12010099 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22045 REGNART RD CONTRACTOR:ROBERT BIGLER PERMIT NO: 12010099
OWNER'S NAME: ROBERT BIGLER 11,230 BLBB RD DATE ISSUED:01/12/2012
OWNER'S PHONE: 7068175984 CUPERTINO,CA 95014 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION F
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lie.# F 4
MECH RESIDENTIAL COMMERCIAL
Contractor Date
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REMOVE&REPLACE SHINGLES WITH NEW COMP
(commencing with Section 7000)of Division 3 of the Business&Professions SHINGLES
Code and that my license is in full force and effect. 580SQ
I hereby affirm under penalty of perjury one of the following two declarations:
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.
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:$1250
permit is issued.
APPLICANT CERTIFICATION APN Number:36646004.00 Occupancy Type:
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 PERMIT EXPIRES IF WORK IS NOT STARTED
indemniN and keep harmless the City of Cupertino against liabilities.,judgments,
costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,the applicant understands and will comply 18O DAYS FROM LAST CALLED INSPECTION.
%vith all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
Issued by: Date:,/, y Z
Signature Date
OWNER-BUILDER DECLARATION
RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material be 'installed.If a roof is
the fallowing two reasons: installed without first o ming an inspection,I agr rer o e all new materials for
I,as owner of the property,or my employees with wages as their sole compensation, inspection. /
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code) Signature of Applicant ate:
1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I hereby affirm under penalty,of perjury one of the following three
declarations: HAZARDOUS MATERIALS DISCLOSURE
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 I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material.
Additionally,should I use equipment or devices which emit hazardous air
Permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will
I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertin Municipal Code,Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's Health Safety Code,Sec ns 25505, 533,and 25534.
Compensation laws of California. If,after making this certificate of exemption,I ',
Owner or t orized a
become subject to the Worker's Compensation provisions of the Labor Code,I must Lforthwith comply with such provisions or this permit shall be deemed revoked. '' E4�w L/
APPLICANT CERTIFICATION CONSTRUCTION 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 of work's
correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.)
to building construction,and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
costs,and expenses which may accrue against said City in consequence of the
granting of this p tit.Additionally,the applic and tands and will comply
with all non-po t s ice regulaticxts per the p tin.. it unicipal Code,Section ARCHITECT'S DECLARATION
9.l 8. -i 1 understand my plans shall be used as public records.
Signature Date 1 Licensed Professional
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36646004 . 00
DATE ISSUED. . . . . . . : 01/12/2012
RECEIPT #. . . . . . . . . : BS000015750
REFERENCE ID # • . . 12010099
SITE ADDRESS . . . . . : 22045 REGNART RD
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : ROBERT BIGLER
ADDRESS . . . . . . . . . . : 11230 BUBB RD
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : BIGLER PROJECTS
CONTRACTOR . . . . . . . : LIC # *OWNER*
COMPANY . . . . . . . . . . : ROBERT BIGLER
ADDRESS . . . . . . . . . . : 11230 BUBB RD
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
TELEPHONE . . . . . . . .
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 1,250 .00 1. 00 0 .00 1.00 0.00
1BSEISMICR VALUATION 1,250 .00 0.50 0 .00 0 .50 0 .00
1REROOFRES SQ FEET 6 .00 84 . 00 0 .00 84 .00 0.00
---------- ---------- ---------- ----------
TOTAL PERMIT 85 .50 0. 00 85 .50 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 85.50 #115
---------------
TOTAL RECEIPT 85 . 50
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
309 EXTERIOR LATH 311 SCRATCH COAT
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
OWNER-BUILDER DISCLOSURE FORM
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
CUPERTINO (408)777-3228 • FAX(408)777-3333•5uildino5cupertino.orc
Dear Property Owner(s):
An application for a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified at:
SITE ADD ESS APN
/f/Q B P#
O R N OWNER ADD SS
DESC IPTION OF WORK:
(
We are providing you with an Owner-Builder Acknowledgment and formation Verification Form to make you aware of
your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner-Builder. We
will not issue a building permit until you have read, initialed your understanding of each provision, signed, and
returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless
you, the property owner, obtain the prior approval of the permitting authority.
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION
(DIRECTIONS:Please read and initial each statement below to signify you understand or verify this information.)
C1. 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-
lB der building permit that erroneously implies that the property owner is providing his or her own labor and material
personally. I, as an Owner-Builder, may be held liable and subject to serious financial risk for any injuries sustained by
an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not
provide coverage for those injuries. I am willfully acting as an Owner-Builder and am aware of the limits of my
insurance coverage for injuries to workers on my property.
2. 1 understand building permits are not required to be signed by property owners unless t
the construction and are not hiring a licensed Contractor to assume this responsibility.
they are responsible for
3. 1 understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that I may
protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her y
name instead of my own.
4. 1 understand Contractors are required by law to be licensed and bonded in California and to list
v numbers on permits and contracts. their license
� dContractor
5. I understand if I employ or otherwise engage an persons, other than California
total value of my construction is at least five hundred dollars ($500), including labor and Imate icensgals, I may bes' and the
considered an "employer" under state and federal law.
I understand if I am considered an "employer" under state and federal law, I must register with the state and
federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to
unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject
me to serious financial risk.
'6� 7. I understand under California Contractors' State License Law, an Owner-Builder who builds single-family
es`idential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by
licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work
is performed under contract with a licensed general building Contractor.
8. 1 understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for
ny financial or personal injuries sustained by any subsequent owner(s)that result from any latent construction
defects in the workmanship or materials.
OwnerBuilde•Form_2010.doe revised 04/14/10
9. I understand I may obtain more information regarding my obligations as an "employer"from the Internal
'venue Service, the United States Small Business Administration, the California Department of Benefit Payments,
nd the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State
License Board (CSLB) at 1-800-321-CSLB (2752)or www.cslb.ca.gov for more information about licensed
contractors.
10. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I
m the party legally and financially responsible for proposed construction activity at the site address listed above.
11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide
y all applicable laws and requirements that govern Owner-Builders as well as employers.
C . I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the
ormation I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If
you contract with someone who does not have a license, the Contractors' State License Board may be unable to
assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed
Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or
employee of that individual or firm is injured while working on your property, you may be held liable for damages. If
you obtain a permit as Owner-Builder and wish to hire Contractors, you will be responsible for verifying whether or not
those Contractors are properly licensed and the status of their workers'compensation insurance coverage.
CONSTRUCTION LENDING AGENCY
(DIRECTIONS:Please complete the following construction lending agency information.)
I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued
(Sec 3097 Civ.)
Lender Name: Lender Address:
Before a building permit can be issued, this form must be completed and signed by the property owner and
returned to the agency responsible for issuing the permyt, Note: copy of the property owner's driver's license,
form notarization, or other verific ti accept le to the ci m y b re uired to be presented when the permit is issued
to verifythe property owner's si nafu /
Property Owner's Signature: U I LT Date: - I
--(NOTE:---T-h--e-fo-llo-w-i-n--g--A--u-th--o-r-i-z-a-t-i-o-n F--o-r-m---i-s--r-e-q--u-i-r-e-d--t-o--b--e--c-o--m--p-l-e-t-e--d--b-y--t-h-e--p--r-o-p--e--rt-y--o--w-n--e-r--o-n-l-y--w--h-e--n--d--e-s-i-g-n--a-t-in--g--a--n
---
agent of the property owner to apply for a construction permit for the Owner-Builder).
