B-2016-1416 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1416
19621 LA MAR CT CUPERTINO,CA 95014-3372(369 25 042) (SUNSHINE
CONSTRUCTION)
SAN JOSE,CA 95148
OWNER'S NAME: BANKS JOHN D AND GABRIELA M TRUSTEE DATE ISSUED:02/23/2016
OWNER'S PHONE:4088395684 PHONE NO:4082702091
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#929829
Contractor(SUNSHINE CONSTRUCTION)Date 2/23/2016 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:
REMOVE(E)ROOF;INSTALL(N)30#FELT PAPER;(N)OSB
I hereby affirm under penalty of perjury one of the following two declarations: PLYWOOD AND(N)LIFETIME COMP ASPHALT SHINGLES-35 SQ'S
1. 1 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.
v Jt'2t 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:$20000.00
APPLICANT CERTIFICATION
certify that I have read this application and state that the above
information is correct.I agree to comply with all city and county APN Number: Occupancy Type:
ordinances and state laws relating to building construction,and hereby 369 25 042
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 PERMIT EXPIRES IF WORK IS NOT STARTED
expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,t e applicant undQrstands and will
comply withal[non-point source r la'on ergo- Cupertino Municipal 180 DAYS FROM LAST CALLED INSPECTION.
Code,Section 9.18.
i
, ns£ Issued by:PAUL O'SULLIVAN f
Signature f Date 2/23/2016 Date:2/23/2016
OWNER-BUILDER DECLARATION RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of the All roofs shall be inspected prior to any roofing materia�imtall.drlf a roof is
following two reasons: installedwpithout first obtaining an inspecti n,I agr raterials for
1. I,as owner of the property,or my employees with wages as their sole i ect
compensation,will do the work,and the structure is not intended or offered
for sale(Sec.7044,Business&Professions Code) Signature of Applicant:
2. I,as owner of the property,am exclusively contracting with licensed Date:2/23/2016
contractors to construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
L 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 HAZARDOUS MATERIALS DISCLOSURE
performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the
2. I have and will maintain Worker's Compensation Insurance,as provided for California Health&Safety Code,Sections 25505,25533,and 25534. i will
by Section 3700 of the Labor Code,for the performance of the work for which maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
this permit is issued. Health&Safety Code,Section 25532(x)should I store or handle hazardous
3. 1 certify that in the performance of the work for which this permit is issued,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
will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
Worker's Compensation laws of California. If,after making this certificate of the_Health&Safety Code,Secf ons 25505 ,and 25534.
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 Owner or authorized agent:
be deemed revoked. Date:2/23/2016
APPLICANT CERTIFICATION CON9 RUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance
correct.I agree to comply with all city and county ordinances and state laws of work's for which this permit is issued(Sec.3097,Civ C.)
relating to building construction,and hereby authorize representatives of this city Lender's Name
to enter upon the above mentioned property for inspection purposes. (We)agree
to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Address
judgments,costs,and expenses which may accrue against said City in
consequence of the granting of this permit. Additionally,the applicant ARCHITECT'S DECLARATION
understands and will comply with all non-point source regulations per the I understand my plans shall be used as public records.
Cupertino Municipal Code,Section 9.18.
