYW-D OSB
TYPE: ❑ CDX-
PITCH: RC,OF ---
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PROPOSED ROOF TYPE: ❑ BUILT -LT ROOF SPHALT SHINGLES ❑ WOOD SHAKES ElWOOD SHINGLES ❑ OTHER
ICC -ES REPORT
DESCRIPTION OF WORK:
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By my signature below, I certify to each of the following: I am the property own -dr"authorized agent to act on the property owner's behalf. I have read this
application and the information 1 have provided is coire ave read the D ription of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building constru tion. I a thorize r esentatives of Cupertino to enter the above-identi ed pr perry for inspection purposes.
7,3
Signature of Applicant'Agent: _ Date:
SUPPLEMENTAL INFORMATION QUI D
OFEIC TSE ONLY
PLAN CHECKTIPE -
ROUTING SLIP
If building is associated with a Home Owner' Asso ' Ion, provide letter
❑; OVER -THE -COL -LATER
❑ BUILDING PI.ANREV IEW
of approval frOIri HOA.
Provide Planning approval to verify if there any restrictions.]',
EREss- ,
❑ :PLANNING PLAN itEt IEA' _ -
__ Provide copy of Manufacturer's Installation Specifications.
❑' STANDARD
❑ FIRE DEPT
Provide signed copy of Cupertino's Tear -Off Policy.
❑ oTitER:
XeroofApp_2011.doe revised 03/16/11
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 - buildin-Wo-cupertino.org
PROJECT ADDRESS 2z 4 �� j WA� I � �
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I UNDERSTAND AND AGREE TO THE FOLLOWING:
1. The re -roof project shall comply with all applicable provisions of the 2016 California Codes.
2. An inspection request can be scheduled up to one business day before the requested inspection date.
To schedule inspections 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 out to the
job site 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/" 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 mo dedetectors are required to be installed in accordance with Sections R314 and R315 of
the 2016 California Residents Ctod�de- 1 — I . --,
of Applicant/Agent: '14� \ Date:
ReroofPolicy_2014.doc revised 06/01/7