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09070174CITY OF CUPERTIN O BUILDING PERMIT BUILDING ADDRESS: 21810 ALMADEN AVE OWNER'S NAME: FARIBA ARIA :R'S PRONE: 4084462534 ❑ LICENSED CONTRACTOR'S DECLARATION License Class Lic. #_ E 74 o Contractor 1?& 2� CA(} (* rNC1 Date %, 22 f a1 1 hereby affirm that I am licensed under the provisions of Chapter 9 (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 penalty of perjury one of the following two declarations: 1 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. APPLICANT CERTIFICATION I certify that 1 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 upon the above mentioned property for inspection purposes. (We) agree to save 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 with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature_ _ Date Z `� ❑ OWNER- BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for one of the following two reasons: 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, Business & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: 1 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. 1 certify that in the performance of the 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 Compensation laws of California. If, after making this certificate of exemption, I 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. APPLICANT CERTIFICATION 1 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 upon the above mentioned property for inspection purposes. (We) agree to save it ify and keep harmless the City of Cupertino against liabilities, judgments, U1, nd expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. CONTRACTOR: TBD - TO BE DETERMINED PERMIT NO: 09070174 DATE ISSUED: 07 /27/2009 • PHONE NO: WILDING PERMIT INFO: BLDG r ELECT i— PLUMB f- MECH f— RESIDENTIAL f— COMMERCIAL I JOB DESCRIPTION:RE -RF RMVAL OF OLD ROOF & REPLACING VITH 7160SB :;HEETING 30LBS ROOFING PAPER COVERED W 30YRS GOOFING ASPHALT SHINGLS, CLS A 14SQ Sq. Ft Floor Area: \PN Number: 35715034.00 ss Valuation: $6000 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. ued by: Date: RE- ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is nstalled without first obtaining an inspection, I agree to remove all new materials for nspection. :signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE have read the hazardous materials requirements under Chapter 6.95 of the -alifornia Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain ,• ompliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & :safety Code, Section 25532(a) should 1 store or handle hazardous material. Additionally, should 1 use equipment or devices which emit hazardous air ,:ontaminants as defined by the Bay Area .Air Quality Management District 1 will naintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the iealth & Safety Code, Sections 25505, 25533, and 25534. 3wner or authorized agent- / Date: CONSTRUCTION LENDING AGENCI' hereby affirm that there is a construction lending agency for the performance of Hork's or which this permit is issued (Sec. 3097, Civ C.) .ender's Name .ender's Address ARCHITECT'S DECLARATION understand my plans shall be used as public records. Signature -- Date_ I Acensed Professional __ _ 090_70t�� CITY OF CUPERTINO `' RE ROOF CUPEkTINO PERMIT APPLICATION APN # S -7 — 5 - 6 3 Date: J 2-7/69 Building Address: �2 k 2 D A\ C v ?4_,C� c n o CA q S-6 i Owner's Name: �ri' & Phone #: HOA: Yes ❑ No ❑ If yes, provide letter from HOA Contractor: Phone #: cl zS - -7?, 1,? - 4 o Z N[O%A,( t-► �r�tyGV" - Zuo��"� Fax #:`IZ� -�76 -8 Cupertino Business License #: Contractor License Type of Roof Covering: Existing: Proposed: • Built -Up Roof ❑ Built -Up roof • Asphalt Shingles ael Asphalt Shingles • Wood Shakes ❑ Wood Shakes u'*' Wood Shingles ❑ Wood Shingles ❑ Other (Specify) ❑ Other (Specify) Number of existing coverings ❑ Provide I.C.C.E.S. Report # ❑ To be Removed ❑ Provide Mfgr. Installation Specs. Job Description: %Z 1 h G-i E.f r- Ce.. ver�d 3o '''vim?