12090040 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 604 PHIL CT CONTRACTOR:ROOFING RESPONSIBLY PERMITNO: 12090040
OWNER'S NAME: NIKLAS&CA1L1 I1ALLIN 1357 EL CAJON LN DA'Z'E ISSUED:09/062012
OWNER'S PHONE: 4082536744 LOS BANOS,CA 93635 1'110NE NO:(650)568-5980
❑ LICENSED CONTRAC'FOR''S DECLARATION BUILDING PERMIT INFO: BLDG (_ ELECT❑ PLUMB r'
License Class Lit.d ! 2V K6/'
r r r_1DIECH RESIDENTIALCOMMERCIAL
Contractor /�a/Ify:✓( t=hereby I affirm that 1 am licensed under the p visions of Chapter 9 30B DESCRIPTION:REMOVE EXISTING ROOF TAR AND GRAVEL AND
(commencing with Section 7000)of Division 3 of the Business&Professions RELACE
Code and that my license is in full force and effect. WITH 28 SQ MINEREAL CAP ROOFING CLASS A
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,for the performance of the work for which this
permit is issued Sq.Fl Floor Area: Valuation:$13450
,\I'1'I,ICAN'I'CFR'I'IFICA7'ION
I certify that I have read this application and state that the above information is ANN Number:37542024.00 Occupancy'rype:
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, 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 will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR
with all non-point source c ulabors per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION.
9.18.
Signature - Dale2'<—/ Z Issued by: �/✓ �jG/7 Date: d?.e L
❑ OWNF,WBUILDF.R DECLARATION
hereby affirm that I ora exempt from the Contractor's License Law for one of RE-ROOF'S:
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 sole compensation, installed without first obtaining an inspection,1 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 Applicant: Date:
construct the project(Sec.7044,13usiness R Professions Code).
hereby affirm under penally of perjury one of the following three ALL ROOF COVERINGSTO BE CLASS"A"OR BETTER
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's IIA/\RDOIIS MATERIALS DISCLOSURE
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this pemtit is issued. I 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 llealth&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 Cu perdno Municipal Code,Chapter 9.12 and the Ilealth&
Safety Code,Section 25532(a)should 1 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,I shall contaminants as defined by the Bay Area Air Quality Management District I will
not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Compensation laws of California. If,after making this certificate of exemption,I llealth&Safety 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 o nrizeJ agent: Z
Uafc�
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
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 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 stave Lender's Name
indemnify and keep harmless the City of Cupertino against l iabilities,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 ARCHrrrcT'S DECLARATION
9.18.
1 understand my plans shall be used as public records.
Signature Date
Licensed Professional
I Zvq c)L)LI �
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTME14T•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228" FAX(408)777-3333•buildinG(d)cuoertino.oro
CUPERTINO
PROJECT ADDRESS 'O f 7 Cl__ APN N �J L 2 — C) 2�•I
OWNER NAME /t 4PHON (1174_E."L
STREET ADDRESS CITY, ST TE,l. ZIP FAX. wc2T
CONTACT NAME PHONE E-MAIL
STREET ADDRESS CITY.STATE, ZIP FAX
❑ OWNER EIowN -BUILTFR 130WNERAGENT CONTRACTOR 13 CONTRACTOR AGENT ❑ ARCHIECr ❑ENGINEER ❑ DIWILOPER -1 TENANT
CONTRACTORNANE LICENSENUNSER LICENSE TYPE BUS,LIC.N
CONPANY•NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
RRCTRTET G"^ "' E LICENSE NUMBER BUS,LIC.N
COMPANY NAME n �/ EMAIL FAX
STREETADDRESS/5f C�✓�y C�/ CITY.STATE ZIP / /}�'✓� PHONErvS��_/�Oa'J�
USE OF ' SFD or Duplex ❑ Multi-Family, ROOF AREA: L/ VALUAnorv: /3 7/
STRUCTURE: ❑ Commercial ` ' zl��
EXISTING ROOF TYPE: 7RUILT-UPROOF ❑ASPHALT SHINGLES 11 WOOD SHAKES ❑WOOD SHINGLES Cl OTHER(SPECH'YJ
REMOVE/REPLACE CI YES IF NO. PLYWOOD 0 :5' ❑ PLYWD ❑OSB PITCH: ROOF
N C YLAYERI .KNS ❑ 55' TYP 11 ❑. —'(, CLASS. :1
PROPOSED ROOF TYPE: UILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT N
DESCRIPTION of WORK: ,l
/��hta✓S OLO �ae/' //r:n �✓� �?.vdllJ /7i"f ///'7rrc /� �`'L' �/ uk+
By my signature below,I certify to each of the followin(T I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and die information 1 have provided is correct. 1 have read the Description of Work,and verify it is accurate. 1 agree m comply with all appliubte local
ordinances and slate laws relating Or buildin. n6ruction. I authorize representatives of Cupertino to enter the above-identified propery for inspection purposes.
Signawre Of Appl icanUAgenD Date:
SUPPLEMENL�NFORAIATION REQUIRED •OFFICE USE ONLY
_If building is associated with a[ionic Owners Association,provide letter _ PLAT:CHECK TYPE. - ROUTING SLIP
of approval from HOA. OYER-THE-COUNTER BUILDING PLAN REVIEW'
_Provide Planning aliproval to veriN if there any resvictions. El' PLANNING PLAN REVIEW
_Provide copy,of Manufacturer's Installation Specifications. ❑ yTAn❑XRu ❑ FIRE REPT
Provide signed copy ofCupertino's Tear-Off Policy. - ❑ �OTIIEH:
Reroojdpp_2011.doc remised 03116/11
CITY OF CUPERTINO
FEE ESTIMATOR —*BUILDING DIVISION
ADDRESS: 604 Phil Ct DATE: 09/06/2012 REVIEWED BY: Sean
APN: BP#: 'VALUATION: 1$)6450
*PERMIT TYPE: Minor Building Permit PLAN CIIFCK TYPE: Re-roof
PRIMARY SFD or Duplex PENTAD1ATION 1SFDWLROOF
USE: PERMIT TYPE:
WORK Remove existing roof tar and gravel and replace with mineral cap roofing.
SCOPE
FEEID ROOFAREA
s.f.
1REROOFFRES 2,800
Alech. Plan Check Phuub. Plan Check Elea. Plait Check
Mech. Permit Fee: Plumb.Permit Fee: Ele'.Permit Fee:
orber Alech. Insp. Other Plumb Insp. Other Elce.Insp. El
,1-kch.Insp. Fec: Plumb. lap.Fee: Elcr.Insp.Few:
NOTE: This estimate does not include fees due to other Departments(i.e. Planning, Public (Forks, Fire,Sanitary Sewer District School
District.etc.). These ees are based on the prelintinan information available and are only an estimate. Contact fire De t or atldn'I info.
FEE ITEMS (Fee Resoltuion 11-053 E/T 7/1/11) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Sup/j/. PC Fee
Plunih./Meeh./Elec
Permit Fee: $420.00
Suppl. Insp Fee
Plumb./d•lech./Elec
Plumh.1,44eelt.lElee Permit Fee:
Consn•uction Tax:
1 dminisu•ative Fee:
Work Without Permit? 0 Yes Q No $0.00
Advanced Planning Fees:
Travel Documentation Fees:
Strong. Motion Fee: IBSEISAfICB $1.65 Select an Administrative Item
Bldg.Sids Commission Fee: iBCBSC $1.00
SUBTOTALS: 1 $422.65 $0.00 TOTAL FEE: $422.65
Revised: 07/01/2012