08080207 CITY OF CUPERTINO *' +s+ms F+' " �" "t •`" $"?'
BUILDING DIVISION PERMITnNTRACTOR IN'FOItMA�ION
BUILDING ADDRESS: PERMIT NO.
.?20b3 BAXLEY CT R E ROOFING & CONSTRUCTION 08080207
KWS NAME: PERMIT DATE
ANI'llONY RODR:I:GUES 15230 CLYDELLE AVE 08/26/2008
PHONE: SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
REMOVE EXISTING 1 LAYER OF BLDG ELEcr PLUMB MECH
WGOB u00 ±NSTAbb MEW
LICENSED CONTRACTOR'S DECLARATION JobDescription
uC 1 hereby affirm Nell n
licensed under Provisions,or Chapter 9(c nneac Bing '^•• ^-•-- ---"-`
IdE with Basion]OIIU)o( 9(NCButinemand Pra(maCede.udmylimmmis
s N full forte aM one I �{l' GLse CI sDab
C�.n - -
ARC r1EC1undersunJ my Plam 1 be N
e Licensed Professional
3 OWNER-BUILDER DECLARATION
1 hereby sports Nal 1 em mmnepl from the Canuattots License law for the
p o following mason.(Sation]101.5.Business and Professions Codc:Any city or county
j$( which.,uiroa a permit to construct.alb,.improve,dem0lHh.or repair any nmetum
_I< priwmislssuame.LLw uimatheapplieulforsahpormitbfmleasignedsulemem
E�C don he is licensed Pa.,b to provisions of the Constructor's LksvLaw w(Chapter 9 Sq.FC Floor Area Valuation
$ (commencing with Section70DD)of Division 3 of the Business and Professions Codc)or
_
that he is attempt therefrom and the bus for the alleged ewmption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant In a civil penally of APN Number Occupancy Type
and mare Ihu firs hundred dollars(SSW).
I,uowrer of the pmpenYormY wployes with wagmulkhwle wmpensstion,
and
will Pr Newark.ands a-nhe tumisnotinterlded,Law Idforme(Sec.]ON,Inner or
Pro arty wh bis ldsdm The Canrruclnfs andante Law des rot apply b an awns or Required Inspections
own
Property who Wilds ideal ayes Maps wdwh0 desolbdwme morin onthrovge his
awnemployes,lding or
pr vemimpmwmenuartre year
dPIcImd far sale t-
Lowder.the building or improvement is cold within nm yes of wmole for the bweu-
Wilder will have the buNcn of proving wt he did rot Wild or improv for purpose of
isle.),
O 1,as owner of the property,am exclusively contracting with licensed contrxbm to
comtmcl the project(Sec.7044,Business and Professions Cade:)The Con radar's U-
cube Law does not apply m w owner of primly who builds act Imprown thereon,me
who cenaaN for aceta projcm wide a eOOVaelar(s)licensed parents,as the Connector,
Lica.Law.
❑ I oro Tempt under See .B&P C for this mason
nv DECLARDab
WORKERS COMPENSATION ATION
1 hereby of rm under penalty of perjury one olden following drelandam:
Iluw arM will mainuiva Certifiom ofCmscmmself-insurefarWon4YSComlen-
satian,as provided fm by Section 3700,d the Labor Code,tar the Performance It the
work for which this merit is issued.
1 hake and will maintain Worker's Compensation Insuramx,as required by Sectian
of the tabor Code.for NC Performance of the work for which this Permit is issued. '
My Worged/frs-ComPemapn Inwrantt artier and Policy her am:
Carrier.fa 1 r Policy No.:
CERTIFICATE EXEMPTION FROM WORKERS'
COMP NSATION INSURANCE
race do.reed net W completed if the pert,is furca hundred dollar(51 W)
or Ira)
I certify that in the perf..of ora:were for which Nis Permit is issued,I her am
employ any pawn in any manures u to become subject to the Warkeri Compensation
Laws of California.Data
Appllcase
NOnCE TO APPLICANT:IC after making this Cenifmceb of Exemption,you should
become subject to the Workcra Compensation provisions of the tabor Cede.you most
,J O forthwith camplY with such provisions or this peril shall be doomed revoked.
Z " CONSIRU=ON LENDING AGENCY
1 thereby affirm that then is...due lending a
(~ r e gerey for the perfarmwerr
llvi the wore fur which this pemit s issued(Sec.3097,Civ,C.)
Q Lenders Name
z Lenders Address
U O t ari[y that 1 Wes rad this application aM sub Nu Ne aWw information is
w ~ comet.1 agree b comply with JI city and county aNlnNaa and a0Q laws Riming to
.�(V! Wildingeonsouction,she hereby mdomie representatives of this city to envy upon Ne
Nd aWw-mentiomd
property g[an expensesspected purposes.
�" Pm I%)agree to saw,indemnify and Incept harmless the City of Cupertino against
h lia 'iti-judgmenu.crna codeaten...which may In try way accrue against mid Ciry
U sen c0 m�e[the grating of Nu permic
APPI,I ERSTANDS AND W COMPLY WITH N N- Issued by: Date
5
Re-roofs
Signature a(Appli pate
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will ft applicant or(inurebuildinge,Chapter
,handle Health and
az dcRSec Section
the Cupertino Munici Codc.Chaper 9.11.wtl the Health and Safety
.SC Y.ns3z(a)T All roofs shall be inspected prior to any roofing material being installed.
