08010018 CITY OF CD"'INO
BUILDING'DIVIS10N PERMIT
BUILDING ADDRESS: PERMIT NO.
10121 MILLER AVE #200 REINHARDT ROOFING INC 08010018
OWNER'S NAME: PERMIT Li5UE DATE
HUNTER PROPERTIES 8250 ENTERPRISE DR 01/03/2008
ONE: SANITARY NO. CONTROL NO.
5107137014
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
-BLDG BLECT PLUMB MECH
mop LICENSED CONTRACTOR'S DECLARATION lob Description 1 hereby aliment Nm
al I em limod under provisions of Chapmr 9(commencing
-Zj wife Section 70(10)o'Divrion3oflheBusiness and ProfessionsCode,and mylicmueie RMV EXTNG CPSHT RF,RPLC DRYROT & INSTL 2 LYR ELK
seein fullfoteomd.ffecL..
FiZ .3 Lk [ S 8S( FB1 CLASS A. INSTL FIRESTORM 60MILL TPO MEMBRANE
� Liccnx Ql' Van
eel Dau
ContractorDELL
% As Mail he
MECCH ATTCH
1 uMem.nJ my plana shall be toed as public mcards
zyU
yoy LkenseJ Proposal onel
OWNER-exemptR DECLARATION
f I hereby.,firm Net 1 1, exempt from fee I.IosCCommittees License Law for the
O O following moon.(Section]1131.5,Business and Profusion Cole:Any city s county
3$ which its issuance.
a Permit m construct,alar,improve,temoliIL t or repair any atrodum
prions its i ensed p also tequiten thovisio s o far such uclon' Llcmo rile scsignedwstatement
�<
that me cingwiit pursuant to ties provisions of fee Camnnur9Llrenec law(Chapur9 Sq.Ft.Floor Area Valuation
$ (cath.Is
(commencingwith Section 7M)the
basisofroftWeged second PmfAn vi Code)of 37100
— feat h<4 31.5 b tWrefeom and the aper for the subjects
the exemption.Any l penalty
of
Section 7031.5 by hundred
WPlinm for a permit abjeeu the applicant ro a civil penalty of ppt�7 Number Occupancy Type
wt mote than fes hundrtd dollen(5300). 36907001 :Cf4'
0 1,as owmr of the property,or my employes with wages as Lack wale compenuthe".
will do the work and the sWmute r not mounded or offered for sae(Sec.7014.Business Required Inspections
and Pmfealon Cade:The Contravenes Lmemcoee law does t apply b an owner of q p
propenywho builds ear improves theman.and who dasstach workhimselforthmogh his
awn emplayes,provided that such imFrovmenu are not mnuntlW conflicted forule,If,
however,she building or Improvement is sold within sem year of ecmpleden,the avnce.
builder will haw the burden of proving Out he did rot Wild or improve for purpose of
sal..).
❑1,as owner of the property,am exclusively connoting with limned conuactma m
construct the project.(Sec.7044.Basi om and Profession Cade:)The Commuter's W-
cine Law docs not apply an an owner of property who Wilds or improves Duman,and,
who contracts for such projects with a crmmelor(s)licensed pursuant m the CanmcuoS
License Law.
❑I am exempt sender See B k P C for this moon
Owner Dau
WORKER'S COMPENSATION DECLARATION
1 heteby alRm under penalty o/perjury aro of the follewin[declentian:
1 have ad w01 maimsin a C.r ftmm of C...i m self-Imo re rerWorke's Compen.
on,as provided for by Section 3700 of the labor Code,for the performance of tho
wart( which this Permit is issued.
hav and will maintain Workmrs Campenation Insuranm,as required by Section
37W of to labor Code,for the performance of the wart for which this Permit is leaned.
My Worker's Command..Insurance carrier and Polity number am:
Carrien�V AS VI Policy No.:w C 117 76,gi: a-.G G f
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(this action need not W camplcwd if the Permit Is Areas hundreddollaa(SIM)
or lea)
I certify that in the performance of the work for which this Permit is issued,l shall not
employ any person in any manner an as In become subject in the Warkcrs'Cmaram abort
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,time making this Certificate of Exemption,you should
became subject in the Worker's Compensation provisions of dm Labor Cade,you want
rJ O forthwith comply with such provision or this permit Mall x turned mocked.
w'Z,t55 CONSTRUCTION LENDING AGENCY
[-+ I hereby aflfm the them is a cmntmction lending agency for the performance of
ani the work for which this permit Is issued(Sm.3097,Civ.C.) -
W Q Undoe's Name ,
z Lender's Address
U Q 1 certify that I have read this pplication and sum Lou the above inforoutien is
W;•� comet.I agree m comply with all city and county ordinances and stats laws misting to
SV' building commotion,and hereby authorie representatives of this city to order upon the
W .hove-el...d property for inspection purposes
d (We)agree to ave.indemnify and kmp harmless the City of Cupertino against
fAl
U in consequence of the[taming of this permit.
liabilities,judgments.costs and expenses which may in any way acerae against aid City
icy
APPLICANT UNDERSTANDS AND COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS ✓/".ice 1-3-09.
