12020016 CITE' OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21783 TERRACE DR CONTRACTOR:CASTO ROOFING PERMIT NO: 12020016
OWNER'S NAME: ABE THEODORE T AND MARGARET M 1938 OLD MIDDLEFIELD WAY DATE ISSUED:02/06/2012
OWNER'S PHONE: 4089419466 MOUNTAIN VIEW,CA 94043 PHONE NO:(650)961-8922
f
LICENSED CONTRACTOR'S DECLARATION l
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic.# Z Q!7 2.2_3
" t MECH RESIDENTIAL£ COMMERCIAL '
Contractor(�4%q v a ,`y,S-Date`c, ( 1Z__
[hereby atTirnr that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:TEAR OFF EXISTING ROOFING&.INSTALL 7/16"OSB
(commencing with Section'17000)of Division 3 of the Business&Professions SHEATHING.RE-ROOF 29S(�WITH COMP SHINGLES CLASS A
Code and that my license is in fill force and effect.
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 fix Worker's
Compensation.as provided for by Section 3700 of the Labor Code,for the
performance of the work fix which this permit is issued.
I have and will maintain Worker's Compensation Insurance,a,provided for by Sq.Ft Floor Area: Valuation:$10250
Section.3700 of the Labor Code,for the performance of die work for which this
permit is issued.
APN Number:35617016.00 Occupancy Type:
APPLICANT CERTIFICATION
I certify that I have read this application and state that tl€e 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 PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes. (We)agree to save
indemnity and keep harniless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply 180 DAY F M LAST CALLED INSPECTION.
with all non-point source regulations per the Cupertino Municipal Code,Section i'I
`� l8. _ Issued by: Date: L•k"(
Signa Date
❑ OWNER-BUILDER DECLARATION RE-ROOFS: /r
All roofs shall be inspected prior to any roofing material being installed.If a roof is
t hereby affirm that I am exempt from the C'ontractor's License Law for one of installed without first obtaining all inspection,I agree to remove all new materials for
the following two reasons: inspection.
I,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and tine structure is not intended or offered for sale(Sec.7044, Signature of A pli Date:
Business& Professions Code) ��l
1,a,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 sett-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the
Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 2.5534. I will maintain
performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material.
Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
I certify that in the performance of due work for which this permit,is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534.
not employ any person in any manner so as to become subject to the[Worker's >
Compensation laws of California. If,after making this certificate of exemption,I Own irr au rze
become subject to the Worker's Compensation provisions of the Labor Code,I in Date
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's
I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.)
correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
with all non-point source regulatitxrs per the Cupertino Municipal Code,Section I understand my plans shall be used as public records.
9.18.
Licensed Professional
Signature Date
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY #
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . 35617016 . 00
DATE ISSUED. . . . . . . : 02/06/2012
RECEIPT #. . . . . . . . . BS000015931
REFERENCE ID # . . . 12020016
SITE ADDRESS . . . . . 21783 TERRACE DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . ABE THEODORE T AND MARGARET M
ADDRESS . . . . . . . . . . 1 W EDITH AVE
CITY/STATE/ZIP . . . : LOS ALTOS, CA 94022
RECEIVED FROM . . . . LINDSEY D CASTO
CONTRACTOR . . . . . . . CASTO, LINDSEY LIC # 21324
COMPANY . . . . . . . . . . CASTO ROOFING
ADDRESS . . . . . . . . . . 1938 OLD MIDDLEFIELD WAY
CITY/STATE/ZIP . . . MOUNTAIN VIEW, CA 94043
TELEPHONE . . . . . . . . (650) 961-8922
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 10, 250 .00 1 . 00 0 .00 1.00 0 . 00
1BSEISMICR VALUATION 10,250 .00 1.03 0 . 00 1 .03 0 .00
1REROOFRES SQ FEET 29 .00 406 . 00 0 .00 406 .00 0 .00
---------- ---------- ---------- ----------
TOTAL PERMIT 408 .03 0 .00 408 .03 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 408 .03 VISA
---------------
TOTAL RECEIPT 408 .03
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
j ADDRESS: 21783 Terrace Dr. DATE: 02/06/2012 REVIEWED BY: A. Salvador
1 APN: I BP#: VALUATION: 1$10,250
PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration /Repair
PRIMARY B�pj or Du lex PE+NTAMATION 1SFDWLROOF
USE: p PERMIT TYPE:
WORK Tear-off existing roofing. Install 7/16" OSB sheathing. Re-roof 29 s with comp. shingles.
