12060019 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 1227 BELKNAP CT CONTRACTOR: PERMIT NO: 12060019
OWNER'SNAME: KICKS LEWIS AND JUANITA ��ricLb �O r DATE ISSUED:06/0.12 0 1 2
OWNER'S PHONE: 4086903352 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
License Class= Lic.q �Z C
I/ �� MECH r RESIDENTIAL r COMMERCIAL r
Contractor Vyx ,Q--I. 9—,PJ07A Date
hereby affirm that 1 am licensed under the provt tons of Chapter 9 JOB DESCRIPTION: RE-ROOF REMOVE EXISTING WOOD SI IAKE,REPLACE
(commencing with Section 7000)of Division 3 of the Business&Professions WITH
Code and that r) license is in full force and effect. COMP SHINGLES CLASS A 40 SQ
1 hereby affirm under penally 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
Section 3700 of the labor Code,for the performance of the work for which this
Permit is issued. Sq.Ft Fluor Area: Valuation:$15000
APPLICANT CERTIFICATION
I eenify that I have read this application and stale that the above information is APN Number:36210022.00 Occupancy Type:
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
upon the above mentioned property for inspection purposes. (We)agree to save
indemnify and keep harmless the City of Cupertino against l iabilities,judgments, PERMIT EXPIRES IF WORK IS NOT STARTED
costs,and expenses which may acerae against said City in consequence of the
granting of this pe »iL Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR
with all on-p -ll simrec reulatims per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION.
9.18.
Signora Dal L �� Issued by: ale:
❑ -BUIL. f:CLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS:
the following two reasons: All rools shall be inspected prior to any roaring material berig installed-lla roof is
I,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection.I agree to remove all new materials for
will do the work,and the structure is not intended or offered for sale(Sec 7044, inspection.
Business&Professions Code)
I,as owner of the property'.ant exclusively contracting with licensed contractors to Signature of Applicant: Daw
construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE:
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 read the hazardous materials requirements under Chapter 6.95 of the
I have and trill maintain Worker's Compensation Insurance,as provided for by California health&Safety Code,Sections 25505,25533,and 25534- I will maintain
Section 3700 of the Labor Code,for the performance of the work for which this compliance with the Cupertino Municipal Code.Chapter 9.12 and the Health&
Safety Cade.Section 25532(a)should I store or handle hazardous material.
permit is issued. Additionally,should I use equipment or devices which emit hazardous air
I certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District l will
not employ any person in any'manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code.Chapter 9.12 and the
Compensation laws of California. If,after making this certificate of exemption,I Health&Safety Code,Sections 25505,2.5.533,and 25534.
become subject to the Worker's Compensation provisions of the Labor Code,I must
forthwith comply with such provisions or this permit shall be deemed revoked. w Tor au rized agent: L
Dele (j Z�
APPLICANT CERTIFICATION NS'fRll(:TION LENDING AGE:NC\'
I certify that I have read this application and slate that the above information is
correct. I agree to comply with all city and county ordinances and state laws relating I hereby a at there is a constretion lending agency for the performance of work's
to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.)
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may aceta against said City in consequence of the Lender's Address
grunting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code.Section ARCHITECT'S DECLARATION
9.18.
1 understand my plans shall be used as public records_
Signature Dale
Licensed Professional
r Community Development
10300 Torre Avenue
' Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
CUPERTINO .
Building Department
JOB ADDRESS: C1 PERl� j 6,G /<;,Z Nrt 1- / ,L
OWNER'S NAME: Ce S PHONE # SS')
GENERAL.CONTRACTOR: C-1- FAX # 555 35 C G
I am not using any subcontractors: �'� � br/z
Si tune Date
Please check applicable subcontractors and co Tete ollowing information
SUBCONTRACTOR BUSNE98 NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
Glass/ Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental.Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Til
Owner ntracto i a e
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO,CA 95014-3255
CU PE RTI N O (408)777-3228- FAX(408)777-3333•buildino(a)cuoertiinnoZ.orci
V PROTECT ADDRESS "I Z / ^V f) I APN p
N.
OWNERNAE l••' .,� I r1Gl11J PHOONNEL b I o E-MAIL
STREET ADDRESS CITY, STATE,ZIP / FAX
CONTACT NAME �l //�I, PHONE S j�� L/I11 L,�l 6 E-MAIL
STREET ADDRESS �J C /' �fJLYA A CRY,STATE, ZIP ��pl'•IJI �l C) J!L, FAX
01`�WER ❑ OW'NFA-BUILDER ❑ OWNERAGENT CONIRACrOR ❑CONTRACTOR AGENT ❑ ARCIBTECT /❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME - ��1.. �S�dl"2a LICENSE NUMBER G LIC, SE TYPE BUS.LIC.0
/ �C
COMPANY NAME EMAIL FAX
PEA--), Iinrc C ir- r , ' I / /
STREET.ADDRESS I M n- ) AY-4- CRY,STATE.ZIP l 6
/N e ^ _ PHONE l S OI V I� 6 1(,
1 G`
ARCHITECT)ENGINEER NAME LICENSE NUMBER BUS.LIC.9
COMPANYNAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF SFD or Duplex ❑ IvIBItI-F81rllly, ROOF AREA', VALUATION'.