G e V Re-roofs
Signaurt of ApplicaO Dau
HAZAR
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
WIII y tt applicant or(urate Wilding e,C1Wp a9.1 u handle Health and
u dented by the Cupertino Munici 1 Code,CMPmr 9.13.and the Hevlth and Safely I
Code,Section 35532(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yea No
Will the applicant a future build'n emupant pee equipment or dcvucs which If a roof is installed without first obtaining an inspection,.I agree to remove
t haadnm air camaminanu as d by the Bay Arta Air Quality Management all new materials for inspection.
vela?
❑Yea u
I have mad the hoard...materials requirements under Chapter 6.95 of the Califor.
nia Health&SafetyCaM,Sectian255D5,25533ald25534.lundcraandthailtM building
dons not cu r.unank the it'u my responsmilhy memory Use occupant of Ne
reyumarro� hich 0sat armissmocof.cenlfimuofOceupaney 5 Signature of Applicant Date
Owner 37 agent // a3 Dow All roof coverings to be Class"B"or better
090 ► 00191
CITY OF CUPERTINO
(itsREROOF
®CUPEkT`1NO PERMIT APPLICATION
APN# 3 VI 0 -7601 , () y Date:
Building Address:
10111 N dl e r A J -c_ -i`=�- ) O
Owner's Name: NO U D CO A- -7 r ,c,41 j ✓ Phone #:
CSO ) C10 - 2 / ti3
Contractor: Pei n h 44Lj t Pd E, �J 1t-i L Phone #:(:'/u J 713. -2611,
Fax #: LSro) 7 /3 - 2 Z y a
Cupertino Business License #: v 9 (o Contractor License #:
L-1 IS 8`i l
Type of Roof Covering:
Existi Proposed:
Zluilt-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) Is"Other(Specify) F 'eJ�° �'T i P. O(
Number of existing coverings O N I ❑ Provide I.C.B.O. Report#
4--�o be Removed ❑ Provide Mfgr. Installation Specs.
Job Description: ReMu✓G 'eYutj. Cflastic. t /100-i /�ePIgce ,Or7r0 t--
-T:Ns 1,w((
---T:Ns1,wu Twe Int e,, o4 e4 F3 1 oup/� su blT1-9i-e , n�-racc Fi ,4e-rl&
(Q0ra•( 1 7P, 491fgGtie-(.
Residential ❑ Commercial KF
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are any restrictions: ❑
Valuation: 3 -7
16 0
I Have RcajdjJnqerstand and Will Comply with Cupertino's Tear-Off Policy:
Signature
CITY OF CUPERTINO
Zzmlw REROOF
CITY OF
0CUPERTINO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
,578 1RER0OFC0M Re-roof Commercial B 1COMMLROOF
/ 1BSEISMICO Seismic Commercial B
1RER00FRES Re-roof Residential B 1SFDWLROOF
1BSEISMICRE Seismic Residential B
1RER00FMRES Re-roofMulti-FamilyB IMFDWLROOF.
1BSEISMICRE Seismic Residential B
1BUSLIC Business License B
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 1997 UBC Standards
and manufacturers specifications on re-roofing.
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 the re-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. I,'
2) h1-progress inspection approval. L/
3) Final inspection approval.
a) Spark arrester installation. /J/'l.
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-ruufing.
Homeowner's Name:
Job Site Address: I j�
Roofing Company Name: L'!,l I n d l�a s A.,i
c
Applicant's Signature: C Date:
® Greg Casteel
Building Official
Revised 11/2/04
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
® Telephone: (408) 777-3228
Fax: (408) 777-3333
Building Department
REROOF TEAR OFF POLICY
1. You must schedule an inspection for the tear off the day before
you wish the inspection to be made. The procedure is to call the
Building Division (408) 777-3228 between the hours of 7:30 a.m. and
3:30 p.m. to request a next-day inspection.
