B-2017-2017 ' CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-2017
21700 RAINBOW CT CUPERTINO,CA 95014-4829(366 38 002) CUPERTINO ROOFING
INC
SAN JOSE,CA 95129 •
OWNER'S NAME: WEINTRAUB MITCHELAND DORALEE S DATE ISSUED:11/22/2017
OWNER'S PHONE:408-821-2481 • PHONE NO:(408)973-9427
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C39 Lic.#565437
Contractor CUPERTINO ROOFING INC 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 SHINGLE(41 SQ)
I hereby affirm under penalty of perjury one of the following two declarations:
1. I haveand 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 ,
r ) performance of the work for which this permit is issued.
r.. 2. 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:$35000,00 ,
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 • 366 38 002
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 ISNOT STARTED
may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
f Additio - .e applicant understands and will comply with all non-point
source regulatio •er the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
•Signatures &/r _� Date 11-22-2017 Issued by:Kim Dunbar ,
Date: 11/22/2017 - •
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. 1,as owner of the property,or my employees with wages as their sole installed without firs ing 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 Appli nt: _ 4111 '
contractors to construct the project(Sec.7044,Business&Professions Code). Date: 11-22-2017
i
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"At'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
Health&Safety,Code,Section 25532(a)should I store or handle hazardous
s. I certify that in the performance of the work for which this permit is issued,I I I
material. Additionally,should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the
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 compliatpee-wit • .. •ertino:Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sec 4405505,:25S33,and 25534.
Labor.Code,I must forthwith comply with such provisions or this permit shall 1
be deemed revoked. Owner or authorized agent: j e ra,AL '�
APPLICANT CERTIFICATION Date:11-22-2017 , I
I certify that I have read this application and state that the above information is CONSTRU : ' ENDING 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 11-22-2017professional
r:.c . f CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
=4,? r 408 777-3228 • buil din c cu e7 tino.org PEMIT#B-
CUPERTINO • REVD DEF#
❑ NEW CONSTRUCTION ❑ADDITION EIALTERATION 1:11T.I. CIMEP ElRE-ROOF ❑SWIMMING POOL/SPA .
PROJECT ADDRESS 71 00 j DIlQ\, (Q O W C-71--- APN# Li CO ` ?�0 D 2 -
OWN tiYNA`E+-CAeN V JQ i v\-4-• l� Q`) Ib P O,(�NU ^ca j —�,r I E-MAIL
STREE�TTADDDRESS CITY, STATE,ZIP `1
0 CONTRACTOR NAME ❑OWNER-BUILDER COMPANY NAME LICENSE NUMBER • LICENSE TYPE
STREET ADDRESS CIpI,STATE, ZIP •
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E-MAIL PHONEBUS.LIC p
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0 ARCHITECT 0:OWNER ❑OWNER AGENT'O CONTRACTOR AGENT 0 ENGINEER❑DEVELOPER 0 TENANT
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CONTACT NAME E-MAIL
STREET ADDRESS CITY,STATE,ZIP PHONE
• DECRIPTON 4.._.
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,SINGLE-FAMILY/DUPLEX 0 MULTI-FAMILY 0 INDUSTRIAL 0 COMMERCIAL I
EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES 6 TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION(5)
REMODEL : REMODEL KITCHEN REMODELOTHR GARAGE 0 ATTACHED
BATHROOM{SF SF ' : SF SF ❑DETACHED .
EXISING !ID YES EICHLER ❑'.YES SECOND STORY ADDITION O
FIRE SPRINKLERS,❑'NO 0' NO NO
DWELLING SECOND DWELLING ❑YE:9 ❑ATTACHED DETACHED OTHER
UNrTS4 UNITADDITON: ;' 0 N SF
POOLS' ❑FIBERGLASS ❑' VINYL-LINED ❑GUNITE 0 PREFABRICATED
POOL•SF ',,SPA-5F ! ,I !SPA ATTACHED El YES 0 NO I TOTAL-SF
RECEIVED BY:
I (TOTAL VALUATION:
Commercial or Multi-Fmnilu Butldmgs with Public 57vinuving Pools reotrires Department of Environmental Heath approval 1��-�
RE-ROOF 'EXISTING ROOF TYPE:'❑:BUILT-UP ROOF E ASPHALT SHINGLES WOOD SHAKES E WOOD SHINGLES E TILE OTHER(SPECIFY)
EMOV /REPLACE❑NO IF NO ' PLYWOOD E 1/2" ❑3/8" PLYWOOD TYPE: PITCH: ROOF CLASS
' ®YES F OF LAYERS__ THICKNESS El5/8" OTHER I(P' J OSB ❑CDX OTHER i• 12 A
PROPOSED ROOF TYPE:❑BUILT-UI ROOFTJASPHALTSHINGLES 0 WOOD SHAKES❑WOOD SHINGLES 0 OTHER
Provide a;signed;copy of the Cupertino's Tear-Off Policy SF Pot SQUARES
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.or ' ances and state laws relating to building construction. I authorize representatives of Cupertino to
enter the above-identified property for ins tion purposes. I acknowledge and authorize all information contained on this application form
to be made available for,public record. —7
Signature of Applicant/Argent: r _ ��1-t_,_ Date: I ~1.
SUPPLEMENTAL:INFORMATION REQUIRED
*New SFD/Second'Dwelling Units/Multifamily Dwellings:•A Demolition permit is required prior to issuance of a building permit for all new construction.
*CommercialBuildings: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project.
*Copy of Planning Approval Letter,or Meeting with Planning prior to submittal of Building Permit application. .
*HOA-Provide,a letter of approval;from the Home Owner's Association •
Bldg,9pp_2017.doc revised 08/01/17.
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O.,BUILDING OFFICIAL
CURERT{Pt0 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 2� f
(408)777-3228•FAX(408)777-3333•buildinoc cuoertino.orq v 1
PROJECT ADDRESS z ^ T^ (\Q '�bo, APN# 2( 1^ - V
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OWNER NAME V We%
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PHONE g G ls n —24 7(E-MAIL
STREET ADDRESS z I c)0,3 0 , Lo CITY, STATE,Z FAX
CONTRATO AIS(J�` LICENSE NUMBER LICENSE TYPE BUS.LIC.#
COMPANY N E-MAIL FAX
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STREET 9po Ss�+q Z ` ` CI C -�6�AZIP Tin
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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 7:3;072:300i(Friday) to
schedule inspection. For Tear-Off and Nailing Inspections, you must also call on the qday: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.
Bymy 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 behI I un.e d and agree to comply with the re-roof policy stated above. I also understand that
smoke detectors and carbon monoxide .etectors are required to be installed in accordance with Sections R314 and R315 of
the 2016 California Residentia Code.
Signature of Applicant/Agent: Date: 11—3_T--' (' 7
ReroofPolicy_2014.doc revised 06/01/7