12070122 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10126 CARMEN RD CONPRACI'OR:SILVA ROOFING PERMIT N0: 12070122
OWNER'S NAME: JESSICA 110 3211 WHITE ROSE DR DATE ISSUI.D:07/172012
OWNER'S PHONE: 4089962856 SAN JOSE,CA 95148 PHONE NO:(408)590-5623
❑ LICENSED CON''I'R,\CI'ORp'S DECLARATIONJOB DESCRIPTION' RESIDE\PIAL El COMMERCIAL
License Class C-39 Lic.0 0�� /Y- RE-ROOF 36 SQ-TEAR OFF WOOD SHAKE INSTALL
COMP
Contractor Date_ )2 SHINGLES
hereby affirm flint I am licensed under the provision.of Chapter 9
(commencing,with Seclinn 7000)of Division 3 of the Business S Professions
Code and that my license is in full force and effect.
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. Sq.FI Floor Area: Valuation:$19000
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 t
permit is issued. his
APN Number:35709063.00 OccupancyTpe:
APPLICANT CERTIFICATION
I certify that I have read thisappllcatlon:and stale that the above information Is PERMIT EXPIRES IF WORK IS NOTSTARTED
correct. I agree to comply with all city and county ordinances mrd suite 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 ON7 LAST CALLED INSPECT ON.
indemnify and keep harmless the City of Cupertino against liabilities,judgments.
costs,and expenses which may accrue against said City in consequence of �/
granting of this permit. Additionally,the applicant understands mid will comply Issued by: z 'I L Date! 2,
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
q Rb:ROOFS:
Signature Date. ��2d�Z All roofs shall be inspected prior to any roofing material being installed If a roof is
-- installed without first obtaining an mspenon,I agree to remove all new materials for
inspection.
❑ O\\;N lilt-BUILDI91 DECLARATION yy
Signature of Applicant: &rA Date.: x— /r-
1hereby affirm Ihal 1 am exempt from the Contractor's License Law for one of`
the following two reas01Isu ALL ROOF C( 'ERLNGS'I'O BE CIs\SS"A"OR RP:I'I'ER
I,as owner of the property,or my employees with wages as their sole compensation,
will do the work,mid the structure is not intended or offered for sale(Sce.7044,
Business C Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to IIA%ARDOUS NIATERIALS DISCLOSURE
construct the project(Sec.7044,Business 3 Professions Code). I have read the hazardous materials requirements under Chapler 6.95 of the
California 11calth S Safety Code.Sections 25505.25533,and 25534. 1 will
hereby affirm under penally of perjury one of the following three maintain compliance with the Cupertino Municipal Code.Chapter 9.12 and the
declarations: 1lcalth S Safety Code.Section 25532(a)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined b) the Ray Area Air Quality Management District
performance of the work for which this pemtit is issued. will maintain compliance with the Cuperlino Municipal Code.Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code.Sections 25505,255 ,.tad 25531.
Section 3700 of the Labor Code,for the performance of the work for which this'
Owner 0r authorized agent: Date:
pemrit is issued
I 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 CONS'I'RI1CI'ION LENDINGAGENCY
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 decnned revoked work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
.U'I'I,IG\N"1'CIiIi'I'I FIG\"PION Lender's Address
I certify that I have read this application mid state that the above information is
correct. I agree to comply with all city and county ordinates mid 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, ARCHITECT-S DECLARATION
costs,and expenses which may accrue against said City in conscyumme ol'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
:Y irx..:....'-"^'� :1. _ ,..—.- . ,..-.,:::...,so--•_..r..ia.�. ,-�.,— :i%:-:,-f�.:"'7'-^(F�ysa"'.rar-'
REROOF TEAR-OFF POL"ICY ;
-' 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(Wcupertino.ore
/�
PROJECT ADDRESS �/7V�TP ( �11�i;�;.,,I.J/ (� n,^ ^ 1!C'��� AP,Yp
OWNER NAME ��e3t / `PPHONHl/A. )C7"/7f r �n�AIL@-�7)! ,
STREET ADDRESS//� (2/�', 7._../! �/t CIN, STATE�7�1/P //(I I��±('Ye�T..J�J/y(ly��-1 FA%
CONTRACTOR NAME`rJ �I�// ,'yt1� r(1�1�1� /f�" I/I 'VVJ�/J=yLIC CYS[NUMBER/mGYf2 /('a'{i;J"e��IjlG j`P TE/i ,�C� BUS.LIC.a
COMPANY NAME .LSV !`n 'L�F EMAIL `�:�'`/Jll��l'J/ �/05 / n(��—T 9 r`7'a f O
STREF.TADDRESS '2 �/I ��IX�IZ�S" Q CITY.STATE.ZIP PHONE
d�1/7lJ�I{rrlll n07J.RO'1
I-UNDR� AND AND AGREE TO THE FOLCOy INE:
S I L V H- L' 001,:f j 6r
1. The re-roof project shall comply with all applicable provisions of the 2010 California Codes.yv8
.,,� l,,�� ,_ �,
2. An inspection request can be scheduled up to the day before the mspeeion'date. Please4dall%(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•tAKughout, all the nails/fasteners shall be either
completely knocked-down or removed poor to this inspection.