Yes No
Will thea hoes,act robin Wilding attn If a roof is installed without first obtainingan inspection,I agree to remove
PP a pant use equipment or devices which P $
emb havardom air contaminants u dc0md by be Bay Area Air Quality Mamgemem all ma[eri spectio
Dissm,?
❑Yn u /� r
Ihaw afc,yC vaNammamda.25533 requirements under ClsPbr G95afthe Califon-
nieHeslth&S MJYYhaw IStttiashstE it 25Y%,cosibok1 in amisnd Jwtifdedt it
or
n01 nllY haw almman dW it 1,my mi "ybrmafy �Inf
requimmcns metp bi f Cc 'fi sof y.
Signature o nt Date
afircd ager Dam. All roof coverings to be Class'aW'or better
CITY OF CUPERTINO
ISIX REROOF
CITY OF
*CUPERTINO PERMIT APPLICATION
0 g bra zv�
APN #
3.57P UCv 024- 00
Building Address:
Owner's Name: Phone #:
Contractor: Phone #: O
IFax #: � O�S- �6 —
Cupertino Business License #: 2_U (q Contractor License #:
. 72-7S
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles Asphalt Shingles
Wood Shakes / ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other (Specify)
Number of existing coverings ❑ Provide I.C.B.O. Report#
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
Job DescriptiorK -RoK cltvw k L Ma— W W 602 S It kKk 1
MQ14� WOW
Residential Commercial
Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if
Green Building Checklist & attach it to the application or if there are any restrictions: ❑
applicable, include in plan set & the sheet index.
Valuation: pU !1 O
He Rea Understand and Will Com with Cupertino's Tear-Off Policy:
e
Signa
Revised 6/16/08
San
CITY OF CUPERTINO
REROOF
OF
CUPERTINO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1RER00FC0M Re-roof Commercial B 1COMMLROOF
1BSEISMICO Seismic Commercial B
3 1REROOFRES Re-roof Residential B ISFDWLROOF
1BSEISMICRE Seismic Residential B
1RER00FMRES Re-roof Multi-Family B 1MFDWLROOF
IBSEISMICRE Seismic Residential B
1BUSLIC Business License B
Revised 6/16/08
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
Fax: (408)777-3333
Building Department
Subject: Re-roofing policy for the City of Cupertino
1. Prior to permit issuance,you must agree to comply with 2007 IBC Standards
and manufacturers specifications on re-roofing.All roofs are Class "A"per Cupertino
municipal code 16.04.080.
2. New roof coverings shall not be applied without first obtaining all inspection
and written approval from the building inspector. A final inspection and
approval shall be obtained from the building inspector when there-roofing
is completed.
3. All roofs shall be inspected prior to any roofing installation.
4. To receive a final sign off from the City, the following steps are
required:
1) Pre-inspection and/or tear off approval.
2) In-progress inspection approval.
3) Final inspection approval.
• a) Spark arrester installation.
5. If plywood is installed, a plywood nail inspection is required.
6. Any roofing which is applied without first obtaining an inspection,
will require the removal of all new material down to the sheathing,
so a proper City inspection can be performed.
7. NOTE: If you call for a plywood nail inspection and the job is not ready,
you will be charged a re-inspection fee of$176.18. The re-inspection fee must
be paid before another inspection can be scheduled
IMPORTANT:
1. Flat roofs must have a minimum of 1/4 "per foot slope and demonstrate
that there is no ponding.
2. An I.C.B.O. report is required to be on the job site at the time on inspection.
I understand and will comply with the above stated policy on re-roofing.
Homeowner's Name: G{lJ c e?
Job Site Address: 2 2 0 0 'D/p.-/(y "N l�
Lp d1F 1 N (r
Roofing C Name: Q
• App ' ant's Signa e• ep
L Date:
Greg Casteel
Building Official
Revised 07/30/08
CITY OF CUPERTINO
• � 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: SylvidM
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN I . . . . . . . : 35606024 . 00
DATE ISSUED. . . . . . . : 08/26/2008
RECEIPT # . . . . . . . . . : BS000005906
REFERENCE ID # . . . : 08080207
SITE ADDRESS . . . . . : 22063 BAXLEY CT
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : ANTHONY RODRIGUES
ADDRESS . . . . . . . . . . : 22063 BAXLEY CT
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4744
RECEIVED FROM . . . . : RE ROOFING
CONTRACTOR . . . . . . . : PROCTOR, PAUL LIC # 20615
COMPANY . . . . . . . . . . : R E ROOFING & CONSTRUCTION INC
ADDRESS . . . . . . . . . . : 15230 CLYDELLE AVE
CITY/STATE/ZIP . . . : SAN JOSE, CA 95032
• TELEPHONE . . . . . . . . : (408) 626-9320
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- --- - ---------- ---------- ----------
IBSEISMICR VALUATION 18, 000 . 00 1 . 80 0 . 00 1 . 80 0 . 00
IREROOFRES SQ FEET 34 . 00 442 . 00 0 . 00 442 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 443 . 80 0 . 00 443 . 80 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
C:HECK 443 . 80 12336
---------------
TOTAL RECEIPT 443 . 80
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF