12050199 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10368 LFOLA CT CONTRACTOR:DAN FLLIOTT'S PERPIIT NO: 12050199
ROOFING CO
OWNER'S NAME: MIKB WU P013OX 26878 DA'Z'E ISSUED:05125/2012
OWNER'S PIIONE: 6508592328 SAN JOSE,CA 95159 PHONE NO:(408)559-7327
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL LJ COMMERCIAL.
License Class Lic.NCf) //e3.3 RE-ROOF 27 SQ-REMOVE ALL SHAKES, REPLACE
FLASHING
Contractor Date & VALLEY, INSTALL 15/32 OSB INSTALL LANDMARK PRO
I hereby affirm that I am licensed under the provisions of Chapler9 LIFETIME CLASS A
(commencing with Section 7000)of Division 3 of the Business&Professions
Code and that my license is in full force and effect.
1 hereby affirm under penally of perjury one of the following two declarations:
I have and will maintain a certificate of consent to sclf-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. Sq.Ft Floor Area: Valualion:$9794
1 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
APN Number.37504024,10368 Occupancy'1)pe:
permit is issued
APPLICANT CERTIFICATION
I certify that I have read this application and slate that the above information is PERMIT EXPIRES IF WORK 1S NOT STARTED
correct.1 agree to comply with all city and county ordinances and stale laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction,mid hereby authorize representatives of this city to enter
upon the above mentioned propertyfon inspection purposes. (We)agree to save 180 DAYS R� M LAST CALLED INSPEC ION.
indemnif}'and keep harmless the City of Cupertino against liabilities,judgments, �7C
costs,and expenses which may accrue against said City in consequence of the c C-U
granting of this permit. Additionally,the applicant understands and will comply Issued by: / �( Da L J
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. 6-29-1 Z
RF:-ROOFS:
Signatur Dale All roofs shall be inspected prior to any roofing material being installed Ira roof is
installed without first obtaining an inspection.I agree to remove all new materials for
inspection.11OWNER-BUILDER DECLARATION
Signature of Appliean .z�_ !Y—/Z
I hereby affirm that 1 am exempt from the Contractor's License Law for one of
the following Iwo reasons: AL1,ROOF COVERINGS TO BE CLASS"A"OR BETTER
1,as owner of the property,or my employees with wages as their sole comfensation,
will do the work,aid the structure is not intended or offered for sale(Sce.7044,
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to IIA%ARDOU3 M ATERUAI S DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). 1 have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safely Code.Seclions 25505,25533,and 25534. [will
1 hereby affirm under penally of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Ilealth&Safely Cade,Section 25532(a)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined be The Bay Area Air Quality Management District
performance of the work for whichthis permit is issued. will maintain compliance with the Cupertino\lunieipal Code.Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the I Iea11h&Safely Code.Sections 25505,25533, I 25534.
Section 3700 of the Labor Code,liter tlhe performance of the work for which this
Owner or authorized agent: hale:
permit is issued.
I certify that in the performance ofthe work for which this permit is issued I shall
not employ any person in any manner so as to become subject to the Worker's
Conmpenswain laws of Cal ifinrLa. IL after making this certificate of exemption,I CONSTRUCTION [.ENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,1 must I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit Is issued(Sec 3097,Civ C.)
Lender's Name
APPLICANT CERTIFICATION Lender's Address
I certify that 1 have read(his 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,mond hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes.(We)agree to save
indemnity and keep harmless the City of Cupertino against liabilities,judgments. ARCHITECT'S DECLARATION
costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records,
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
CITY OF CUPERTINO
3 ITEMS OF 15 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN 37504024 . 10368
DATE ISSUED. . . . . . . : 05/25/2012
RECEIPT #. . . . . . . . . SS000016921
REFERENCE ID # . . . : 12050199
SITE ADDRESS . . . . . : 10368 LEOLA CT
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : MIKE WU
ADDRESS 4170 ALTA MESA
CITY/STATE/ZIP . . . : PALO ALTO, CA 95014
RECEIVED FROM . . . . : DAN ELLIOTT
CONTRACTOR . . . . . . . : DAN ELLIOTT LIC # 21466
COMPANY . . . . . . . . . . : DAN ELLIOTT'S ROOFING CO
ADDRESS . . . . . . . . . . : P 0 BOX 26878
CITY/STATE/ZIP . . . : SAN JOSE, CA 95159
TELEPHONE . . . . . . . . : (408) 559-7327
FEE ID UNITQUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 9, 794 .00 1. 00 0. 00 1 . 00 0. 00
1BSEISMICR VALUATION 9, 794 .00 0 . 98 0. 00' 0 .98 0 . 00
1REROOFRES. SQ FEET 27 .,00 378 . 00 0. 00 378 .00 0 . 00
---------- -- ---------- ----------
TOTAL PERMIT 379. 98 0. 00 379 .98 0.00
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
0 REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
CUPERTINO 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255
(408)777-3228•FAX(408)777-3333-building0cupertino.orp
PR01 T D REBS / e UIa C f' APNn
OWIq NA. E (' P IONF E-MAIL
STRF.ETADDRESS CITY. STATE.ZIP FAX
LICESE E BUS.LIG
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CO YNAME -MAR - / FAX '�J /- 17
STV T D R S % /, I CI .STATE, 9_ 73A7
r I UNDERSTAND AND AGREE TO THE FOLLOWING: (1
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 obtaining 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 `/4" 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 monoxide detectors are required to be installed in accordance with Sections R314 and R315 of
the 2010California Residenti I o
Signature of Applicant/Agent: Date: .? ' a zy-/ ,
Ro Il'nliet20l Ldnc i'rrised 02116/l l
IREROOFPERMHT}A6aIF8UCAWPVI
COMMUNITY DEVELOPMENT-DEPARTMENT-CUILDING DIV!SION
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