• ISd'A,,-t ��•„ Residential Commercial Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if Green Building Checklist & attach it to the application or if there are any restrictions: ❑ applicable, include in plan set & the sheet index. Valuation: I Have Read, Understand and Will Comply with Cupertino's Tear -Off Policy: � r7 Signature Revised 02/05/09 -1, ao� CITY of CUPEkTINO CITY OF C UPERTINO REROOF FEE SCHEDULE Number of Squares Fee ID Fee Description Fee Group Permit Type 1 REROOFCOM Re -roof Conunercial B 1COMMLROOF 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICO Seismic Commercial B 1REROOFRES Re -roof Residential B 1SFDWLR00F l 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICRE Seismic Residential B 1 REROOFMRES Re -roof Mu lti- Family B 1MFDWLROOF 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICRE Seismic Residential B 1BUSLIC Business Li,;ense B Community Development Department Building Division City of Cupertino 10300 Torre Avenue Telephone: (408) 777 -3228 Fax: (408) 777 -3333 Building Department Subject: Re- roofing policy for the City of Cupertino 1. Prior to permit issuance, you must agree to comply with 2007 IBC Standards and manufacturers specifications on ri!- roofing. All roofs are Class "A" per Cupertino municipal code 16.04.080. 2. New roof coverings shall not be applied without first obtaining all inspection and written approval from the building inspector. A final inspection and approval shall be obtained from the building inspector when the re- roofing is completed. 3. All roofs shall be inspected prior to any roofing installation. 4. To receive a final sign off from the Cit /, the following steps are required: 1) Pre - inspection and /or tear off approval. 2) In- progress inspection approval. 3) Final inspection approval. a) Spark arrester installation. 5. If plywood is installed, a plywood nail inspection is required. 6. Any roofing which is applied without first obtaining an inspection, will require the removal of all new material down to the sheathing, so a proper City inspection can be per.=ormed. 7. NOTE: If you call for a plywood nail nspection and the job is not ready, you will be charged a re- inspection fee of $176.18. The re- inspection fee must be paid before another inspection can be scheduled. IMPORTANT: 1. Flat roofs must have a minimum of 1/ " per foot slope and demonstrate that there is no ponding. 2. An I.C.B.O. report is required to be on the job site at the time on inspection. I understand and will comply with the abov a stated policy on re- roofing. Homeowner's Name: Fa. r: b n A t--%x Job Site Address: 2-12 \ a 4 (wk,-.-L JL--0 " A V-C Roofing Company Name: I /e uJ 4`AV Vf' c icvn iZc�� •'Y z��'Qs_�� -^ -j Applicant's Signature: Date: % 2-1 / ° q v c Greg Casteel Building Official Revised 07/30/08 CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: LDt: APN ........: 35715034.00 DATE ISSUED.......: 07/27/2009 RECEIPT # ......... BS000008277 REFERENCE ID # ...: 09070174 SITE ADDRESS .....: 21810 ALMADEN AVE SUBDIVISION ...... CITY CUPERTINO IMPACT AREA ...... OWNER ............: FARIBA ARIA ADDRESS 21810 ALMADEN AVE CITY /STATE /ZIP ...: CUPERTINO, CA 95014 OPERATOR: patg COPY # : 1 RECEIVED FROM ....: FARIBA ARIA 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 ---- - - - - -- 6,000.00 ---- - - - - -- 1.00 ---- - - - - -- 0.00 ---- 1.00 0.00 1BSEISMICR VALUATION 6,000.00 0.60 0.00 0.60 0.00 1REROOFRES SQ FEET 14.00 182.00 - - -- 0.00 ---- - - - - -- 182.00 ---- - - - - -- 0.00 ---- - - - - -- TOTAL PERMIT ---- - - 183.60 0.00 183.60 0.00 METHOD OF PAYMENT --------------- -- CREDIT CARD TOTAL RECEIPT : AMOUNT --------------- 183.60 --------------- 183.60 VOICE ID DESCRIPTION -- - - - - -- ---------------------- - - - - -- 601 ROOF TEAR OFF 604 ROOF IN- PROGRESS REFERENCE NUMBER --------------- - - - -- VISA VOICE ID DESCRIPTION -- - - - - -- ---------------------- - - - - -- 602 ROOF PLYWOOD NAIL 605 FINAL REROOF