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15100171I CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10791 GASCOIGNE DR I CONTRACTOR-- ONTRCTO PERMIT NO: 15100171 OWNER'S NAME: RONALD EVANS TRUSTEE 1 3 Z,4 'fwJ Ln!� I DATE ISSUED: 10/21/2015 OWNER'S PHONE: 5102045193 PHONE NO3/e) ❑ LICENSED CONTRACTOR'S DECLARATION Wf License Class Lic.# C? 6 0 Contractor I hereby affirm th 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: 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. 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. 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 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, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source reg tions er th upertino Municipal Code, Section 9.18. Signature Date ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: t. 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) 2. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: 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. 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. 3. 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 become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. 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 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, costs, and expenses which may accrue against said City in consequence of the 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. Signature Date JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ REMOVE (E) T&G ROOFING AND REPLACE WITH TPO MEMBRANE ROOFING (1500 SQ FT). Sq. Ft Floor Area: I Valuation: $7000 APN Number: 37531026.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: AT e Date: /4 ,7/'/„! RE -ROOFS: 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. Signature of Applicant: Date:/V — 1 S ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(x) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Owner ordhori d age f: Date:f� CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional 'C.9P REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building a()cupertino.org �D17� 11V PROJECT ADDRESS/© y ! l 3 - 6 � /� APN 37J OWNER NAME J PHONE 1 V h � AIL •^J `/•�L/�' — STREET ADDRESS CITY, STATE, ZIP FAX 7 q CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX r El OWNER ❑ OWNTER-BURLDER ❑ OVINTER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ rENAN7 CONTRACTOR NAME LICENSE NUI,/,BER LICENSE TYPE BL'S. LIC. 9 COMPANY NAME E-MAIL ` FAX t S STREET ADDRESS ` CITY, STATE, ZIP J, ONE /l Cw- lO ARCHITECT/ENGINEER NAME LICENSE NUMBER I BUS, LIC. COMPANY NAME E-MAIL FAX s'rREET ADDRESS CITY, STATE, ZIP PHONE USE OF `l�i' SFD or Duplex ❑ Multi -Family ROOF AREA: VALUATION: STRUCTURE: ❑ Commercial / b o EXISTING ROOF TYPE: *t BUILT-UP ROOF ❑ ASPHALT SHINGLES ❑ WOOD SHAKES ❑WOOD SHINGLES ❑ OTHER (SPECIF REMOVE /REPLACE ❑ YES IF NO, PLYWOOD 1:1''/i, ❑ PLYVJD El OSB PITCH: ROOF NO I LAYERS: THICKNESS: ❑ 511 TYPE: ❑ CDX :12 CLASS: A PROPOSED ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES OTHER_ ICC -ES REPORT 4' DESCRIPTION OF 1VORK: 64 V 0. W1 ` � � �`�� 4 L �AA,(S loll / By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property ow'ner's behalf. I have read this application and the information I have provided is correct. I read th Description of Work and verify it is accurate. I agree to comply with all applicable local xhae ordinances and state laws relating to building constructionho e e f Cupertino to enter the above -identified property for inspection purposes. SignatureofApplicant/Agent: Date: O� SUPPLEMENTAL I `TFORIvIA ION REQUIRED OFFIC"Sj b vI If building is associated with a Home 0�N'ner's Association; provide letter PLAn CHECK ROUT csi Of approval from HOA. OVER THE CO177vTER = BUII DLG PLAN RENTER c# Provide Planning approval to verify if there any restrictions. _, " ❑ _ _ EMPRESS , PL-A;ATNII�GPLA_N REVIEW, +'� ' Provide copy of Manufacturer's Installation Specifications. x ❑ {] sTALn,utD ,� .y FIRE DEPT �,. Provide signed copy of Cupertino's Tear -Off Policy. ❑ OTHER � ReroofApp_2011.doe revised 03/16/11 71� CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION FEE ID ROOF AREA s.f. 1 REROOFFRES 1,500 DDRESS: 10791 GASCOIGNE DR DATE: 10/21/2015 REVIEWED BY: MELISSA &AAPN: 375 31 026 BP#: *VALUATION: 1$7,000 *PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re -roof PRIMARY USE: SFD or Duplex Plumb. hi , . 1,ee: PENTAMATION PERMIT TYPE: 1 SFDWLROO WORK TEAR OFF E WOOD SHINGLES 15 SQ'S SCOPE Suppl. Insp Fee FEE ID ROOF AREA s.f. 1 REROOFFRES 1,500 NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc.). These fees are based on the Dreliminary information available and are only an estimate Contact the Dept for addh 7 info. FEE ITEMS (Fee Resolution 11-053 Ef1.' 711,,"13) ;Tech. Plan Check r'hrmh. Plcrn Chef k Elec. Plan Check ;ilech. Permit Fee: Plumb. Permit Fee: Elec. Permit Fee: Other a/cc h. Inslr. F1 Other Plumb Insp. E LLJ Other Elec. Insp, Mech. Insp. 1,e<e. Plumb. hi , . 1,ee: Elec. Insp. Fee: NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc.). These fees are based on the Dreliminary information available and are only an estimate Contact the Dept for addh 7 info. FEE ITEMS (Fee Resolution 11-053 Ef1.' 711,,"13) FEE QTY/FEE MISC ITEMS Plan Check P'ee: Suppl. PC Fee Plum b.r11ech./Elet, Permit Fee: $255.00 Suppl. Insp Fee Plumb.ls'lIech./Elec Plunib.lMech.lElec Permit Fee: Construction Tax: ,1chninistr^ative I'c'e: Work Without Permit? Yes (j) No $0.00 Advanced Planning= Fees: Travel Doewnentation Fees: Strong Motion Fee: IBSEISMICR $0.91 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $256.91 $0.00 TOTAL FEE: 1 $256.91 Revised: 10/01/2015 r 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 • buildingc1cupertino.org PROJECT ADDRESS LO 7 �_/_ APN $ ��, � OWNER NAME-MAILPHUNE 5/� � � E STREET ADDRESS CITY, STATE, ZIP I FAX CONTRACTOR NAME LICENSE NUMBER ^ (� LICENSE TYPE BUS. LIC. COMPANY NA1,4E EMAIL FAX STREET ADDRESS Z21626 ` > CITY, STATE, ZIP pW HO > `7 lO 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 7:30-3:30pin (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 (112on-Thurs) and 7:3040:30am 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 N� ork 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 re red to be installed in accordance with Sections R314 and R315 of the 2013 California Residential Code. Signature of Applicant/Agent: Date: r Reroo)Tolicy_2014.doc revised 01115114 �y