12100127CITY OF CUPERTINO BUILDING PERMIT
RUILDINGADDRESS: 1069000RDOVARD CONTRACTOR: CONRAD ROOFING PERMITNO: 12100127
SERVICE
OWNER'S NAM E: LAM MELINDA 11 332 PI I ELAN AVE DATE ISSUED: 10 /17/2012
OWNER'S PHONE: 4089023687 SAN JOSE, CA 95112 PHONE NO: (108(291 -7615
❑ LICENSED CONTRACT'OR'S DECLARATION
License Class C_ 3 Lie.9 Z 1 1 U7 Z
Contractor Dale /V— Z"
I hereby affirm that I am licensed tinder the provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business d Professions
Code and that my license is in full force and effect.
hereby affirm tinder 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
perfommnce 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
pemait is issued.
Al'I'LIC \N'1' CF.R'I'IFICA'I'ION
I certify that I have read this application and slate that the above information is
correct. I agree to comply with all city and county ordinances and state Imes 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,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupenino Municipal Code, Section
9.18. C/y — /�/ %
Signature / °�— Date �0 —' "
❑ OWNER- RUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law fur one of
the following too reasons:
I, as owner of the properly, or my employees with wages as their sole compensation,
will do the wark, and the structure is not intended or offered for sale (Sec.7044,
Business R Professions Code)
I, as owner of the property, am exclusively contracting with licensed contra, clors to
construct the project (Sec.7044, Business S Professions Code).
hereby affirm under penalty of perjury one of the following three
declarations:
1 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,
I certify that in the performance of die work for %%Inch 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 Culifomia. If, after making this certificate of exemption, I
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall he deemed revoked.
APPLIC Nf CERTIFICATION
I certify that I have read this application and state that the above infommtion is
correct. 1 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,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Date
BUILDING PERMIT INFO: BLDG C. ELECT (J PLUMB ❑
p1ECH I- RESIDENTIAL C COMMERCIAL (_
JOB DESCRIPTION: REMOVETWO LAYERS OF EXISTING COMPOSITION
ROOTING
AND INSTALL NEW 30d UNERLAYMENT AND INSTALL NEW 50
YR COMPOSI'T'ION ROOFING (2100 SQFT)
Sq. Fl Floor Area: I Valuation: $8700
APN Number: 34217083.00 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:.�H1-11 A4-2�2rt Date: A� /7/4?
RF- R00FS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
Signature of ApplicmC Date:
ALI, ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIAI S DISCLOSURE
have read the hazardous materials requirements under Chapter 6.95 of the
California Health S Safety Code. Sections 25505.25533, and 25534. 1 will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Ilealth S
Sudety 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 Ilay Area Air Quality Management District 1 will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health S Safety Code. Sections 25505, 25533, and 25534.
Owner 6hori. dagenl: 0— I 7-1 L
Date: (, %
CONS'IRUCFION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
for which this permit is issued (Sec. 3097, Cie C.)
Leader's Name
Lender's
ARCIIITE..CT'S DECLARATION
I understand nay plans shall be used as public records.
Licensed
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CITY OF
CUPEkTINO
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777 -3228
Fax(408)777 -3333
Building Department
JOB ADDRESS:
101010 Cocdovo �-,
PERMIT #
OWNER'S NAME: LAM
PHONE # 902-- 34Q?
GENERAL CONTRACTOR: Lo mc- J IQeo f
FAX #
I am not using any subcontractors: f o - / ,� - 12-
Signature Date
Please check applicable subcontractors and complete the following information:
i
Owner /Contractor Signature
S
(o -17- 1 t
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 Sheei Metal
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
i
Owner /Contractor Signature
S
(o -17- 1 t
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 • buildino(a)cuoenino.oro
PROJECT ADDRESS 1.1 / (� O /' 1 APN M
CiO 6-�
OWNER NAME , I \lt,N/ 1
PHONE C� J � E -MAIL
F g O b1 I
STREET ADDRESS 10 610
5 p 1-,
I FAX
CONTRACTOR NAME LICE LICCENSSJYY� PE
^(L ;--L .
BUS . LIC.9 q
L
COMPANYNAME /' V 41� 1
E -MAIL.
FAX
STREET ADDRESS 3 3 k,� , YL
CRY, STATE. ZIP /, 9i ! y S I I �_
PHONE
1 UNDERSTAND AND AGREE TO THE FOLLOWING:
The re -roof project shall comply with all applicable provisions of the 2010 California Codes.
An inspection request can be scheduled up to one business day before the requested inspection date.
Please call (408) 777 -3228 from 7:30- 3:30pm (Mon- Thurs) or 7:30- 2:30pm (Friday) to schedule
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.
Final Inspections will be given a two hour window.
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 down to the sheathing so a proper inspection can be performed.
6. 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. The re- 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 t0 act on the
property owner's behalf. I understand and agree to comply with the re -roof policy stated above. I also understand that
smoke detectors and carbon monoxide detectors are required to be installed in accordance with Sections R314 and R31 5 of
the 2010 California Residential Cod .
