12060013 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 11142 WILKINSON AVE CONTRACTOR:EAGLE ROOFING PERMIT NO: 12060013
COMPANY
OWNER'SNAME: LOREN%Gf MONTE D AND REBECCA E 1471 AMF.SBURY WA\' DATE ISSUED:06/04/2012
OWNER'S PHONE: 4089738745 SAN JOSE,CA 95127 PI IONF.NO:(408)492-9656
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
License Class C—.3 9 Lic.p -7 f9 n-7 90
MECH r RESIDENTIAL r COMMERCIAL r
Conlmclor PH I LL I P SAALM43ate161YIL?
hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: RE-ROOF REMOVE SHAKES INSTALL OSB PRESIDENTIAL
(commencing with Section 7000)of Division 3 of the Business&Professions COMPOSITION CLASS A 29-�>
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 swill maintain a certificate ofconsent 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
Section 3700 of the Labor Code,for the performance of the work for which this Sq.F1 Floor Area: Valuation:$14998
permit is issued.
APPLICANT CERTIFICATION APN Number:35617071.00 Occupancy Type:
I ccrtif) 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 stale laws relating
to building construction,mid hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED
indemnifyand keep harmless the City of Cupertino against liabilities,judgments.
costs.and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally.the applicant understands and will comply 180 D S FRO L CAL ED INSPECTION.
with all non-point source regulations per the Cupertino Municipal Code,Section 111...
9.18. - • a )�
Issued by: 000 / Date:
Signature ate1����
❑ OWNER-B1IILDF.R DECLARATION
Rt:ROOF'S:
1 hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall he inspected prior to any rooting material being installed If a roof is
the following two reasons: installed withuu first obtaining an inspection.I agree to remove all new materials for
h as owner of the property,or my employees with wages as their sole compensation, inspection.
still do the work,and the structure is not intended or offered for sale(Sec 7044, /J
Business&Professions Code) Si rat rcof pplicnu., ate:
I,as owner of the property,am exclusively contracting with licensed contractors to
construe(he project(Sec.7044,Nosiness&Professions Code). AIA.ROOF COVERINGSTO BE CLASS"A"OR BETTER
I herch) affirm under penalty of perjury one of the following three
declarations: ILVLARDOUS MATERIALS DISCLOSURE
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 I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California Health&Safely Code.Sections 25505,25533.and 25534. 1 will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Section 3700 of the labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material.
Additionally,should 1 use equipment or devices which emit hazardous air
permit is issued. conlamin ants as defined by the Bay Area Air Qualilv Management District I will
I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code.Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's Health&Safely Code,Sections 25505,25533,and 25534.
Conhpcnsalion laws of Califonhia. If,after making this certificate of exemption,I
become subject to the Worker's Compensation provisions of the Labor Code.I must Ow r a h rued ag r
forthwith comply with such provisions or this permit shall be deemed revoked. Dater
APPLICANTCERTIFICATION CONSTRUCTION LENDING AGF.NC\"
I eerily that I have read this application and state that the above information is I hereby affirm that there is a constraction lending agency for the performance of work's
cored. I agree to comply with all city and county ordinances and slate laws relating for which this permit is issued(Sec.3097.Civ C.)
to building construction,and hereby authorize representatives of[his city to enter Lender's Name
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
costs,and expenses which may accrue against said City in consequence of the
granting of(his permit.Additionally,the applicant understands and will comply
with all non-point source regulatiahs per the Cupertino Municipal Code,Section aRC111TF.C'1"S DECLARATION
9.18. 1 understand my plans shall be used as public records.
Signature Date Licensed Professional
[ 2 oto c}
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO,CA 95014-3255
CUPERTIND (408)777-3228 • FAX(408)777-3333 •buildinO(dcuoertino.orO
PROJECT ADDRESS APNA
OWNERNAMEORENZEPONE _ 13715 E-MAIL
STREET.AODRE)' CITY, STATE,ZIP 5014 4 1. X
09907-3561
CONTACTNAM PHON PHILL 12 SA r-14FZ — E-MAIL
50
STREET ADDRE" C . TATE, ZIP O I F _
❑ OWNER ❑ OW'NER-BUILDER ❑ OWNERAGENT M CONTRACTOR ❑CONTRACTORACENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR N M@ ^ LICE M Eg L C-NSE PE BUS.LIC.k
ILLiP SA
COMPANI'NAgAGLF F N ,r P E-M.4IL� FAX —
COM
ROO
STREETADO SS 13OX CITY,STATE.ZIP PHONE
27
On L-1-04
Aei1iLTEs'T( NGINEERNAAIE LICENSE NUMIDER BUS.LICA
COMPANY NAME E-h(A¢ FAX
STREET ADDRESS CITY,STATE,ZIP PHON
USE OF ❑ SFD or Duplex ❑ Multi-Farnlly. ROOF AREA: V,ALU.ATION'.
STRUCTURE. ❑ Commercial S , OO
EXISTING.ROOF TYPE'. 11 BUILT-UP ROOF 11 ASPHALT SHINGLES IN WOOD SHAKES ❑WOODSHINGLES ❑OTHER(SPECIFY,
REMIOVE/REPLACE 11 YESIF NO, PLYWOOD ® S' ❑ PLYWD ®OSB PITCH. 4 ROOF
❑ NIi aLA R THICKNESS ❑ S8' TYPE 11Cox y'(2 CLAc A
PROPOSED ROOF TYPE ❑BUILT-UP ROOF 0 ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT a
DESCRIPTION OF WORK:
F-)(15-17ING WOOD
PLYWOOD. 5
By my signature below,[ceni y to each of the following: 1 am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and Elle information 1 have provided is correct. (have read the Description of Work and verify it is accurate. I agree to comply wish all applicable local
ordinances and state laws reWting w d in c nstruction. 1 a thorize repres tatives ofcuperuno to enter the above-ides'tied property for inspection purposes.
