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12070199CITY OF CUPERTINO BUILDING. PERMIT BUILDINC ADDRESS: 10400 PRUNE :TREE LN CONTRACTOR:" "; -r i::—:'.:.:i:::" I _ .. IPISR\IIT\0:12070199 O\\'NIiK'S NAME: RANDA RUNIO AND MARJORIE M'fRU I►,1.Qp Q,OoFlel6 nM.d CJ' oI of (Je,I DATE ISSUIiD: 07252012 ON'NF.R'S PHONE': 4082522051 I - I PuoNE NO: ❑ LICENSED CONI'ItAC'I'OR'S DECLARATION License Class C 3 Lie. 4_9L$6S( Contractor Date 7- ZS_I Z 1 hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business 3 Professions Code and that my license is in full force and effect. I hercbv affirm under penalty of perjury one of the following.lwu declarations: I have :aid 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 pertbnnance 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. Al'I'LIC,k\ 1' CIi R'1'11'ICATION I cenify 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 :rad keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting ofthis pemnit. Additionally, the applicant understands and will comply with all non -point sour a regulations per the Cupertino Municipal Code, Section 9.18. Signature Date ❑ OWNER -BUILDER DECLARATION hereby affirm that I am exempt from the Contractor's License law fur one of the following tyo reasons: 1, its owner of the property, or my employees with wages as their sole connpensi tion: will do the work, mid the structure is not intended or offered for sale (Sec.7044, Business X Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). 1 hereby affirm under penalty of perjury one of the following three 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. 1 haveand will maintain Worker's Compensation Insurance, as provided for by Section 3700 of Labor Code, for the performance of the work for which this permit is issued. I cenify that in the perfommnce of die work I -or which tris 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 Connpensmion provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CF.RTI FICAT'ION 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 ordinmmes 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,judgmcats, costs, and expenses which may accrue against said City in consequence of the granting of this pernit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. BUILDING PERMIT INFO: BLDG r ELECT I— PLUMB F_ i111ECE1 r RESIDENTIAL r, CODINIERCIAL F7 JOB DESCRIPTION: SINGLE FAMILY DWELLING TEAR OFF EXISTING ROOF SIIAICE, INSTALL NEW COMP SIIINGLES 21 SQI'r CLASS A Sq. Ft Floor Area: I Vuluation: $10200 AI ;N Number: 31633033.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: e_ X1/3/ 1-147,:Il/Date: 7d5 -%a RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining our inspection, I agree to remove all new materials for inspection.. Signature of Applicuu: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BE; FFR IIAZARDOUS MATERIALS DISCLOSURE have read the hazardous materials requirements under Chapter 6.95 of the California Health .4 Safety Code, Sections 25505, 25533, and 25534. 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health S Safety Code. Section 25532(x) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the lealth & Safety Code, Sections 25505. 25533, and 25534. Owner or au rued agent: Date: — 2s IZ CONSTRUCTION LENDING AGENCY I hereby affimr that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Cir C.) Leaderls Name Lender's ARCIIITF.Cf'S DECLARATION I understand my plans shall be used as public records. Date I Licensed FM -51 OF CUPERTINO FEE ESTIMATOR -BUILDING DIVISION LAA ADDRFSS: 10400 prunetree tree In. DATE: 0712512012 REVIENVFD.131': bobs. btech. Permit Fee: APN: BP#: 'VALUATION: $10,200 *PERMITTYPE: Building Permit PLAN CHECK "TYPE: Alteration / Repair PRUi\IARV SFD Or Duplex USE: - PENTAIIATION 1SFDWLR00 PERMIT TYPE: i WORT: sfd tear off existing roof shake install new comp shingles. 