08110007 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRA TpR.IN'EORMST,10N"
BUILDING ADDRESS: PERMIT NO.
10362 SAN FERNANDO AVETBD - TO BE DE
OWNER'S NAME: PERMIT ISSUE DATE
ANT)RRA QUINDRI AND 0aA 8 CONTROL NO.
ONE:
ARCHTIECDENGINEER:
BUILDING PERMIT INFO
BLDG MECH
0 0 0 0
tbt000 LICENSED CONTRACTORs DECLARATION Job Description
gV I Icteby affirm that I am licensed under pmvtalons a Chapter,9(commencing
'uj withSconme7000)ofDivision3ofNo Busfrccaand feaataN de dmylicanxu
TI N inrullrorteaM IT Y j�p� RE-RF TO RF TAR&GAVE INSTL 28LBS BASSHT 2LYR
% a DDateGO 0. t0,14 FBRGLAS PLYSHT 1 LYR 72LBS WHIT CAPSHEET NEW METL
uuy�� ARCHfl=DECIARATIO
� < I UMersund my plans shall be used as public record, CLSA 15 SQ
O y
sj e x I harchy Licensed Pmauo
rcnal
OWNER-BUILDER DECLARATION
afS.that 1 am acmpt from the Canuactat's License Law for tie
COO following muom(Section 7031.5.Business and Predications Cale:Any city or county
$ which haluires a permit to consuOq ales.hnprme.demalts0.N repair any ftraem
_2r prior to its issuance.aro acquires the applicant for such permit an file a signed suuntut
<
than he is licensed pursuant retic provisions of use Commuter's License Law
(chapter 9 Sq.Ft.Floor Area Valuation
y sre- (commencing with Section 7000)of Division 3 of Na Business and ProfoaioN Codc)or
$6868
a — Nat M u esempt thacfrmr shot Ne bids for the alleged exempdm Any violation of
Section 7031.5 by any applicant fa a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
trot more dun fin hundred dollars(5300). 35712024 . 00
❑Luawrcsk.the lbea=a Is omployw with ngNuale(sok c .Business
will Pr the work.and Nemuaure b am's License
a Law does,
far sale(Sec.7014,Business
and PnfesaloN Cade:The Contramolf LI¢Ne law dtea text apply to an owner of Required Inspections
property who Wildsorimprows thereon,andwho downchworkhimselfar through his
owvemployces,prodded that such impmwments are not intended moaeml fa sal[If,
however.Ute building or improvement if sold within ane year of campletion.the owner.
Wilda will mr.Ne burden of proving that In did not Wild tar improve for purpose of
ale.).
1,as owner of the property am exclusively contrazing with licensed conbamars W
construct the project(Sec.70".Business and Professions Code:)Tia Conuumr's Li-
cense law does not apply a sur owner of property,who builds or improves thereon,and
who contracts for such projects with•comeamor(s)licensed pursuant W the CantracteS
License law.
❑I sm exempt under See ,B&PC far this maven
Owner Dao
WORKER'S COMPENSATION DECLARATION
1 hereby alliin under penalty of perjury ane of the fallowing dalandow.
I ban and will maintain a Ceniliate of Cement to self-arum far Workces Comfort.
an,as provided fm by Section 3700 of the Labor Code.far the pehformarae of the
wtsrk for which this permit is issued.
❑1 have and will mainuln Workers Compensation Insurnmen,as mquired by Section
3700 of the Lobar Code.for the pefarmanee of the work for which this permit is issued.
My worker' oro eNai�Yo�n�IIn�su'ha�t{�artier and Policy number
Carrier. F PoIIN
CEMI EXPTI
OFEMON FltAWORKERS'
COMPENSATION INSURANCE
O'hissemlon recd not a=pit"iftbe permit W future hundred dall.($100)
or leu)
I¢nify that in the perfammuce of the work for which Nis permit is based.I shall at
employ airy person in any anchor so of a become subject to the Worker'Compensation
Lauri of California.Data
Appileant
NOTICE TO APPLICANT:If.after making this Ccrt fiaa of Exemption,you should
became subject w the Worker's Compensation provisions of the Inbar Code.you mute
z forthwith cempiy with such proms ons or this pe mit Nall W decreed revoked.
z O CONSTtUCfION LENDING AGENCY
[r I hemby affirm this Nem W s consuuctim lending agency for the perfarmana of
rL Ute work ear which this permit ts issued(Sec.3097,Civ,C.)