Signature of Appl icam/Agent: Date:
SUPPLEMENTAL INIF4MATION REQUIRED OFFICE USE ONLY
_ If building is associated with a Home Owners Association,provide letter PLANCHECKTYPE ROUTINGSLIP
of approval from HOA. —OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW
_Provide Planning approval to verify if there any restrictions. ❑ EXPRESS ❑ PLANNING PLAN REVIEW
_ Provide copy of Manufacturer's Installation Specifications. ❑ STANDARD ❑ FIRE Derr
Provide signed copy of Cupertino's Tear-Off Policy. ❑ OTHER:
v
Reroo df pp_2011.doc rerised 03.16/11
CITY OF CUPERTINO
3 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: •Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35617071 .00
DATE ISSUED.. . . . . . . 06/04/2012
RECEIPT #. . . . . . . . . : BS000016980
REFERENCE ID # 12060013
SITE ADDRESS : . . . . : 11142 WILKINSON AVE
SUBDIVISION . . . . . . .
CITY . . . . !. . . . . . . . : CUPERTINO
IMPACT•AREA . . . . . . .
OWNER ... . . . . . . . . . . : LORENZET MONTE D AND REBECCA E
ADDRESS . . . . . . . . . . : 11142 WILKINSON AVE
CITY/STATE/ZIP- . . . : CUPERTINO, CA 95014-4736
RECEIVED FROM EAGLE ROOFING CO
CONTRACTOR . . . . . . . :, PHILLIP SANCHEZ LIC # 24622
COMPANY . . . . . . . . . . EAGLE ROOFING COMPANY
ADDRESS . . . . . . . . . . : 1471 AMESBURY WAY
CITY/STATE/ZIP . . .: SAN JOSE, CA 95127
TELEPHONE . . . . . . . . : (408) 492-9656
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ------- ----------
1BCBSC VALUATION 14, 998.00 1. 00 0. 00 1 . 00 0 .00
1BSEISMICR VALUATION. - 14, 998 . 00 1.50 0. 00 1. 50 0 . 00
1REROOFRES SQ FEET 29. 00 406 . 00 0. 00 406 . 00 0 . 00
---------- ----- ---- ------
TOTAL PERMIT 408.50 0. 00 408.50 0.00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- ------------ ---------
CREDIT CARD 527. 50 VISA
---------------
TOTAL RECEIPT 527. 50
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
------- - ---------------------------- ----------------------------
309
------------------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: 19620.La Mar Ct. DATE: 06/04/2012 REVIEWED BY: larrys
APN: BP#: `VALUATION: 1$14,998
*PERMITTVPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD or Duplex PENTAMATION 1SFDWLR00F
USE: PERMIT TYPE:
WORK reroof, remove shakes install osb residential composition
SCOPE
FEE ID ROOF AREA
s.f.
1REROOFFRES 2,900
Ie,h. l4un Check Plumb. Pltnr Check lilUc. Pleur Check
med,, f ermit Fre: [Plumb. /Rnnir Fre. lilw Perrnir Fde:
orlrr,ticch. Insp. Other Plumb Inso. Uihcr Ekc. hnp.
,blceh.hmp. Frc: Plumb. hrsp. Fee: Etc(./nsp.Fec:
NOTE: This estimate does not include fees due to other Departments(Le. Planning,Public Works, Fire,Sanitary Sewer District,School
District,eta). Thesefees are based on the prelimina information available and are only an estimate. Contact the Dept for addn 7 info.
FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/11) FEE QTY/FEE MISC ITEMS
Plan Chock Fee:
.Supp/. PC Vee
1'lv m h./,1lec/r.//i l c•c
Permit Fee: $406.00
Suppl. hiss Fee
P'hunh./Alec/r./Flee
Phrmh./Aleelr./E1ec Permit Fee:
Cunslrrrr•tion lax:
if dna ini,cirejINo Fire:
Work Without Permit? Q Yes Q No $0.00
:It,/rancad Plmming Pies:.
lrurel Documenlnlirrrr Feer:
Strong Motion Fee: IBSEISMICR $1.50 Select an Administrative Item
13 Ido,Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: • $408.50 $0.00 TOTAL FEE: $408.50
Revised: 05/01/2012
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•buildinaCadcupertino.org
PROJECT AUDRF.SI APN 4
OWNER NAME PHONE E-MAIL
', LORENZIELT do - ys
STREET ItKIMSON CITY. STATE.21P FAX
IJ90-7- 3561
CONTRACTOR NAME LICENSE N MBER LICENSE TYPE BUS.LIC n
D C-3
CME ROOFING COMPAMY E-M
OMPANY NAA FAX
1 t7 5Lf
STREET ADDRESS CITY.STATE.nZIP FE, CA I2-7 PHON 6-50'-12
I UNDERSTAND AND AGREE TO THE FOLLOWING: G�
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 R314 and R315 of
the 2010 California Residential drr
Signature of Applicant/Agent: Date:6 _ _ _/Z
Rerno(Polier 01 Ldoc revised 0211 h/l1