11�. :)If plywootf is installed, a plywood Nailing lbspection is required.
5. Roofing shall not be applied without first obtaining all prior inspection and wrivcen approvals from the
building inspector. Any roofing which is applied without first obtaining'rapproved inspection will
require the removal of all.new material down to the sheathing soaproper inspects can be performed.
C(L 1710✓L-' � Y.1� r �/! CL r?
6. _ Progress Inspection is required when approximately 50% of roof covering�is installed.
/,'J.-jHti tv.:.l1rF(_rT.lrt/— /> !./. 1✓artCL / 1 •�. JL /.Tj ' �iIS7i1 ( �' LI[;rt7W[ /vitt-1
,7. A Final-inspection and approval shall be obtained from the building inspector when the re-r66fing is
I ( �comple'ted""Pareceive a fi6af sign off, t6efoll6winglitems 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-sitJtto review at the time of the inspection.
C. Proper spark3arr"es or 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 8126.00. The re-inspection-fee shall be paid before another inspection
can be scheduled.
By my signing below, I certify each of the follo ing is true: I am the property owner or authorized agent to act on the
property owner's behalf. I understand and a=ree Io comply with the re-roof policy stated above. I also understand that
smoke detectors and carbon monoxide tlatcct r are rcqui ed to be installed in accordance with Sections R314 and R315 of
the 2010 California Residential Code./�
Signature of Applicant/Agent: ,Date: 4B III
I
RroofPolici 2011.docrevised02116/11
P
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
:121 ADDRESS: 10126 carmen rd. DATE: 07/17/2012 REVIEWED BY: bobs.
APN: BP#: 'VALUATION: 1$19,000
*PERMITTI'PE: Building Permit PLAN CIIECK TYPE: Alteration/ Repair
PRUMARY NTA ON
USE: SFD or Duplex PERMITTYPE: 1SFDWLROOF
i
WORK tear off wood shake install comp shingles.
SCOPE
Much.Plan Check Plumb.Plan Check Flea.Plan Check
Much.Permit Fee: Plumb.Permit Fec: Mee,Permit Fee:
Other Mech. Imp. Other Plumh Insp. Odter Else.Insp.
Mech.hap.rec: Plumb. /n.sp.Fee: Elce.Insp.Fee:
NOTE: This estimate them not include jcev due to other Departments(i.e. Planting. Puhlic Works, Fire,SanitaryServer District.School
District,etc.). These feav are based an the prelintinan information available and are nub•as estimate. Contact the De t or at/tbt 7 info.