Licensed
Professional
Signature Date 2/23/2016
i
�I
REROOF PERMIT APPLICATION
if - h 1
COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
cup-EkTINO (408)777-3228• FAX(408)777-3333 building(@cupertino.org
PROJECT ADDRESS /Ju if ,-" APN# / O
OWNER NAME�. 1Lfa
<"( 'C V-5 C(�I/�C PHONE`a(3 e� -6e
/e E-MAIL
STREET ADDRESS CITY, STATE,ZIP ) FAX
CONTACT NAME PHONE. - E-MAIL
STREET ADDRESS CITY,STATE, ZIP F,9X
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME /1tt f` LICENSE NUMBERrz LICENSE TYPE BUS.LIC.#
COMPANY NAME `/ /
J�� `Il� �c""J vI•s(�y L C( i (+'� E-MAIL -L� LA ��'�S�r-T 4e!/
R FAX p e 72
STREET ADDRESS /1 �{y. �j � CITY,STATE,ZIP �� J Z K -
G lJcrv.d-' ./ J PHONE f-e '2 !3- O .t
ARCHITECT/ENGINEERNAME LICENSE NUMBER BUS.LIC.#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF "' SFD Or Duplex ❑ Multi.-Family ROOF AREA: VALUATION:
STRUCTURE; El Commercial 35 —2-0,0 D 0 •
EXISTING ROOF TYPE,:: 11 BUILT-UP ROOF ❑ASPHALT SHINGLES I OW OD SHAKES ❑WOOD,SHINGLES ❑OTHER(SPECIFY)
REMOVE/REPLACE FJYES IF NO, t PLYWOOD` %" 11PLYWD tPr-E)SB PITCH: `� ROOF
❑I, #LAYERS: I THICKNESS: ❑ im, TYPE: ❑CDX. "P :12 CLASS: A
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF 6<ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD 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 owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I have provided is corre 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 co ion. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature ofApplicant/A en. � Date: -2- � l4
7 .° - +'-s n t„ -� '` z
SUPPLE TAT INFORMATION REQUIRED . _W opt IcAVSAOI�Y.a _ ._ �,u
If building is associated with a Home Owner's Association,provide letter � ACtcF� � ozasiNc s
of approval from HOA.
'T
Provide
32ERRs
Provide Planning approval to verify ifthere any restrictions. f v;
❑�E PRESS R' � qr rh 1NNm LAN$R w�
_Provide copy of Manufacturer's Installation Specifications. t]s r pDr�t'
_Provide signed copy of Cupertino's Tear-Off Policy. XnE
, oT> R
ReroofApp_2011.d6c revised 03116111
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
CUI?IEhTrNt3 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228• FAX(408)777-3333•bLAding(a�cupertino.org
PROJECT ADDRESS � -2_ � ✓` /C( (� APN# 261 f9i
OWNERNAME `LL V'® PHONE ?Jc}V��( 7L� E-MAIL f
STREET ADDRESS CITY, STATE,ZIP / 11 FAX
CONTRACTOR NAME _ff LICENSE NUMBER Cl 2 C � LICENSE TYPE BUS.LIC.#
COMPANY NAME f{ ^ , �' � E-MAIL G FAX Z G* Lo c
V?' }7� � ���� CITY,STATE;ZIP Com_ 7 O S� �'� T5-/�j PHONE 7 d 2 c) /
STREET ADDRESS � j' /
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 rewired to be installed in accordance with Sections R314 and R315 of
the 2013 California Residential Code. -7- -) 1 b
Signature of Applicant/Agent: Date:
ReroofPolicy 2014.doc revised 01/15/14
CITY OF CUPERTINO K106- W 6
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 19621 LA MAR CT DATE: 02/23/2016 REVIEWED BY: PAUL
APN: 369 25 042 BP#: "VALUATION: 1$20,000
*PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY PENTAMATION
USE: SFp or Duplex PERMIT TYPE: 1SFDWLROOF
WoRK I REMOVE E ROOF; INSTALL N 30# FELT PAPER; N OSB PLYWOOD AND N LIFETIME COMP
SCOPE JASPHALT SHINGLES - 35 SQ'S
FEE ID ROOF AREA
s.f.
1REROOFFRES 3,500
y � tz' 3'•
_XP.
f L_„
NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc.). These ees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS(&e Resolution 11-053 E f 7,1113) FEE QTYIFEE MISC ITEMS
py
Permit Fee: 00
}
f
F
Work Without Permit? 0 Yes E) No $0.00
Strong Motion Fee: IBSEISMICR $2.60 Select an Administra v to
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $598.60 $0.00 TOTAL E60
/Revise 01/01/2016