12070241 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21109 RED FIR CT CONTRACTOR:POUR SEASONS ROOFING PERMIT NO: 12070241
OWNER'S NAME: BONELLI ERNESTJ PO BOX 1668 DATE, ISSUED:08/082012
OWNER'S PHONE: 4087339901 SAN JOSE,CA 95109 PHONE NO:(403)278-0330
LICENSED CONIRACI'OR'S DECLARATION BUILDING PERMIT INFO: BLDC r ELECT r PLUMB r
License Class C- 39 Lie.q R-7 2 I01D
2 MECIi r RESIDENTIAL r COMMERCIAL
Contractor R ( '--rut C. Date ? _k -I 2
hereby uffinn that lain licensed trader the precisions of Chapter 9 JOB DESCRIPTION:TEAR OFF WOOD SHAKE&INSTALL I2"CDS
(commencing with Section 7000)of Division 3 of the Business S Professions PLYWOOD Rl
EED
Code and that my license is in fall force and effect. FEET UNNTIAL YMENT.INSTLES(COUNTRY
A Y R AY)13SQ
PRESIDENTIAL COh1P SIiINGLC•S(COUNTRY GRAY)13SQFT
I hereby offinn under penally of perjuy one of the fallowing 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.
1 have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 oflhc Labor Code,for the perfommnce of die work for which this
permit is issued Sq.Ft Floor Area: Valuation:54500
APP LICANI'CIA(TIFICATION
I certify that I have read this application and state that the above information is APN Number:35905041.00 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
indemnity and keep harmless the City of Cupertino against liabilities,judgments. PERMIT EXPIRES IF WORK IS NOT STARTED
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and willcontply WITHIN 180 DAYS OF PERMIT ISSUANCE OR
with all not-point source regulatims per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION.
9.18. �1 / //7 .
Signature Date ` Issued by: �J�/\/ Z470171 Date: v
❑ OWNER-BUILDER DECLARATION
I hereby affirm that 1 am esengrf from the Contractor's License Law for one of RF:ROOFS:
the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
1,as owner of the property,or my employees with wages as their sale 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 S Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant, Date:
construct the project(Sec.7044,13usiness& Professions Code).
I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BFTTER
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's I IA'/.ARDOUS MATERIAI S DISCLOSURE
Compensation,as provided for 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 Worker's Compensation Insurance,as provided for by California Ileal lh S Safely Code Sections 25505,25533,and 75534. 1 will maintain
Section 3700 of the Labor Code,for the erformance of the work for which this compliance with the Cupertino Municipal Code.Chapter 9.12 and the I lealth S
p Safety Code.Section 25532(a)should I store or handle hazardous material.
permit is issued Additionally,should 1 use equipment or devices which emit hazardous air
I certify[hat in the performance of the work for which this pernit is issued,I shall contaminants as defined by fire Bay Area Air Quality Management District 1 will
not employ any person in any manner sons to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Compensation laws ofCaliforia. If,after making this certificate of exemption,1 Ilealth&Safety Code Sections 25505,25533,and 25534.
become subject to the Worker's Compensation provisions of the Labor Code,I must O"ter o th izrn e
2-
forthwith comply with such provisions or this permit shall he deemed revoked
Datro 6 O
APP LICA N'I'CE FIT]F1 CATION . .NSTRUCIJON LENDING AGENCY
I certify that I have read this application mad state that the above information is
correct.I agree to comply with all city and county ordinances.tad 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 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 Cupenino against liabilities,Judgments,
costs,and expenses which may accrue against said City in consequence of the Lender's Address
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section AltCll l'I'FCI"S DECLARATION9.18.
I understand try'plans shall be used as public records.
Signature Dale
Licensed Professional
` 0� CITY OF CUPERTINO
21 FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: "lep _111r L DA'Z'E: 07/30/2012 REVIEWED BY: bobs.
`
AKN: BPH: •VALUATION: 54,500
'PERMIT TYPE: Building Permit PLAN' c ECK"TYPE: Alteration / Repair
I'RIDLUiy PENT,%m,kTION
USE: SFD Or Duplex I'FR,MITTYPF: 1SFDWLR00
NVORK sfd tear off wood shake install new comp shingles.
