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12060071CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10270 MIRA VISTA RD CONTRACTOR: T! PERMIT NO: 12060071 OWNER'S NAME: IIERLTIi WILLIAM A AND VIRGINIA V �r DATE ISSUED: 06/13/2012 OWNER'S PHONE: 4085071309 PI ION F- NO: ❑ LICENSED CONTRACTOR'S DECLARATION r r r License Class//�q Lie.4 1110 Lai BUILDING PERMIT INFO: BLDG ELECT PLUMB r r r ^� MECH RESIDENTIAL COMMERCIAL � � Contractor 6af,4 Date fo—1 �� l- f „f hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION: TEAR OFF EXISTING WOOD SI IAKES AND INSTALL 5/8" (commencing with Section 7000) of Division 3 of the Business & Professions OSR AND NEW COMPOSITION SHINGLES 1700 SQFT CLASS A Code and that my license is in full force and effect. INSTALL 5 TUBULAR SKYLIGI ITS 1 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 which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, loot the performance of the work for which this Sq. F1 Floor Area: Valuation: $8800 permit is issued. APPLICANT CERTIFICATION APN Number: 35702026.00 Oceupanry'1'ype: I 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 indemnify and keep harmless the City ofCupertino against liabilities, judgments, PERMIT EXPIRES IF WORK IS NOT STARTED costs, and expenses which may accrue against said City in consequence of the granting ofthis permit. Additionally, the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non -point source regulations per the Cupertino Municipal Code, Section 180 DAYS FROM LAST CALLED INSPECTION. 9.18. Signature Date Issued b � Date:& �� :�/�T� 131 y: ❑ OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for one of RE -ROOFS: the following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is h 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, am exclusively contracting with licensed contractors to Signature of Applic m Date: construct the project (Sec.7044, Business & Professions Cade). I hereby affirm under penalty of perjury one of the following three ALI. ROOF COVERINGS To BE CLASS "A" OR BETTER declarations: I have and will maintain a Certificate of Consent to self -insure for Worker's IIA'LARDOUS NL\Tf:RLU.S DISCLOSURE Compensation, as provided f -or by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 1 have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain Workers Compensation Insurance, as provided for by California Ilealth & Safely Code, Sections 25505, 25533, and 25534. 1 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 Ileallh & Safety Code, Section 25532(x) 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, l shall contaminants as defined by the Bay Area Air Quality Management District 1 will not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Cade. Chapter 9.12 and the Compensation laws of Cal ifomia. If, after making this certificate of exemption, 1 Deallh & Safely Code, Sections 25505, 25533, 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. Owner aul o ed &: Dele: APPLICANT CERTIFICATION CONSTRUCTION LENDING AGF -NCV I certify that I have read this application and state that the above infomhation is correct. 1 agree to comply with all city and county ordinances and state laws relating I hereby affirm that there is a construction lending agency for the performance of work's to building construction, and hereby authorize represematives of this city to enter for which this permit is issued (Sec. 3097. Civ C.) upon the above mentioned property leer 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 accrue against said City in consequence of the Lender's Address granting ofthis permit. Additionally, the applieanl understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section ARCA TECI"S DECLARATION 9.18. 1 understand my plans shall be used as public records. Signature Date Licensed Professional Community Development 1. 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 CITY OF Fax (408) 777-3333 CUPERTINO Building Department I am not using any subcoritr s: Signature Date Please check applicable subcontractomand complete the following information: JOB ADDRESS: Da�� /�•l�R �� ,9 PERMIT # /eJ� oo 7 BUSINESS NAME OWNER'S NAME: n/ r �L PHONE # Cabinets & Millwork - GENERAL CONTRACTOR fJi E A 7a ii✓ FAX # I am not using any subcoritr s: Signature Date Please check applicable subcontractomand complete the following information: Owner/ Contractor Signature Date SUBCONTRACTOR BUSINESS 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 Tile Owner/ Contractor Signature Date CUPERTINO 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 (408)777-3228 • FAX (408) 777-3333 • building(okuoertino.ora PROJECT OWNER NAME )n1V. .. r �. IMP COMPANY NAME STREET ADDRESS V41 - I UNDERSTAND AND AGREE TO THE FOLLOWING: 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.downto 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 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. 