12020063 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20616 PARADISE DR CONTRACTOR:DADDARIO ROOFING PERMIT NO: 12020063
OWNER'S NAME: DUNN WILLIAM C AND WONG VITA 1734 WILLA WAY DATE ISSUED:02/14/2012
OWNER'S PHONE: 4082578282 SANTA CRUZ,CA 95062 PHONE NO:(831)476-9109
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB '
r—
BUILDING
Class r_'`��I Lie.# µ F_
MECH � RESIDENTIAL ' COMMERCIAL
Contractor Date ��_
I hereby rrtu that I armr licen, d urmder the provision of C ra ter 9 JOB DESCRIPTION: RE-ROOF TEAR OFF WOOD SHAKE AND INSTALL.OSB
(commencing with Section 700 of Division 3 of the Business&Professions LIFETIME COMP SHINGLES CLASS A 225Q
Code and that my license is in full 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 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 Sq.Ft Floor Area: Valuation:$10450
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
APN Number:35916033.00 Occupancy Type:
APPLICANT CERTIFICATION
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 PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes. (We)agree to save
indemnity and keep harmless 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 180 DAYS FROM LAST CALLED INSPECTION.
granting of this permit. Additionally,the applicant understands and will comply
with all non-paint source regulations per the Cupertino Municipal Code,Section ��
9.18. Issued by,- Dat
Signature Date fY
❑ OWNER-BUILDER DECLARATION RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed.If a roof is
I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for
the following two reasons: inspection.
1,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044, Signature of Applicant: Date:<D
Business&Professions Code
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 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 25534. 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 the 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 Owner or authorized a en
become subject to the Worker's Compensation provisions of the Labor Code,I must _Date: O1„�
forthwith comply with such provisions or this permit shall be deemed revoked. <G�
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 regulatiats per time Cupertino Municipal Code,Section I understand my plans shall be used as public records.
9.18.
Licensed Professional
Signature Date
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: ( Ct fCx 4 S4- V•— PERMIT# Z e C:..
OWNER'S NAME: Cts°( I; p< c" PHONE# — /
GENERAL CONTRACTOR: „` % : ✓t BUSINESS LICENSE#
ADDRESS:-'i CITY/ZIPCODE: � �- cJ/0' a J} .5 G'
*Our municipal code requires all businesses working in the city to have a City of Cuper no 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:
s- l
ignat a ate
Please check applicable subcontractors and complete the following information:
V 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
P1 ing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
caner/ ontrac i nature ate
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 20616 paradise dr. DATE: 02/14/2012 REVIEWED BY: bobs.
APN: BP#: VALUATION: 1$10,450
PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD or Duplex PENTAMATION 1 SFDWI_ROOF
USE: PERMIT TYPE:
WORK tear off wood shake replace with comp shingles.
SCOPE
FEE ID ROOF AREA
s.f.
1REROOFFRES 2,200
Ll I Li -I_
NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public{forks,Fire,Sanitary Sewer District,School
District,etc.). These ees are,based on the grelinina information available and are onl an estimate. Contact the De t or addn 7 in o.
FEE ITEMS ;, 'z s t i ti R3 t " i/a FEE QTY/FEE MISC ITEMS
Permit Fee: $308.00
Work Without Permit? 0 Iles Q No $0.00
Fe-: IBSEISMICR $1.05 Select an Administrative Item
B I jl_tjric ,rVii. i�r_3 IBCBSC $1.00
SUBTOTALS: 1 $310.051 $0.00 TOTAL FEE: 1 $310.05
Revised: 1/19/2012
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERTINO (408)777-3228• FAX(408)777-3333 •buildinOC-cupertino.oro
PROJECT ADDRESS - o,5Q t APN# (A' (P—
_'' C)✓
22
OWNER NAME ` ,, . , ( /�/1 PH NE-_ ( y7�u E-MAIL
w VtA — 3 L
STREET ADDRESS2-c-)67 / fi V h CITY. STATE ZIPFAX
APPLICANT N ter E-MAIL
er
STREETDRESS ` CITY STATE, ZIP C �^ FAX
r V
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR 4-r-DNTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CeQVW LICENSE NUMBER LICENSE TYPE BUS.LIC.#
COMPANY NAME E-MAIL J FAX
t
STREET ADDRESS CITY STATE ZIP PHONE
IQLui 2 Lt`2 /4 C'a 47,5G V az5t '-1Z6_,?100,
ARCHITECT/ENGAER.NAME LICENSE NUMB BUS.LIC.#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE ZIP PHONE
USE OF R_"T�or Duplex ❑ Multi-Family ROOF AREA: VALUATION:
STRUCTURE: ❑ Commercial
EXISTING RDOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES940-OD SHAKES ❑WOOD SSHINNG�GI ❑OTHER(SPECIFY)
REMOVE/REPLACE IF NO, PLYWOOD 9-A ❑ PLYWD LTOSB PITCH ROOF
13 NO #LAYERS: y� THICKNESS: ❑ 5/8" TYPE: ❑ CDX 12 CLASS: A
PROPOSED ROOF TYPE: 11I/d BUILT-UP ROOF _A HALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT#
DESCRIPTION OF WORK j
C� YI J 1
a �
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 have provided is correct I have rea4 the D scription of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building construction. I autho a rep sentatives of Cupertino tc enter the above-i ntified pr 1pt for inspection purposes.
Signature ofApplicant/Agent Date: f d l
SUPPLE AL INFOR ON VQUIFED 4 — —
_If building is associated with a Home Owner's Association,provide letterrL """'"vv=T�°TF anvsr "
of approval from HOA. 4 � wT
_Provide Planning approval to verify if there any restrictions.
_Provide copy of Manufacturer's Installation Specifications.
Provide signed copy of Cupertino's Tear-Off Policy. M _.„ �
ReroofApp_2011.doc revised 03/02/11