SCOPE
N077i: This estimate dors noi include fees clue mother Departments(i.e. Planning, Public II'nrks, Fire..Sanitan•Sewer District,School
Dis'/ricr,etc). These fees are based on the pretiminan•information(n ilable and rtreonh•an estimate. Contac!/he Dept far adrin•l info.
FEE ITEMS (Fee Re.u)hainn 11-03 E0' 7.'I:'d Il FEE Q"I 1'/FEIi MISC ITEMS
Plan Check Fee: S0.00 1,300 s.r. Re-roof
Suppl. PC Fee: Q Reg. Q OT 0.0 his 50.00 S195.001 IREROOrRES
PME Plan Check: SO.00
Permit Fee: S0.00
Suppl. Insp. Fee.-G Reg. O O'I 0,0 hrs SO.00
PME Unit Fee: 50.00
PMB Permit Fee: $0.00
O
i
Work Without Permit? O Yes Q No S0.00 (D
Advanced Plannine Fee: $0.00 Select a Non-Residential
Building or Structure 0
Strove Motion Fee: IRSE/SAHCR 50.50 Select an Administrative Item
filch_ Sids Commission Fee: /RCRSC S1.00
SUBTOTALS: $1.50 $195.00 TOTAL FEE: $196.50
Revised: 07/01/2012
IZo - 7
REROOF PERMIT APPLICATION
EM COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO, CA'95014-3255
GUPERTINO (408)777-3228- FAX(408)777-3333•buildingpcupertino.ora
PROTECT ADDRESS
�z O C I APN• r
OWNERNAME R •I PHONE E-NAIL
I
STREET ADDRESS �/ O CITY. STATE.ZIP C 4
3
CONTACTNAM PHONE e E-MAIL
$ I o - -O 3oI
SrREE-rADDRESS SO� ^ CITY.STATE ZIP AN out Tose, CA - qS1
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❑ OWNER ❑ OwNER-BOILOER ❑ OWNER AGENT ..CONTKACroR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACT OR NAME I LICENSE NCNIBER LICENSETYPE I BUS LIC.
FAUir Z 0
COMPANYNANIE E-MAILSAO-4E %J I FAX
STREET ADDRESS S'07- CITY.STATE.ZIP wose C PHONE R_O
ARcHI I-ECTIENGINEER NAME LICENSE NLNIBER BUS.LIC.
COMPANY NAME E-NIAIL FAX
STREET ADDRESS CITY'.STATE.ZI P PHONE
LSE OF ❑ SFD or Duplex J, Multi-Family ROOF AREA: Jor VALUATION. f1.�. AS
STRUCTURE: ❑ Commercial �.y/ 3 S i�
EXISTING ROOT TYPE: ❑BUILT-L'P ROOF CASPIIALTSHINGLES � %%OODSHAKYS ❑W'OODSHINGLES ❑OTHERISPECIFY)
RENIOVF.:REPLACEt'ES IF NO. PL1'T1'GOD Z:- ❑ PLYUD 11 OSB PITCH: ROOF
❑ NO I •Ul'F.RS THICKNE S ❑ .- TYPE - CDX ')? CLASS A
PROPOSED ROOF TYPE: ❑BLILT-UPROOF XISPHALTSHINGLES ❑WOODSIIAKES ❑WOOD SHINGLES OTHER ICC-ES REPORT
DESCRIPTION OF WORK:
5 1�Zll
uWooc� +den 3O# �e_I �Qd-eL�� Men FiACLI If-LC�a�s
JOlerk,%'knkseAe e 'o s6i(%les . Color CnuAcy G r&j
8y my signature below.I cenify to each of rhe following: I 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 correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable Iowl
ordinances and state laws relating It,building conr� tion. I a orize repr<se tiv s of Cupertino to enter the above-identified property for inspection purposes.
Signature ot'ApplicandAgent: �. Date: aO
SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY
_ If building is associated%with a Home OYvner'S Association.provide letter PWNCHECKTYPE ROUTING SLIP
of approval from HOA. '-I EB-THE-COUNTER BUILDING PL,N REVIEW
Provide Planning approval to verify if there am'restrictions. ❑ EXPRESS ❑ PWN'SING PWx REVIEW
/Pry'�de copy of lManufacturer's Installation Specification. ❑ STANDARD ElRRE DEPT
' Provide signed copy of Cupertino's Tear-0 IT Police. ❑ OTHER:
- Reroof4pp_2011.doe revised 03/16111