2. When the roof is torn off, the nails have been removed or driven in,
® and all of the dry-rotted wood has been replaced, you must call the
City Building Division. An inspector will be there within one hour.
There are special hours for this service: from 7:30 a.m. to 10:30 a.m.
and 1:00p.m. to 3:30 p.m., Monday through Thursday and from
7:30 a.m. to 10:30 a.m. and 1:00 p.m. to 2:30 p.m. on Friday. (Note:
Building inspectors are on lunch break from 11:30 a.m. to 12:30 p.m.
and will not be called during that time. City Hall is closed between
12:00 and 1:00 p.m. daily.)
3. If you call for a tear-off 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.
Greg Casteel
® Building Official
Revised 8/13/04
ACORD CERTIFICATE OF LIABILITY INSURANCE DATE12/28/0728/070YYY)
PRODUCER LIC #0726293 1-925-983-3700 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Arthur J. Gallagher s Co. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
assurance Brokers of California, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
03 Camino Ramon, Suite 550 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
San Ramon, CA 94583
INSURERS AFFORDING COVERAGE NAIC#
INSURED
INSURERA:Zurich American Ina Cc Of IL 27855
Reinhardt Roofing Inc
INSURERS:
8250 Enterprise Drive INSURERC:
Newark, CA 94560 INSURER D:
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING
ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR WDL POLICYEFFECTIVE POLICYEXPIRATION
TYPE OF INSURANCE POLICY NUMBER LIMITS
GENERAL LIABILITY EACHOCCURRENCE $
-DAMAGE
COMMERCIALGENERAL LIABILITY PREMISES Err occurence $
CIAIMS MADE [—]OCCUR MEDEXP(AnYoneperson) $
PERSONALS ADV INJURY $
GENERALAGGREGATE $
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMNOP AGO $
PRO- / 1 /✓
POLICY LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
ANYAUTO (Ee accident) $
ALLOWNEDAUTOS BODILY INJURY
(Per person) $
SCHEOULEOAUTOS
HIRED AUTOS BODILY INJURY
NON-OWNEDAUTOS (Pereccident) $
PROPERTY DAMAGE $
(Peremitlen0
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $
ANVAUTO OTHERTHAN EAACC $
AUTOONLY'. AGG $
EXCESSNMBRELLA LIABILITY EACH OCCURRENCE $
OCCUR CLAIMS MADE AGGREGATE $
8
DEDUCTIBLE $
RETENTION $ $
A WORKERS COMPENSATION AND WC437640804 01/01/08 01/01/09 X WC STATU. OTH-
EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $1,000,000
ANY PROPRIETORIPARTN EWEXECUTIVE
OFFICERIMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEEI$1,000,000
BP Eyes,tleealbe under
EC IAL PROVISIONS below E.L.DISEASE-POLICY LIMIT 1$1,000,000
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENTI SPECIAL PROVISIONS
RE: Permit & Business License
CERTIFICATE HOLDER CANCELLATION Ten Day Notice for Non-Payment of Premium
RE: Perm t 6 Business License SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of Cupertino DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR
10300 Torre Avenue
llkREPRESENTATIVES.
pertino, CA 95014 AUTHORIZED REPRESENTATIVE `
USA �
ACORD 25(2001108)ranshar ACORD CORPORATION 1988
7849055
CITY OF CUPERTINO
2 ITEMS OF 2 PERMIT .RECEIPT - OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36907001 . 04
DATE ISSUED. . . . . . . : 01/03/2008
RECEIPT # . . . . . . . . . : BS000003609
REFERENCE ID # . . . : 08010018
SITE ADDRESS . . . . . : 10121 MILLER AVE #200
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : HUNTER PROPERTIES
ADDRESS . . . . . . . . . . : 10525 S DE ANZA BLVD #175
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : REINHARDT ROOFING
CONTRACTOR . . . . . . . : LAWRANCE, CAROLE A LIC # 20967
COMPANY . . . . . . . . . . : REINHARDT ROOFING INC
ADDRESS . . . . . . . . . . : 8250 ENTERPRISE DR
CITY/STATE/ZIP . . . : NEWARK, CA 94560
TELEPHONE . . . . . . . . : 5107137014
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICO VALUATION 37, 100. 00 7 .98 0. 00 7 .98 0. 00
1REROOFCOM SQUARES 58. 00 490.00 0. 00 490 . 00 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 497 .98 0. 00 497 .98 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 497 .98 #6745
---------------
TOTAL RECEIPT 497 .98
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
603 ROOF BATTENS 604 ROOF IN-PROGRESS
605 FINAL REROOF