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12010157 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10310 WALNUT CL CONTRACTOR:PFAHLER'S ROOFING& PERMIT NO: 12010157 WATERPROOF OWNER'S NAME: MURRAY MARLIN K 17788 BERTA CANYON RD DATE ISSUED:01/25/2012 OWNER'S PHONE: 4055911419 PRUNDALE,CA 93907 PHONE NO:(408)224-9013 ❑ LICENSED C'ONTRACTOR'S DECLARATION ' ' C BUILDING PERMIT INFO: BLDG ELECT PLUMB ' License Class Lie.4 ,� MECH RESIDENTIAL ' COMMERCIAL Contractor 1f, J22 JOB DESCRIPTION:APT A&APT B-RE-ROOF TEAR OF WOO _`' Date !r, [hereby affirm that I am licensed under flee provisions of Chapter 9 L)SHAKE INSTALL (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. l/2 OSB&30LB FELT&30YEAR GAF NEW ELK COMP SHINGLES CLASS A 35SO 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. €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. Sq.Ft Floor Area: Valuation:$t 1500 APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is APN Number:35703042.00 Occupancy Type: 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, PERMIT EXPIRES IF WORK IS NOT STARTED costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non-paint source regulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION. 9.18. ,,// Signature � / Date Z-- Issued by: — Date:X 1 J ❑ OWNER-BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS: the following two reasons: All roofs shall be inspected prior to any rooting material being installed.If a roof is 1,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I agree to remove all new materials for will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection. Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant -Date: . Z,�-- 2 1 construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE Compensation,as provided for by Section 3700 of the Labor Code,for the this permit is s issued.Insurance,as provided for by [have read the hazardous materials requirements under Chapter 6.45 of the performance of the work for which Compensation California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain €have and will maintain Worker's this compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3 700 of ilio Labor Code,for the performance of the work for which this Safety Code,Section 25532(x)should I store or handle hazardous material. permit is issued. Additionally,should I use equipment or devices which emit hazardous air I certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District I will not employ any person in any manner so as to become subject to the Worker's ruaintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Compensation laws of California. If,after peaking this certificate of exemption,I Health&Safety Code,Sections 25505,25533,and 25534. become subject to the Worker's Compensation provisions of the Labor Code,1 must torthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized ager : –�—� Date• APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is correct.I agree to comply with all city aril county ordinances and state laws relating I hereby affirm that there is a construction lending agency for the performance of work's to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.) upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the Lender's Address granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION 0.13. 1 understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO 3 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng; Sub: Elk: Lot: APN . . . . . . . . : 35703042 . 00 DATE ISSUED. . . . . . . ; 01/25/2012 RECEIPT #. . . . . . . . . BS000015847 REFERENCE ID # . . . : 12010157 SITE ADDRESS . . . . . : 10310 WALNUT CL SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : MURRAY MARLIN K ADDRESS . . . . . . . . . . : 10310 WALNUT CL CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . ; WM R PFAHLER CONTRACTOR . . . . . . . ; WILLIAM PFHALERS LIC # 21500 COMPANY PFAHLER`S ROOFING & WATERPROOF ADDRESS 17788 BERTA CANYON RD CITY/STATE/ZIP . . . : PRUNDALE, CA 93907 TELEPHONE . . . . . . . . : (408) 224-9013 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 11, 500 .00 1. 00 0 .00 1 .00 0 . 00 1BSEISMICR VALUATION 11, 500 .00 1. 15 0 .00 1 .15 0 .00 1REROOFRES SQ FEET 35 .00 490. 00 0 . 00 490 .00 0 .00 ---------- ---------- ---------- ---------- TOTAL PERMIT 492 . 15 0 . 00 492 .15 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 611. 15 #1846 --------------- TOTAL RECEIPT 611 . 15 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 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10310 walnut cr. DATE: 01/25/2012 REVIEWED BY: bobs. APN: BP#: "VALUATION: 1$11,500 „PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof PRIMARY SFD or Duplex PENTAMATION 1 SFDWE_ROOF USE: PERMIT TYPE: FORK re-roof install new comp shingles. SCOPE FEE ID ROOF AREA s.f. 1REROOFFRES 3,500 Ll __L_ Ll NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc.). These ees are based on the prelinina information available and are only an estimate. Contact the Det Lr addn'l info. FEE ITEMS a' s :%id }= 11-053 t' ^ '-'r i t, FEE QTYIFEE MISC ITEMS Lj Permit Fee: $490.00 F] Werk Without Permit? 0 Yes G No $0.00 ;�t:c>� „7 ��otiog �ee, 1BSEISMICR $1.15 Select an Administrative Item I�<� St"is t'onir��i4sic�r� t~"�.e; IBCBSC _ $1.00 SUBTOTALS: $492.15 $0.00 TOTAL FEE: $492.15 Revised: 1/19/2012 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: Q PERMIT# tl OWNER'S NAME: L PHONE# ex6G GENERAL CONTRACTOR: BUSINESS LICENSE# ADDRESS: 6 a3 42 k CITY/ZIPCODE: *Our municipal code requires Al businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: z = Z l d ignature Date Please check applicable subcontractors and complete the following information: &/ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring/ Carpeting Linoleum/Wood Glass/ Glazing Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333 •buildingecupertino.oro 0 CI ADDRESS APN# 3 (, vj/- 7 u OWNER NAME. PHONE — E-MAIL STREET ADDRESS CITY, STATE,ZIP FAX APPLICANT NAME PHONE 7_71IL STREET ADDRESS CITY,STATE,ZIP FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME LICENSE ER LICENSE TYPE BUS.LIC.# E-MAIL FAX co N n �� )F iv �� STREEADDRESS /G- CITY,STATE,ZIP PHONE T ARCHITECT/ENGINEERNANE LICENSE NUMBER BUS.LIC.# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑ SFD or Duplex ❑ Multi-Family ROOF AREA: VALUATION: / STRUCTURE: EI _Commercial -4:1. 1 ` 0 EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY) REMOVE/REPLACE Z IF NO. PLYWOOD ❑ h" 131 PLYWD OSB PITCH- ! ROOF ❑ NO #LAYERS: CKNESS: ❑ 5/S" TYPE: ❑ CDX �-v 12 THICLASS: A ICC-ES REPORT# PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAD'S �W6i � U OTI�R DESCRIPTION OF WORK v ��- � l r' G6 ei e By my signature bel ,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 have provided is 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 relating to building construction. I authorize.representatives of Cupertino tc enter the above-identified pmpert-,for inspection purposes. Signature of Applicant/Agent Date: Z Z- � l SUPPLEMENTAL INFORMATION REQUIRED .• -� �" s _If building is associated with a Home Owner's Association provide letter � ��-AM— � QU�� 2 T- -— - of approval from HOA. = N�P Provide Planning approval to verify if there any restrictions. �P>r�rs�vv- a = _ Provide copy of Manufacturer's Installation Specifications. I e signed copy of Cupertino's Tear-Off Policy. TMW ReroofApp_2011.doc revised 03/02/11