STRUCTURE. ❑ Commercial �V
EXISTING ROOF TYPE'. 12 BUILT-UP ROOF ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY)
REMOVE(REPLACE AYES IF NO. PLYWOOD ❑ '.'i' ❑ PLYWD UL OSB PITCH: -� ROOF
❑ NO I LAYE Z' 1 K ❑ 'A TYPE ❑CDX �') ) CLAF$' 'a
PROPOSED ROOF TYPE ❑BUILT-UP ROOF C(ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT a
DESCRIPTION OF WORK:
application
my signature below.I information
to each of the foMnre Toip.D owner or authorized agent coact a the to I agree
owner's behalf.w I have read This
application and thz infonnalion I bay provi is eortect I read tlK Description of Work and verify it is accurate_ 1 agree ro comply with all applicable local
ordinances and stale laws relating ng constru I authorize representatives ofCupenino to enter the -identified pro for inspection purposes,
Signature of Applicant/Agent: Dates RJ'2. -7c/7
SUPPLEMENTAL INFORM 1 REQUI OFFICE USE ONLY
_ 1f building is associated ome Owners Association,provide letter PLAIN CHECK TYPE GROUTING SLIP
of approval from HOA. oL9�Y1R-rxetu
oNTER NT ILDING PLBUAN REVIEW
_ Provide Planning approval to verify'if there any restrictions. ❑ EXPRESS ❑ PLANNING PLAN REVIEW
Provide copy of Manufacturer's Installation Specifications. El STANDARD ❑ FIRE DEPT
(%Provide Signed copy of Cupertino's Teat'-Off Policy. ❑ OTHER:
Rerooj4pp_2011.doc revised 03'16/11
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 1227 belknap ct. DATE: 06/04/2012 REVIEWED BY: bobs.
APN: BP#: 'VALUATION: 1$15,000
"PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration I Repair
PRIMARY SFD or Duplex PENTAMATION 1SFDWLR00F
USE: PERMIT TYPE: Al
WORK Remove exisiting wood shake. replace with comp shingles.
SCOPE
II'd, Ph r'ha,;; Plrwifi. 1%...Ch", On. Pl,w(7+r k
,1l.aJr. l'�""a Iy. "olb. Pe.rnir 14c:
1�r4;a ,1 , hr,rl Other PlrunL/n.vP. Urhr,lilrr. la,p. Ej
lh,h. /mp_ her' Pllw,h. h"p. Frac h.lrr. Lrep. Fri r
NOTE: This estimate does not include fees due to other Departments(i.e. Planning,Public Works, Fire,Sanitary Sewer District,School
District,etc. . These fees are based on the prelinnuina information available and are only an estimate. Contact the Depr for addn7 info.
FEE ITEMS (Fee /lesohnion /1-053 Ef. 7/1.11 U FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 4,000 s.f. Re-roof
Suppl. PC Fee: Q Reg. Q OT F0,0Thrs $0.00 $560.00 IREROOFRF.s
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee:Q Reg. Q OT 0,0 T hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
,on.,I) T,cc
Adnelni.gi,uir,. 1.4.,.
Work Without Permit? Yes Q No $0.00
Advanced Planning Pec: $0.00 Select a Non-Residential
(ixs. Building or Structure 0
77-rn'r/ /. cunnuurrinnr - �
Strong Motion Fee: IBSE/SM/CR $1.50 Select an Administrative Item
Bids Slds Commission Fee: IBCBSC $1.00
SUBTOTALS: $2.50 $560.00 TOTAL FEE: $562.50
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•buildingla,�.cugertino.orq
PROJECT ADDRESS I '7 7—76 A APN n r
OWNER NAME C.. IS V Its I�� ll' I PHONE 507 C/I� E-MAI
STREET ADDRESS CITY, STATE.ZIP CU ' 'fie J /I L/ FA%
CONTRACTOR NAME I`+ LICENSE NUMBER ZC-3 LICENSETYPE BUS,LIC,u
COMPANY NAME /- EMAIL J FAX
G
STREET ADDRESS 1/ CITY.STATE.ZIP Uo PHONES�q
-1 I UNDERSTAND AND AGREE TO THE FOLLOWING: D
I. 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 1/." 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 d ctors are required to be installed in accordance with Sections R314 and R315 of
the 2010 California Residential C d .
Signature of Applicant/Agent: Date: TL, r:
Rrrou/Polirr ?0/Ldor rrrised 0?/l/ql
PFF
CITY OF CUPERTINO
3 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub:, Blk: Lot:
APN . . . . .. . . . 36210022.00
DATE ISSUED. . . : . . . : 06/04/2012
RECEIPT #. . . . . . . . . : BS000016992
REFERENCE ID # . . . : 12060019
SITE ADDRESS . . . . . : 1227 BELKNAP CT
SUBDIVISION . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
. IMPACT•AREA . . . . . . .
OWNER . . . . . . . . . . . . : HICKS LEWIS AND JUANITA
ADDRESS . . . . . . . . . . : 1227 BELKNAP CT
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-4904
RECEIVED FROM . . . . : KENNETH N ESPARZA
CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096
COMPANY TBD - TO BE DETERMINED
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
TELEPHONE . . . . . . . . :
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
--—------ ----------- ------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 15, 000 .00 1.00 0 . 00 1. 00 0 . 00
1BSEISMICR VALUATION 15, 000 .00 1.50 0. 00 1. 50 0 .00
1REROOFRES SQ FEET 40 .00 560.00 0. 00 560. 00 0.00
---------- ---------- ---------- ----------
TOTAL PERMIT 562 . 50 0.00 562 .50 0.00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- -------------------- _
CREDIT CARD 681.50 MC
-------------
TOTAL RECEIPT 681.50
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