12090131 f
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22455 RANCHO DEEP CLIFF DR CONI'RACI'OR:SORENSON& PFRM IT NO: 12090131
ASSOCIATES ROOFING INC
OWNER'S NAME: REN MITCI4ELL PO BOX 786 DA'Z'E ISSUED:09/142012
OW'NER'S PHONE: 4082263300 BRENTWOOD,CA 94513 PIIONE NO:(925)626-7682
❑ LICENSED CON T'RACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAI. CO\IJIF-RCIAI.
License Class94q 21{t Lie.M C RE-ROOF 19 SQ INSTALLATION OF DURO LAST SINGLE
PLY
Contractor 56ae.>,sa..t L5cale,^^-5 Date y-Ili-I L. CLASS
[hereby affirm that I am licensed under the provisions or Chapter 9
(commencing with Section 7000)of Division 3 of the Business&Professions
Code and that my license is in full force and effect.
hereby affirm under penalty of perjury one of the following two declarations:
1 have and will mainmin 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 whichthis permit is issued. Sq.Ft Floor Area: Valuation:$13400
1 have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for die performance of die work for which this
APN Number:35602033.00 Occupancy Type:
permit is issued.
AI'PLIC,%N'I'CER'TIFICA'TION
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 ani county ordinances and state Imes 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)agrw to stave 180 DAYS FROM LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments, ' I
costs,and expenses which may accrue against said City in consequence of the �f,�� G
granting of this permit. Additionally,the applicant understands and will comply Issued by: r �/ Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
R[:ROOFS:
Signmu Date 9-14-1 All roofs shall be inspected prior to my roofing material berg installed.Ira roof is
installed without first obtain'rgmR,'inspection,I agree to remove all new materials for
inspection.
❑ OWNER-BUILDER DECLARA'T'ION p u
Signature o(Applipn. Date:
1 hereby alarm that 1 um exempt from the Contractor's License I-aw for one of
the following two reasons: ALI-ROOF COVERINGS TO BE CLASS"A"OR BETTER
I,as owner of the property,or my enployces 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)
1,as owner of the property,am exclusively contracting with licensed contractors to IIAZARDOIIS MATERIAIS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Ilealth&Safety Code,Sections 25.505,25533,and 25534. 1 will
1 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 Section3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District
performance of the work for whichthis permit is issued. will maintain compliance with thoCZaWerfirm Municipal Coda Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections-, 25. ,a 25534.
Section 3700 of the Labor Code,for die performance of the work for which this _ —1Z
agent:
or authorized agen
permit is issued. Date:
I certify that in the performance of the work for which this permit is issued,I shall
not employ any person inmiy manner so m to become Subject to die Worker's j
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
indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCIII'TF.CI"S DECLARATION
costs,and expenses which may acerae 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-paint source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
REROOF PERMIT APPLICATION
,C COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
CUPERTINO (408)777-3228 • FAX(408)777-3333 • buildinGcDcupertino.org I2003
PR01
T ADDRESS ,y( I APN a C] •Q 3
OWNER NAME E T� V1 G� PHONE •� 6-3b3 E-MAIL
STREET ADDRESS �l CITY.STA T$ FAX
/YLJGr/� i!/f7� n/O GSI
APPLICANT'NAME PHONE E-MAa.
STREFi ADDRESS CrIY,SPATE,ffi FAX
❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONIRACrOR ❑CDNnMA=R AGENT ❑ ARCH= ❑ENGINEER ❑ DEVELOPER ❑TENANT
CON TORNAME LICENSE NUMBER LICENSE TYPE I BUS.uc.0
Mr�T
COMPANY NAME "MAE I FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
ARCHIiECTIENGINEER NAME LICENSE NUM M BITS.LIC P
COMEANY NAME E-MAIL FAX
STREET ADDRESS CITY.STATE,ffi PHONE
USE OF ❑ SFD Or Duplex mould-Family ROOF AREA: VALUATION:
STRUCTURE: ❑ Commercial Sq. 'A , s, o
EXISTING ROOF TYPE: ;Z BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY)
REMOvE/RFPLACE ❑YES 9NO. PLYWOOD ❑ %.. ❑ PLYWD ❑ OSB PITCH: ROOF
ZNQ I 6 I ❑ TYPE. ❑ Mx A2 A
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SKNM ES ❑WOOD SHARES ❑WOOD SHINGLES ❑o-rIEIi0!r!1.4jA 1CC-ES REPORT f
DESCRIPTION OF WORE: ,
By my signmim below,I certify to each of the following: 1 am the property owner or authorized agent to act on the pmpery owners behalf. 1 have read this
application and the information I have rovided is correct. I have read the Description of Work and verify it is acourate. I agree w comply with all applicable local
ordinances and state laws relating to cons on. 1 autho=.represenmtivcs of Cupetino to enter the above-identified property for inspection purposes.