W�0 Lender's Name
z Lemees Address
U O 1 unify that I have mud this application and sum Nu the abon information W
corms I agine to comply with all city and county ordinances and sou Ian relating to
pU Wilding coNmction,and barely molonac tepecommuns or that city On cots Open He
above-mentioned end property for ses
inspection purpo
HC (We)agree to can.indemnify and keep harmless the City of Cupertino sgairal
to liabilities.judgments,cow arW expeNN which may in any way amu,again said Cityk2a
U Z APPLIICCA�LeUNDEof the RSTANDS ANof this D WILL COMPLY WITH ALL NON-POINT Issued by: Date f 3'
SOUR ULATIONS. /) S — —
—LO Re-roofs uv
Signature of cm .u, Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Wil th,appliantorrutum Wilding occupantstare orlundk ha ankmamamrial '
as,defined by tic Cupertino Municipal Cade.Chapter 9.13,and the Health and Safety
code. lss3z(U7
El Y. ONO
All roofs shall be inspected prior to any roofing material being installed.
El Y.
Will the applicant or future building meWart use equipment m dcviaw which If a roof is installed without first obtaining an inspection,I agree to remove
it ha,ardous air contaminants u thOned by the Bay Ara Air Quality Management all new materials for inspection.
uics7
Dyes [I No
I ban mad Ne hvardrnrs materials relar,mcnts under Chapter 6.95 of the Caltfor.
.is Health&Safety Code.*..25505.25533 and 15534.1 understood that ifthc Wilding //� J• Q
dans not cumntiy hen a temm,Nat it IS my hopOna bility a ratify,Ute occupant of Ne
mquire0"nich must W met priapApsmace,ofacerdBcateofaapancy. Signature Applicant Date
/- S'"6
Owner or mind.,at Dare All roof coverings to be Class'W'or better
CITY OF CUPERTINO
•3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: pdtg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35712024 . 00
DATE ISSUED. . . . . . . : 11/03/2008
RECEIPT # . . . . . . . . . : BS000006529
REFERENCE ID # . . . : 08110007
SITE ADDRESS . . . . . : 10362 SAN FERNANDO AVE
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : ANDREA GRINDELAND
ADDRESS . . . . . . . . . . : 10362 SAN FERNANDO AVE
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : CARY 0 NEAL
CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096
COMPANY . . . . . . . . . . : TBD - TO BE DETERMINED
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
TELEPHONE . . . . . . . . :
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- --------- ----
1BSEISMICR VALUATION 6, 868 . 00 0. 70 0 . 00 0 .70 0 . 00
1BUSLIC FLAT RATE 1 . 00 110 . 00 0 . 00 110 . 00 0 . 00
1REROOFRES SQ FEET 15 . 00 195 . 00 0 . 00 195 . 00 0 .00
---------- ---------- ---------- ----------
TOTAL PERMIT 305 . 70 0 . 00 305 . 70 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- ------
CREDIT CARD 305 . 70 VISA
---------------
TOTAL RECEIPT : 305 . 70
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ------------- ----------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
s
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 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.
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: (!�;,Q l N fl)rn LAN IJ
Job Site Address: 163 6 Z CN
P
Roofing Company Name: 6,�I(eA L AeO !v`C71 LNC
Applicant's Signature: Date:-z_1_3_&?8
• Greg Casteel
Building Official
Revised 07/30/08
CITY OF CUPERTINO
SCUP
a� "ROOF
EkTNO PERMIT APPLICATION
• -
APN # 2� I Q J C� Date:
Building Address:
Owner's Name: Phone #:
G12/!)DE L_,4n/d
Contractor: Phone #:
pN� AC
Fax#:
Cupertino Business License #: Contractor License #:
63aR84
Type of Roof Covering:
Exist g: Prop ed:
Built-Up Roof b Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other (Specify) ❑ Other (Specify)
Number of existing covering _ ❑ Provide I.C.B.O. Report #
❑ To be Removed ❑ Provide Mfgr. In Specs.
Job Description: -1e;4 GQRdk; L
p �k� D .�oo G�
pivc� CA ti/L. 72,tar
Residential Commercial ❑
Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if
Green Building Checklist & attach it to the applica ' n or if there are any restrictions: ❑
applicable, include in plan set & the sheet index.
Valuation:
I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
v 0 �
Signature
Revised 6/16/08
I
CITY OF CUPERTINO
` REROOF
CUPEI,TINO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1REROOFCOM Re-roof Commercial B 1COMMLROOF
1BSEISMICO Seismic Commercial B
1REROOFRES Re-roof Residential B 1SFDWLROOF
J 1BSEISMICRE Seismic Residential B
IREROOFMRES Re-roof Multi-Family B 1MFDWLROOF
1BSEISMICRE Seismic Residential B
1BUSLIC Business License B
Revised 6/16/08