B-2017-1055CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
10350 MORETTI DR CUPERTINO, CA 95014-3639 (375 15 006)
OWNER'S NAME: LUONG DOMINIC T
OWNER'S PHONE: 408-257-7180
LICENSED CONTRACTOR'S DECLARATION
License Class Q;'},Q Lic. #814909
Contractor DANEL ROOFING INC Date 08/31/2018
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.
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.
z. I have and will maintain Worker's Compensation Insurance, as provided for by
1 v 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 regul do er the Cu-6rtin//o''M/uni11cipal Code, Section 9.18.
Signature �Date 6/30/2017
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
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)
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.
z. 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 6/30/2017
CONTRACTOR: I PERMIT NO: B-2017-1055
DANEL ROOFING INC
SAN MARTIN, CA
95046
ISSUED: 06/30/2017
NO: (408) 695-0072
BUILDING PERMIT INFO:
X BLDG —ELECT —PLUMB
_ MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
RE -ROOF; TEAR OFF TAR AND GRAVEL; INSTALL ASPHALT COMP
SHINGLES (19 SQ)
Sq. Ft Floor Area: I Valuation: $11960.00
"N Number: Occupancy Type:
375 15 006
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: Jasmine Archbold
Date: 06/30/2017
RF. -ROOFS:
All roofs shall be inspected prior o any roofing material being installed. If a roof is
installed without first ob ' ing i spection, I a ee to remove all new materials for
inspection. q
Signature of Applicant:, / v�
Date: 6/30/2017
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. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay A,.rea Air Qualianagement District I
will maintain compliance with the pe ti Municip Code, Chapter 9.12 and
the Health & Safety C de, ec 'on 25505, 2 3—ind 25534. ,{
Owner or authorized agent: -'
Date: 6/30/2017
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
REROOF PERMIT APPLICATION
C1 COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
CUPERTINO (408) 777-3228 • FAX (408) 777-3333 • building0cupertino.ora ` l rW5_
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PROJECT ADDRESS 10 0ek)e1 777
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OWNER NAMEPHONE
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CONTACT NAME
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CITY. STATE, ZIP
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❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME \ \ - ® I LICENSE QNU; �n O �
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LICENSE TY
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ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS LIC4
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY. STATE, ZIP
PHONE
USE OF SFD or Duplex ❑ Multi -Family
STRUCTURE: ❑ Commercial
ROOF AR
0
VALUATION: COO
Cl 60
EXISTING ROOF TYPE V BUILT-UP ROOF ❑ ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER (SPECIFY)
REMOVE /REPLACE JO Y'ES
❑ NO
IF NO,
I # LAYERS.
PLYWOOD ❑ b:" ❑
THICKNESS. ❑ 5/8"
PLYWD ❑ OSB
TYPE. ❑ CDX
PITCH.
_a_:12CLASS-
ROOF
A
PROPOSED ROOF TYPE. ❑ BUILT-UP ROOF AI ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES OTHER 'rte n
ICC -ES REPORT #
DESCRIPTION OF WORK
By my signature below, 1 certify rtidvachkthk following: am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information haWpvidis correc 1 haveread the Description ofWork and verify it is accurate. I agree to comply With all applicable local
ordinances and state laws relati tonstructio I authorize representatives of Cupertino to enter the aboveAdentified Urty IT7ectlon purposes.
Signature of Applicant/Agent Date' `('^
SUPPLEMENTAL INFORMATION REQUIRED
_ If building is associated with a Home Owner's Association, provide letter
of approval from HOA.
Provide Planning approval to verify if there any restrictions.
Provide copy of Manufacturer's Installation Specifications.
Provide signed copy of Cupertino's Tear -Off Policy.