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby
authorize the following person(s)to act as my agent(s)to apply for, sign, and file the documents necessary to obtain an
Owner-Builder Permit for my project. p ) N)l l� ,
Scope of Construction Project or Description
of Work): G!%n2P1ja /!�
Project Location or Address: '7-7-0 LtS— tZ�ILW /� KOOO ,
Name of Authorized Agent: ) (ti/l fl fiey c� Tel No
Address of Authorized Agent:
I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the
above information and certify its accuracy. Note:A copy of the property owner's driver's license, form notarization, or other
verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's
signature.
aojl► Property Owner's Signature: Date: �L�� Z Z16
CL1'71e]Buildel'Fol771 2010.doc revised 04/14/10
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 22045 regnart dr. DATE: 12/21/2011 REVIEWED BY: bobs.
APN: BP#: "VALUATION: $1,250
y°PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY PENTAMATION 1 SFDWLROOF
USE: SFD or Duplex PERMIT TYPE:
WORK remove and replace shingles with new comp shingles.
SCOPE
FEE ID ROOF AREA
s.f.
1REROOFFRES 580
NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc. . Thesefees are based on the prefiltdina information available and are only an estimate. Contact the De t or addn 7 info.
FEE ITEMS (Fee Resolution 11-053 Eff 711/11) FEE QTY/FEE MISC ITEMS
Pe::.:it Fee: $84.00
Work Without Permit? 0 Yes No $0.00
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg=Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $85.50 $0.00 TOTAL FEE: $85.50
Revised: 12/04/2011
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
CUPERTINO
(408)777-3228• FAX(408)777-3333•build ing(&-cupertino.org
PROJECT ADDRESS ^ APN#
OWNERNAM% PHONE - E-M
STREET ADDRESS CITY, STATE / IQ (e7 AX
_
(ti /lf
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC.#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
I UNDERSTAND AND AGREE TO THE FOLLOWING:
1. The re-roof project shall comply with all applicable provisions of the 2010 California Codes.
2. An inspection request can be scheduled up to the day before the inspection date. Please call (408)777-
3228 from 7:30 - 3:30pm (Mon-Thurs) or 7:30 - 2:30pm (Friday) to schedule the next day 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. Progress
and 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 obta�ning 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. Progress Inspection is required when approximately 50% of roof covering is installed.
7. 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'/" 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.
8. 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 of$126.00. 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 mono detectors re requi edr install accordance with Sections R314 and R315 of
the 2010 California Residential Ch de
Signature of Applicant/Agent: c Date:
/ 2-.
ReroofPolicv 2011.doc revised 02/16/11
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
La 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255
CUPERT[NC3 (408)777-3228 • FAX(408)777-3333 • buildinGCcDcupertino.org
alp G�I.P W
PROJECT ADDRESS k La APN#
OWNERNAME, PHOE-MAIT -
C2�,f - •s --
1
STREET ADDRESS Lo CITY,
ST ZIP FAX
1
APPLICANT NAME PHONE E-
STREET ADDRESS CITY,STATE, ZIP FAX
❑ OWNEROWNER-BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC.#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC.#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF SFD or Duplex ❑ Multi-Family ROOF AREA: V UATION:
STRUCTURE: ❑ Commercial
EXISTING ROOF TYPE: ❑BUILT-UP ROOF ASPHALT SHINGLES 11WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY)
REMOVE/REPLACE 2< IF NO, PLYWOOD h" ❑ PLYWD �C 0O PITCH ROOF
11 NO #LAYERS. THICKNESS: 135/S" TYPE: m CDX '12' CLASS: A
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF 01ASPHLT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT#
DESCRIPTION OF WORK
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 ha rovided is correct. I e read the scription Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relatin bu'lding con ction. aII orize. pre ntative of uper'iao tc enter the above-identified pro err;For' pec'on urposes.
Signature of Applicant/Agent: Date: " r
SUPPLEMENT ORMATION REQ D L;
_If building is associated with a Home Owner's Association,provide letter _ _ Q
of approval from HOA.
—Provide Planning approval to verify if there any restrictions.
_Provide copy of Manufacturer's Installation Specifications. - '-°E
. =
rovide signed copy of Cupertino's Tear-Off Policy. .- — �pT
ReroofA,pp_2011.doc revised 03/02/11