71 SCOPE $0.00 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 has'ed on the Dreliminan• information available and are onh, an estintate. Contact the Dent for addn7 into. FEE ITEMS (Fee Resolution /1-053 FIT 711111) Xtech. Man Check Plumb. Pion Check Flet. Plan Check btech. Permit Fee: Phunh. Permit ree: rice. Penni( ree: Other Mech. Insp. Other Plumb Insp. Other rice. Insp. I'lath. lup. Fee: Plumb. lisp. ree: clec. Insp, ree: 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 has'ed on the Dreliminan• information available and are onh, an estintate. Contact the Dent for addn7 into. FEE ITEMS (Fee Resolution /1-053 FIT 711111) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 2,100 s.f. $315.00 Re -roof IREROOFRES I Id Suppl. PC Fee: Q Reg. Q OT 0.0 firs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. Q OT 0.0 firs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tac: Adininistrarive Fee: 0 E) Work Without Permit? O Yes (F) No $0.00 Advanced P annin, Fee: $0.00 Select Non -Residential Building or Structure 0 'Travel Documentation Fees: Strong Motion Fee: IBSE/SMICR $1.02 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $2.02 $315.00 TOTAL FEE: $317.02 Revised: 07/01/2012 CUPERTINO REROOF.PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building0cuoertino.oro 110 PROJECT ADDRESS 1 oi-+&D `J %- •� p -Q Q `- ` -- APN M / _ // 1 V OWNERNAME PHONE q(5b-2Sz- IE -MALL STREET ADDRESS F O` C)o IJ,^e �^�. `�"` CITY, STATE,Z�ZIIIIPC,-�Cfk;^D! 5-D/✓ FAX 1 CONTACT NAME \ \� „/` w_ _ ,�G.L I.zS PHONET)D _, 7,7—FM7 E-MAIL STREETADDRESS O (, bx 5,, CRY. STATE. ZIPSSC^/ ��U�J.L� p t{[`p 1 FAX ❑ OWNER ❑ OWNER -BUILDER. ❑ OWNER AGENT WCONTRACTOR ❑ CO.YRUCroR AGENT ❑ ARCHrrECr ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTORNAME I I�l �eS�-,r \ rt V V V l LICENSENUMBER M51 LICEHr.!E,� BUS, LIC.b COMPANY NAME E-AIAB.M_ SIC' ry ( FAX //''�� STREEFS TADDRS?,S,)y !�J Y` ( /p CITY. STATE, ZIP q L.CJr��}�'D- 9YS VOT PHJNES IO �q-Z•��St�7 V ARCHITELTJENGIN'-EEIE``BRNAME LICENSENUMBER BUS, LIC.0 COMPANY NAME EMAIL FAX STREET.ADDRESS CITY, STATE. ZIP PHONE USE OF FD or Duplex ❑ Multi -Family, STRUCTURE, ❑ Commercial ROOr�A%REIA: s F V lO O VALUATION: O 1, EXISTING ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES SHAKES ❑WOOD.SeHINGLES ❑ OTHER (SPECIFY) REMOVE /REPLACE �YE$ ❑ NO IF N0, pLA Rc �puK100D PLYw'tR)D Al A- ❑ ICKNESS- ❑ Ga" PLYWO X OSB TYPE. ❑ fD. PITCH: It '12 ROOF PROPOSED ROOF TYPE: ❑ BUILT-UP ROOF X 1SPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER ICC -Es REPORT p DESCRIPTION OF WORK: AV l „/ l l- ` �/z .+ S% �"0�0., l nh�N uN ti� L U I w -e By my signature below, I certify to each of rhe following: I am the property owneror authorized agent to act on the property owner's behalf. I have read this application and the information 1 have provided is coect. 1 have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to �buil (��tm `tion. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Appl icandrlgenC �1J / Date: �� 2 SUPPLEMENTAL INFORMATION REQUIRED _ If building is associated with a Home OWnars Association, provide letter, of approval from HOA. Provide Planning approval to verify if there any restrictions. Provide copy of Manufacturer's Installation Specifications. _ .4rovide signed copy of Cupertino's Tear -Off Policy. OFFICE USE ONLY PLAN CHECK TYPE ROUTING SLIP •iSOVER-THE.COUN7ER - 1-1 ❑ STANDARD J �i BUILDING PLANREVIEW ❑ PLANNING'. PLAN REVIEW. ❑ FIRE DEPT ❑ OTHER: Reroojdpp_2011.doe revised 03/16111