SCOPE
L1
NnTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Warks,Fire,Sanitary Sewer District,School
District,etc.). These.Lees are based on the erefinina information available and are onl an estimate. Contact the De, t or addn'l info.
FEE ITEMS ''}.-'1 L FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 2,900 1 s.f. Re-roof
Suppl.PC Fee: Q Reg. 0 OT 0.0 hrs $0.00 $406.00 IREROOFRES
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee-0 Reg. Q OT Q,Q hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
0
Worl:Without Permit:' 0 Yes 0 No $0.00
:=t 1 $p.00 Select allon-Residential {'
_.....
Building or Structure ('
Fee: 1BSEISMICR $1.03 Select an Administrative Item
:'g� `�t�i t'=,3r�irnis��ic,r� Fee_:_ IBcBsc $1.00
SUBTOTALS: $2.031 $406.00 TOTAL FEE: $408.03
Revised: 1/19/2012
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•building(d)cupertino.org
PROJECT ADDRESS �I APN#
OWNERNAME �/� �/ •/_ PHONE 6�Z /- / / `, 4✓ E-MAIL
STREET ADDRESS CITY, STATE,ZI // j ,/ _ vt�i/�1 FAX
Cp1T1ITRAQOt NAME EUR / LICSE' _ BUS.LIC.#"� / (�
COMPANY NAME EZ'1"101
0 .S�i� �r� �►G 7(/�� L'/% tel, r /U� G)
STREET AVe 3, N4( /l.0 / /� ' CITY,STATE,ZIP , / PHONE
I UNDERSTAND AND AGREE TO THE FOLLOWING:
1. The re-roof project shall comply with all applicable provisions of the 2007 California Building Code.
2. You must schedule all needed inspections a minimum of one day before the requested inspection date.
Please schedule inspections online or call (408)777-3228 between 7:30-3:30 (Mon-Fri).
3. Tear-off roof inspection is required. Please call for tear-off inspection after the roof is torn off and all
the nails/fasteners have been removed. Any and all dry-rotted wood shall be replaced prior to this
inspection. A building inspector will be available within one hour.
There are special hours for this service: 7:30 — 10:30am and 1:00—3:30pm (Mon—Thurs);
7:30 — 10:30am and 1:00—2:30pm (Friday).
4. If plywood is installed, a plywood nailing inspection is required.
5. In-Progress roof inspection is required. Call for an in-progress roof inspection to verify building is
weather tight after installation of approximately 25% of the roofing material.
6. New roof coverings shall not be applied without first obtaining all inspections 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.
7. A final inspection and approval shall be obtained from the building inspector when the re-roofing is
complete. To receive a final sign-off, the following items will be verified:
a. Flat roofs shall have a minimum of'/4"per foot of slope and must 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.
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 unde nd and agree to comply with the re-roof policy stated above.
Signature of Applican Date: Z/
RerooJPolicy_2010.doc revised 05/17/10
CITY OF
CITY OF CUPERTINO
1-01REROOF
CUPERTINO PERMIT APPLICATION
APN # � �i y��� , y° � / _ Date:
Building Address:
Owner's Name: Z Phone #:
HOA: Yes ❑
No If es, rovide letter from HOA
Phone #: 7 ci
Contractor: Casto Roofing Inc. ��'
1933 Old Middlefield Way
Mountain View, CA 94043-2503 Fax#:
Cupertino Business License #: j Contractor License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles �( Asphalt Shingles
�a, Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other (Specify) ❑ Other (Specify)
Number of existing coverings ❑ Provide I.C.C.E.S. Report#
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description: ( ��nbv-� ,(� A Crt-� r`-�.-I�i'�:�� C)
r
Residential [ Commercial
Green Building: Please complete relevant portion of the Conf rmed 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:
I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
Signatu e
Revised 02/05/09