OFFICE USE ONLY
PLAN CHECK TYPE
ROUTING SLIP
❑ OVER-THE-COUNTER
❑ ExPREss
❑ STANDARD
❑ BUILDING PLAN REVIEW
❑ PLANNING PLAN REVIEW
❑ FIRE DEPT
❑ OTHER:
ReroofApp_2011.doc 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 - building@cupertino.org
PROIF("r ADDRESS
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OWNS NAME
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I UNDERSTAND AND AGREE TO THE FOLLOWING:
I . 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 144" 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, l certify each of the following is true: I am the property owner or authorized agent to act on the
property owner's behalf. 1 understand and agree to comply with the re -roof policy stated above. 1 also understand that
smoke detectors and carbon monoxifN detectors are required to be installed in accordance with Sections R314 and R315 of
the 2016 California Resident` 1 od
Sienature of Amlicant/A>_ent: _ Date:
RerooJPolicy_201 d.doc revised 06%017
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-1055
10350 MORETTI DR CUPERTINO, CA 95014-3639 (375 15 006)
DANEL ROOFING INC
SAN MARTIN, CA
95046
OWNER'S NAME: LUONG DOMINIC T
DATE ISSUED: 06/30/2017
OWNER'S PHONE: 408-257-7180
PHONE NO: (408) 695-0072
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class Q -M Lic. #814909
Contractor DANEL ROOFING INC Date 08/31/2018
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 TAR AND GRAVEL; INSTALL COMP
I hereby affirm under penalty of perjury one of the following two declarations:
SHINGLES (19 SQ)
t. I have and will maintain a certificate of consent to self -insure for Worker's
REV#1 - CHANGE ROOFING MATERIAL TO A TORCH -DOWN
Compensation, as provided for by Section 3700 of the Labor Code, for the
ISSUED 7/14/2017
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
Sq. Ft Floor Area:
Valuation: $11960.00
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
375 15 006
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, a ap ant under nds and will comply with all non -point
source regu a i ns a the Cup rtino Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 07-14-2017
Issued by: Jasmine Archbold
OWNER -BUILDER DECLARATION
Date: 06/30/2017
I hereby affirm that I am exempt from the Contractor's License Law for one of the
RF–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: 07-14-2017
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" 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
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 ea Air Quality Management District I
Worker's Compensation laws of California. If, after making this certificate of
will maintain compliance with the pT o Municip ode, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety Co s 25505, 2 533, and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.Owner
or authorized agent:
APPLICANT CERTIFICATION
Date: 07-14-2017
1 certify that I have read this application and state that the above information is
CONSTRUCTION LENDINGAGENCY
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.
1 understand my plans shall be used as public records.
Licensed
Signature Date 07-14-2017
professional
CUPERTINO
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 r` ,�
(408) 777-3228 • FAX (408) 777-3333 • building(okupertino.org REVISION #
❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI N( REVISION / DEFERRED
ORIGINAL PERMIT #Z � 0 1 '-f" -/ JJ
PROJECT ADDRESS 1C.,e)go
M� 0r I
APN # 3-1^. (310/0
OWNER NAME
T
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(P*bf)
E-MAILl
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STREET ADDRESS
CITY, STATE, ZIP(
FAX
V3 O�i
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CONTACT NAME
PHONE
E-MAIL
STREET ADDRESS
CITY, STATE, ZIP
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAMES
LICENSE NUMBER
LICE TYP
BUS. LIC # 4Q33 J
COMPANY NAME l \
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E-MAIL � ` '
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PHONE (��Q�LQS
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ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
{� a
1 10
h"/- �� , .� Lo
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-ell
EXISTING USE
PROPOSEDUSE CONSTR.
TYPE
# STORIES
USE
TYPE
OCC.
SQ.FT.
VALUATION ($)
EXISTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NET AREA
BATHROOM KITCHEN
OTHER
REMODEL AREA REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA: UDETACH
❑ ATTACH
I
# DWELLING UNITS:
IS A SECOND UNIT ❑ YES
SECOND STORY ❑ YES
BEING ADDED? []NO
ADDITION? []NO
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
R D B
TOTAL VALUATION:
PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER
EICHLER HOME? ❑ NO2±k
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 h ided - correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws int -la o bu' d' co tructio representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: Date: —?— It/`
SUPPLEMENTAL INFORMATION REQUIRED
PLAN CHECK TYPE
ROUTING SLIP
❑ OVER-THE-COUNTER
❑ BUILDING PLAN REVIEW
_ New SED or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
permit for new building.
❑ EXPRESS
❑ PLANNING PLAN REVIEW
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
El STANDARD
❑ PUBLIC WORKS
form if any Hazardous Materials are being used as part of this project.
❑ LARGE
❑ FIRE DEPT
_ Copy of Planning Approval Letter or Meeting with Planning prior to
❑ MAJOR
❑ SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
BldgApp_201 Ldoc revised 06/21/11