FEE ITEMS (Fee Rcsalalion 11-053 Eff 7L Il) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 3,600 S.f.. Re roof
Suppl. PC Fee: 0 Reg. 0 OT 0.0 hrs $0.00 $540.00 IREROOFRES
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee:(D Reg. 0 OT 1 0.0 1 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Constriction Tax:
Administrative Fee: 0
Work Without Permit? 0 Yes (j) No $0.00 0
Advanced Planning Fee: $0.00 Select a Non-Residential E)
Travel Documentation Fees: Building or Structure 0
A
Strong iiyiotion Fee: IBSEISMICR $1.90 Select an Administrative Item
131du Stds Commission Fee. IBCRSC $1.00 lx o
SUBTOTALS: $2.901 $540.001 TOTAL FEE: $542.90
Revised: 07/01/2012
REROOF PERMIT APPLICATION
,C COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION (�
70300 TORRE AVENUE •CUPERTINO, CA 950143255 �� U
CUPERTINO (408))7777-3228 • FAX(408)777-3333 • buildinD(e)cuperino.om
PROTECT ADDRESSj / e IU U ! U co
C
OWNE0.NAME C- 5:5SIGA #0 PHONE Va� '776-29!5$
`q/ rZ`! EMAM
STREET ADDRESS /o/ I CT', STATE,ZIP / /t0 O-/ 01, FAX
/o/�/Z to CflRlnenl/ �D Cc/P�P�1qa, C�{ _
APPWCANT NAME / �PriskIe-L (J.�Si..C..�/f� PHONE r[�p S�� A�7. -MALL
STREET ADDRESS /)./�I LR/ ll' ,)ECSC �0 CITY.STATE, ZIP OC^ ' J..aTal��/ CGi 9s :t .
❑OWNER ❑ OWNER-BUILDER ❑l OWNS AAG YYc1,T Acron ❑CONnTRAcroJR AGGEEN'r ❑ ARtFVr£R ❑ENGINEER ❑ DEVE10PFR ❑TENANT
CONT7tACT0A NAME CL 5
1 L✓A UCENSENUWIDER fj LICENSE]YPE I BUS.LC.6
COMPANY NAME S, t-m- go-or_rn1�� I 6MAm O of (..� I FAX
STREET ADDRESS I (,(�fF_ I'IDSE p1C °T1'•STATE.� S`�3rJ Jp� •� PHONE �y1,�/ z�
ARCHITECT/ENGINEER NAME LICEtSENU)ABER I BUS.LIC0 / /0
COWANY NAME E-MAIL FAX
STREET ADDRESS CITY.STATE,ZIP PHONE
USE OF ElSFD or Duplex ❑ Multi-Family ROOF AREA:/'(�/ VALUATION: / L�
STRUCTURE: ❑ Commercial / '
EXISTING ROOF TYPE: ❑BUB-T-UP ROOF ❑ASPHALT SFUNGLFS WSCOOD SHAKES ❑WOOD SHIT GLES ❑OTHER(SPECIFY)
OV�/REPLACE EYES IF NO. I PLYWOOD Y," 11PLYWD ❑ OSB PTTCEL �:)Z ROOF CLASS q
❑ PLAYERS � �
PROPOSED ROOF TYPE: ❑BULLT-UP ROOF ❑ASPHALT SHA
INM ❑WOOD SHAKES ❑WOOD SHG F Nd'O7 u, ICC-ES REPORT a
DFSO=ON OF WORK y /
Cvno>/� LXf57r�CT u�'rI74'F-CS //JSTf1'L�L ( �- � OS� -
/+vSTR-1.� �v,,.rrE)2C�,.LH-(�•D cC�)oa✓�-L:�f-�•,��7 - /n1.Srsl� C•(Cr�tTcJ�C
By my signature below,I certify to each o'rme following: am the Property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I have provided is tort . I have reed me Description of Work and verify it is accurate. I agree to comply With all applicable local
ordinances and state laws relating to buildin ti I authorize representatives of Cuperino rn enter the above/_'dentifiedypropertp for inspection purposes.
Signature of Applicant/Agent Dau: / //""2��
27
SUPPLEMENTAL A ORMATION 1tEQUIRED -- - ''FFICE: ,A^ ,y;mg"e'er
If building is Associated with a Home Owner's Association,provide letter RLAx�exss ottn,+c si�.as-' .
l�'{- Tin-f'«rt^ut4iPfe"� a j.'�
of approval from HOA. ot,�oasl v�1 �
sem,. -'�im.�niuc PDA^.AEv7Etr�
Provide Planning approval to verify if there any restrictions.
� VAC PI.At�-AEVtL'R+�}�
_Pryvide mpy of Manufacturer's L•istaliadon Specifimtions.
Provide signed copy of Cupe=o's Tear-Off Policy. b. _ L74orxeix.`
/ ReroofApp_2011.doc revised 03/02/11