Signature of Applicant/Agent: Date:
RerooJPo1icy_2011.doc revised 1017112
CUPERTINO
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
(408) 777 -3228 • FAX (408) 777 -3333 • buildinn(G )cupertino.orci
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PROTECT ADDRESS D I /� Q` J ✓�
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APN u r �1 1 '%
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OWNER NAME
PHONE (�O -'j� /)
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STREET ADDRESS '�69e1O C_ `cVra-JA A�
CITY, STA :,(ZIP
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CONTACT N&NUS
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PHONE .Zg Y -761
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STREET ADDRESS -3 3
CITY,�T TE, 21P � O / I L
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FAX
❑ OWNTR ❑ OWNER BUILDER ❑ OWNIERAGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME��`��
LICENSE NUMBER .2-11 &�Z
LIC�S =Z'P
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RUS. LIC.p
COMPANYNAAIE ` n
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E -MAIL
FAX
STREET ADDRESS 332- (p°
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CITY, STATE, 2IP /r /� / -4/
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PHONE 2_t }y_� /'�
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ARCHITECTI GINEERNAME
LICENSENU�NIBER
BUS. LIC.0
COMPANY NAME
E -MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF S171) or Duplex ❑ Muld- Family
STRUCTURE: ❑ Commercial
ROOFAREA:
2- 1
VALUATION:
` ii% 7o cN
EXISTING ROOF TYPE: ❑BUILT- UPROOF %11SPHALTSUINGLES ❑ Wool) SHAKES ❑WOODSHINGLES ❑ OTHER (SPECIFY)
RGIOVErREPLACE KddYES
❑ PNO
IF NO
bLA1FRS 2
PLYWOOD 11 A- Cl
1 THICKNESS O 518-
PLYWD ❑OSB
E' ❑ COX
PFFCB:
�'1
ROOF
CLASS' A
PROPOSED ROOF TYPE: ❑ BUILT -UP ROOF ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER
IMES REPORT Y
1 \_ _ L T I 3 J 1 / �
` 'r
DFSSCUPTTION OF WORK: (� V.1 -•i -mil J / I,
/O
✓��Y
y SO Z(� , 1..0/Ail O J - "`^7 l.l'
By my signature below, I certify to each of the 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 1 have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and slate laws relating to wnst etion. I authorize representatives of Cupertino to enter the above - identifiedpropeny for inspection purposes.
Signature of Applicant/Agent: Date: /C' — 1? — 2'
SUPPLEMENTAL INFORMATION REQUIRED
_ If building is associmed With a [ionic Owners Association, provide letter
Ofapproval from IIOA.
_ Provide Planning approval to verify if there any restrictions.
_ Provide copy ofMaIDlfacturefS Installation Specifications.
Provide signed copy Of CupenlnO s'l'car -Off Policy.
OFFICE:
USE ONLY _
PLAN CHECK TYPE_
ROUTING SLIP
VF.R- TIIF.'COUNTER
'�"xPRESS
0' STANDARD.
41UILm NG. TITAN REVIEW
' �� 1'1L %NNING PLAN REVIEW^
0 E'IRP.DEPT'
❑ ODIER: _
ReroofApp_2011.doc revised 03116111
CITY OF CUPERTINO
FEE ESTIMATOR— BUILDING DIVISION
FEE ID ROOFAREA
s.f.
1REROOFFRES 2,100
ADDRESS: 10690 Cordova Road
Plumb. Plan Check
DATE: 1011712012
REVIEWED BY: Sean
\
APN:
BP#:
'VALUATION:
$8,700
*PERMIT TYPE: Minor Building Permit
Plunrh. hup. Fee:
PLAN CHECK TYPE: Re -roof
PRIMARY SFD or Duplex
USE:
Permit Fee:
PENTAMATION 1SFDWLROOF
PERMIT TYPE:
WORK
Remove two layers of existing composition roofing and install new 30# underla ment and install new 50
SCOPE
yr composition roofing (2100 sq ft).
FEE ID ROOFAREA
s.f.
1REROOFFRES 2,100
A'OTE: This ecdnmte does not include jeev due to other Departments (i. e. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc). These fees are baser/ on the nrelinhinare information available and are only an estinutte. Contact Ilse Dent for addn'I info.
FEE ITEMS (Fee Resolution I1 -053 Eff 711112)
blech. flan Check.
Plumb. Plan Check
Dec. Plan Chock
rllech. Permit Fee:
Plumb. Permit Fec:
flee. Permit Fee:
Orher,lfech. Insp.
Orher Plumb Insp.
Other flee. lay.
Mach. hop. Fee:
Plunrh. hup. Fee:
flee. Insp. Fee:
A'OTE: This ecdnmte does not include jeev due to other Departments (i. e. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc). These fees are baser/ on the nrelinhinare information available and are only an estinutte. Contact Ilse Dent for addn'I info.
FEE ITEMS (Fee Resolution I1 -053 Eff 711112)
FEE
QTY /FEE
MISC ITEMS
Plan Check Fee:
Suppl. PC Fee
Phnnb.A1lech.1E1ec
Permit Fee:
$315.00
Suppl. Iiisp Fee
Phtnib.111ech. /F,lec
Plush.1,11ecb. 10ee Permit Fee:
Construction Tax:
Administrative Fee:
Work Without Permit? O Yes Q No
$0.00
Advaticcel Phinning Pces:
�
Travel Documentation Fees:
Strong Motion Fee: IBSF.ISMICR
$0.87
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$316.87
$0.00
TOTAL FEE:
$316.87
Revised: 10/01/2012