Signanue of Applicent/Agenu Date:
SUPPLEMENTAL INFORMATION REQUIRED R
if building is associated with a Home Owner's Association,provide letter PLAT'c�ncTt2P, ,-% � ouT1i•c sLTP
of approval from HOA. TotEi�eE-coav-gn= "�- i>IIIDn.c ` � �
Provide Planningapproval to vers If there an restrictions.
PP verify� Y r-ExCREss "T3 :eunNwePr�tTea -'�
Provide copy of Manufacturer's Installation Specifications. p,c'�"'s-L-- "_
Provide signed copy of Cupenino's Tear-Off Policy.
ReroofApp_201 Ldoc revised 03102111.
Ismoke detectors and carbon monoxide detectors are required to be installed in accordance With Sections 11314 and R315 of
the 2010 California Residential Code.
Sienature of Ann1icant/Aaenc Date: _ _ I
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 22455 Ranco Deep Cliff DATE: 0911412012 REVIEWED BY: Sean
APN: BPk: 'VALUATION: $13,400
*PERRIITTI'PE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY Multi-FamilyDwelling Buildina is [PERPE:
USE: g >3 Stories O Yes (0!) NO PERMITTYPE: 1R2R00F
WORK Installation of duro-last si nle ply memebrane over existing BUR roof.
SCOPE
FEE ID ROOFAREA
s.f.
1REROOFMRES 1,900
Meeh. Plan Check Phunh. Plan Check Elee,flan Check
blech. Permit Fee: Plumb.Permit Fee: lilec.Permit Fee:
Other Mech./asp. Other Plumb Insp. Ej Otter Elec.Insp.
Hech. Insp. Fec: Phunh, hap. Fee: Eke.Insp. rec.:
A'OTE: This estimate does not include fees clue to other Departments(i.e. Planning, Public H'orks, Fire,Sanitary Sewer District,School
District,etc.). Thesefees are bused on the prelintinan information available and are onb,an estimate. Contact the De t or adcht7 in o.
FEE ITEMS (Fee Resolution 11-053 Eff 7/1/11) FEE QTY/FEE MISC ITEMS .
Plan Check Fee:
Suppl. PC Fee
Plumb./ddech./Flet
Permit Fee: $285.00
Suppl. Insp Fee
Plumb./A/ech./Elec
Plunth.41lech./Elec Permit Fee.
Construction Tax:
Administrative Fee:
Work Without Permit? O Yes Q No $0.00
Aelconced Planting Fees:
Travel Doctunemution Fees: A
Strone Motion Fee: IBSCISMICR $1.34 Select an Administrative Item
Bldg Stds Commission Fcc: IBCBSC $1.00
SUBTOTALS: $287.341 $0.00 TOTAL FEE: $287.34
Revised: 07/01/2012
-Q REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
CUPERTINO 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408)777-3228• FAX(408)777-3333•buildingg(�.cupertino.org
PROJECT AD00.ESS APN p
C
OWNER NAME PHONE EMAIL
STREETADDRESS CIT'.STATE ZIP FAX
CONTRACTOIj NAME LICENSE NUMBER LICENSETYPE BUS.LIC.<
p L L
COMPANY NAME I E-MAIL FAX
S REST 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 the day before the inspection date. Please call (408)777-
3228 from 7:30 - 3:30pm (Mon-Thurs) or 7:30 - 2:30pm (Friday) to schedule the next day 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. Progress
and 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. Progress Inspection is required when approximately 50% of roof covering is installed.
7. 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 1/0 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.
8. 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 of S 126.00. 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 2010 California Residential Code.
Signature of Applicant/Agent: Date:
RerooJPolicr_201!aloe rerised 02ll6Q I