12050197 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10370 LEOLA CT CONTRACTOR:DAN ELLIOTT'S PERMIT NO: 12050197
ROOFING CO
OWNER'S NAME: MIKE WU PO BOX 26878 DATE ISSUED:05/25/2012
OWNER'S PHONE: 6508592328 SAN JOSE,CA 95159 PHONE NO:(408)559-7327
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL CO$IMERCL$L
License Class (C Lic.461,11 3 RE-ROOF 24 SQ-REMOVE ALL SHAKES, REPLACE
FLASHING
Contractor Date &VALLEY, INSTALL 15/32 OSB INSTALL LANDMARK PRO
1 hereby affirm that 1 am licensed under the provisions of Cbatiter9 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.
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 whichthis permit is issued. Sq.Ft Floor Area: Valuation:$8837
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:37504023.10370 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.l agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAY F M LAST CALLED INSP CTI N.
indemnify and keep harmless the City of Cupertino against liabilities,judgments, /
costs,and expenses which may accme against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply Issued by: qt. Date: GJ
with all non-point source regulations peri he upenino Municipal Code,Section
9.18.
_ _ _ 5• `�„s; /_z RE-ROOFS:
Signmu Dale — All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed without first obtaining an inspection I agree to remove all new materials for
inspection.
❑
OWNER-BUILDER DECLARATION 5
Signature of Appli Datc. f'
I hereby affirm That 1 am exempt from the Contractor's License Law for one of
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I,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,
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to IIAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Ileallh&Safely Code,Sections 25505,25533,and 25534. I will
1 hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Cade,Chapter 9.12 and the
declarations: Health&Safely Code,Section 25532(a)should 1 store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should 1 use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District 1
performance of Elie work for whiclhthis permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Ileallh&Safety Code,Sections 25505,25- ,and 2553.1, _
Section 3700 of the Labor Code,for the performance of the work for which this z --f
permit is issued. Owner or authorized agent Dale:
I certify that in the performance of the Work for which this permit is issued,I shall
not employ any person in my manner so as to become subject to the Worker's
Compensation laws of Cal ifomo. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I 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
1 cenify that I have read this application and state that the above information is
correct.1 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, ARCIBITF-CT'S DECLARATION
costs,and expenses which may accme 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 . . . . . . . . . 37504023.10370
DATE ISSUED. . ... . . . : 05/25/2012
RECEIPT #. . . . . . . . . : BS000016921
REFERENCE ID # . . . : 12050197
SITE ADDRESS . . . . . : 10370 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 O BOX 26878
CITY/STATE/ZIP . . . : SAN JOSE, CA 95159
TELEPHONE . . . . . . . . : (408) 559-7327
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
----------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 8,837. 00 1. 00 0. 00 1 .00 0. 00
1BSEISMICR VALUATION 8,837 .00 0. 88 0.00 0 .88 0.00
1REROOFRES SQ FEET 24 .00 336. 00 0.00 336 .00 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 337. 88 0.00 337 .88 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
REROOF TEAR-OFF POLICY
2 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 an.Cuoertino.orq
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STREETADDRESS CITY.STATE ZIP J FAX
CONTRACTOR ME �/J/D n c, I LICENSE tJUMBER LICf�SE TYP BITS.LIC.u
PANYN %/ _ / /-MAIL
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STATf,`LI S e r 6S 9-7 31.3
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 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. 1 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 8314 and R315 of
the 2010 Cal ifomia Resid ti 1 Cod
Signature of Applicant/Age Date:
RemolPolirr 201 Lrlor reri9orl 02/16111
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