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. There -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. 1 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 Co Signature of Applicant/Agent: Datc: ra neroo/rancy_aii 1.r10c reriaev UZn 0111 3 ITEMS OF 4 CITY OF CUPERTINO PERMIT RECEIPT Sec': Twp:Rng: Sub: Blk: Lot: APN ' ........: 35702026.00 DATE,ISSUED.:.....: 06/13/2012 RECEIPT #...:.....: BS000017057 REFERENCE ID '# ...: 12060071 SITE ADDRESS : 10270 MIRA VISTA RD SUBDIVISION ....... CITY .............: CUPERTINO IMPACT' AREA : OPERATOR: patg COPY # : 1 OWNER HERLTH WILLIAM A AND VIRGINIA ADDRESS ......-....: 10270 MIRA VISTA RD CITY/STATE/ZIP....': CUPERTINO, CA 95014-2705 RECEIVED .FROM .'...:ANTHONY J ARANDA 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- '8,800.00 ---------- 1.00 ---------- 0.00 ---------- 1.00 ---- — -- 0.00 — 1BSEISMICR VALUATION _ '8,800.00 0.88 0.00 0.88 0.00 1REROOFRES SQ FEET ' 17.00- 238.00 0.00 238.00 0.00 TOTAL PERMIT ---------- 239.88 ---------- 0.00 ---------- 239.88 ---------- 0.00 VOICE ID DESCRIPTION ----- ------------- .----------- 309 EXTERIOR LATH 601 ROOF.TEAR'OFF 604 ROOF IN -PROGRESS VOICE ID DESCRIPTION ----- ---------------------------- 311 SCRATCH COAT 602 ROOF PLYWOOD NAIL 605 FINAL REROOF FM CITY OF CUPERTINO IMI FEE ESTIMATOR -BUILDING DIVISION KADDRESS: 10270 Mira Vista Rd DATE: 06/13/2012 APN: BP#: REVIEWED BY: Sean 'VALUATION: $8,800 "PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re -roof PRIMARY SFD or Duplex USE: li!rc. /'..moil F,,: PENTAMATION 1SFDWLROOF PERMIT TYPE: WORK Tear off existing wood shakes and install 5/8" OSB and new composition shingles 1700 sq ft). Install SCOPE (5) tubular skylights. FEE ID ROOFAREA s.t. 1REROOFFRES 1,700 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 prefinddna information available and are only an estimate Contact lite De t or addn'/ info. FEE ITEMS (Fee Resolution 11-053 E/I 71111// l"' /I Plan ('h, ( F. I'hunh. Plou (,hncA £lee. I'1,m (7a erF ,ll•,:h. l'.a'nut Fe". Plumb. Penni/ l" li!rc. /'..moil F,,: 0/if" Ilrrh. lnsp Olh,a l'hlrrrh ln,ep.Li I lilrr_ b,ap. lA.,h. ln.,p. 1',r1 /'boob. hop. Fra: tiler. loop. V; 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 prefinddna information available and are only an estimate Contact lite De t or addn'/ info. FEE ITEMS (Fee Resolution 11-053 E/I 71111// FEE QTY/FEE MISC ITEMS Plan I_'Ilec% Frr: .Cupp/. l'(.: Fir Permit Fee: $238.00 Su1!p1. h(c1l i l: 1'1 umb.; :d lc•rll.'lflcc l'lnmhJJ-hrrlL/lili'c Nurulil Fisc: i. onsfl'uciion Itl.A': i1iXm illi it(fill " /""'. Work Without Permit? 0 Yes (j) No $0.00 ,I.lrunrml /'/coining Fres' A /,Iol ,l l!ncinnollruion Fara: Stions; Motion Fee: IBSEISMICR $0.88 Select an Administrative Item 131(1': Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: 1 $239.88 $0.00 TOTAL FEE: $239.88 Revised: 0 6/0 512 01 2 CUPERTINO 12 v (- C) REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildinalacuoertino.ore PROJECT ADDRESS 0 Q � j' I .APN 9 - l _ % [— OWNER NAME A' ^v /`/ (i O ^0_j O E-MAIL STREET .ADDRE>S CITY, STATE, ZIP ctl JvU C - al FAX CONTACT NAME PHONE - E-MAIL STREET ADDRESS CRY, STATE. ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑CONTRACTORAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANr CONTRACTORNAME WhtDf LICENSE NUMDER qqoq/ LICENSETVPE BUS LIC., COMPANY NAME J/ kyr, LCJ E-MAIL �vPI/ 1 W �j ` STREET ADDRESS ��' C 1 CITY. STATE IP ARCHITEC'DENGINEER NAME ,CENSE NUMBER BUS. LIC. ¢ COMPANY NAME E-MAIL FAX STREET ADDRESS CITY. STATE. ZIP PHONE USE of _SFD or Duplex ❑ Multi-Famlly, sraurruRE. I❑ Convnercial ROOF AREA ON VALUATI Q xi W�1 EXISTINGROOFTYPE: ❑BUILT-UPROOF ❑ASPHALT SHINGLES XWOODSHAKES ❑WOODSHNGLES ❑OTHER ISPECIFYJ 0.EM1IOl"E /REPLACE YES ❑ NO IF NO, ¢L YER PLYWOOD ❑A- ❑ 19 FS" PLYWI) OSB TYPE' ❑ CDX PITCH. ,1 ')` ROOF LA :1 }.�iulcuM55 PROPOSED ROOF TYPE: ❑ BUILT-UP ROOF kASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER ICC -ES REPORT e DESCRIPTION OF WORK: �ttJoop SN C5) /✓ GG // LL -A Gl By my signature below, [certify 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 The information 1 have provided is correct. I have read the DescnpGon of Work and verifv it is accwate, 1 agree in comply with all applicable local urdinances and state laws relating to bu Id in c n=c on I itudionze representatives of Cupertino to enter the above-iJentmeJ prorry for inspection purposes. Signatureof ApplicanUAgenLAU4 Date: — SUPPLEMENTALINFO NATION REQUIRED _ If building is associated with a Home Owners Association, provide letter of approval from HOA. Provide Planning approval to verify if there any restrictions. _ Provide copy of Manufacturer's Installation Specifications. Provide signed copy of Cupertino's Tear -Off Policy. OFFICE USE ONLY PLAN CHECK TYPE ROITTINGSLIP OVER-TH1bCOUNTER EXPRESS ❑ STANDARD ❑ BUILDING PLAN REVIEW ❑ PLANNING PLAN REVIEW ❑ FIRE DDPT ❑ OTHER: Reroofdpp_201I-doc revised 03'16/!I