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12100183 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1035S LEOLA CT CO\I'RACI'OR:LANCASTIiR TERRY 131'AI. PERDIII'NO: 12100183 OWNER'S NAME: LANCASTER TERRY ET AL 10358 LFOLA CT DATE, ISSUED: 10252012 OWNER'S PHONE: 6509960289 CUPEIRT'INO.CA 95014 PIIONRNO: ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG F- ELECT r PLUN113 rl License Class Lie.q p1ECH (— RESIDENTIAL (- COMMERCIAL - Contmctor Date I herebv affirm that 1 am licensed under the provisions of Chapter 9 .JOB DESCRIP-TION: 10358-10360-REMOVE AND REPLACE WOOD SHAKE (commencing with Section 7000)of Division 3 of the Business S Professions ROOFING ON DUPLEX WITII N13W COMPOSITION ROOFING Code and that my license is in full force and effect. (5,00 SQF)CLASS A hereby affirm ander penalty of perjury one of the following two declarations: I have and will maintain a cenificate of consent to self-insure for Worker's Compensation,as providedforby 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 of the Labor Code,for the performance of the work forwhich this Sq.Pt Floor Area: Valuation:$15000 - permit is issued. API'LICAN'I'CISRT'II'IC,\'I'IO,N APNNumher:37504025.00 Occupancy Type: I certify that Ihave 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)ogree to save PERMIT EXPIRES IF WORK IS NOT STARTED indemnify osts,a dexpenses harmless the cru ofCupertinosato against liabilities.judgments. WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said Cit'in consequence of the granting of this permit. Additionally,the applicant understands and w ill comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Issued by: �!�!/✓ �r�ii( Date:1,4•aJ f�- Signature Dale (]/ ON'NFR-B1I11.DP:R DIiCL.\RATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law formic of All roofs shall be inspected prior to any tooling material bcing installed.If a roof is the following two reasons: installed without first obtaining tam inspection,I agree to remove all new materials for 1,as owner of the property,or my employees with wages a5 their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business S Professions Code) Signature of Applicant: Date: I,as owner of the property,ran exclusively contracting with licensed contractors to construct the project(Sec.7044,Business g Professions Code). ALL ROOF COVERINGSTo BF.CLASS"A"OR BET`fER I hereby affirm under penalty of perjury one of the following three declarations: IIA%\RU(1115\IA"I'EI2h\LS DISCLOSURE 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 I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Ilcalth S Safety Code.Sections 25505.25533,end 25534. I will muintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Coda Chapter 9.12 and the Ilealth& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Ray Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code.Chapter 9.12 mW the not employ any person in any manner so as to become subject to the Worker's Health S Safety Code.Sections 25505,25533,and 25534. Compensation laws of California. If,alter making this cenificam of exemption,1 become subject to the Worker's Compensation provisions of the Labor Code.I muss Owner or ar t ed agent: forthwith comply with such provisions or this permit shall be deemed revoked. Date: 10 12C)I'2— CONSTRIICITON LENDING AGENCY AI'PLIC,\NI'CERTIFIC,\'PION I certify that I have read this application and state that the above information is I hereby adimh that there is a construction lendingagency for the performance of work's correct.I agree to comply with all city and count'ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(%%re)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address costs,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply ARCIIITECI"S DECLARATION with all non-points urecregulations per the Cupertino Municipal Code,Section 9.18. 1 understand my plans shall be used as public records. Signora Date D L'"1 2 Licensed Professional Building Department City Of Cupertino 10300 Torre Avenue Cupertino,.CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax_ : 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS: 16 3 5b- t .'b PERMIT# OWNER'S'NAME: —TF2\ LA-\ C PHONE # f S- 3, ICIG 0289 GENERAL CONTRACTOR: I BUSINESS LICENSE # ADDRESS: IDLE-,�- C I CITY/ZIPCODE: gEblk *Our municipal code requires all businesses working in the city to have a City of Cupertino business.license. NO BUILDING FINAL'OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF C_UPERTINO BUSINESS LICENSE. 1 am not using any subcontractors: Li`l 12— Signature ZSignature Date Please check applicable subcontractors and•complete the following information: SUBCONTRACTOR BUSINESS NAVE BUSINESS LICENSE # Cabinets•& Millwork Cement Finishing Electrical Excavation Fencing Flooring/Carpeting Linoleum /Wood Glass/ Glazing Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 10358 & 10360 Leola Ct DATE: 1012512012 REVIEWED BY: Sean \PN: BP#: 'VALUATION: $15,000 *PERMITTYPE:. Minor Building Permit PLAN CIIECK TYPE: Re-roof PRIMARY SFD or Duplex PENTAMATION 1SFDWLR0OF USE: I PERMIT TYPE: WORK Remove and replace wood shake roofing on duplex with new composition roofing 5000 sq ft). SCOPE FEEID ROOFAREA . (s.f. 1REROOFFRES 5,000 Meth. Ilan Check Plumb.Plan Cheek Flee.Plan Check Mech.Permit Fee: Plumb.Permh Fee: F.lec. Permit Fee: Other Hech.Insp. Other Plumb Insp. Other Elec.Insp. ,11ech.hap. Few: Plumb. losp. Fee: F-lce.Insp.Fee. NOTE: This estin ate does not include fees due to other Departments(i.e. Planning, Public 11'orks, Fire,Sanitary Server District,School District,etc. . Thesefees are based an the relindnarr information available and are only an estimate. Contact the Dept for addh'I info. FEE ITEMS (Fee Resohuion 11-053 Ejf 711111) FEE QTY/FEE MISC ITEMS Plan Check Fee: Suppl. PC Fee Phtntb.11lech.lElec Permit Fee: $750.00 SuppL /asp Fee Phimb.111ech.lElee Plunih.lMech.&Iec Permit Fee: C'onsirttction Tar. Administrative Fee: Work.Without Permit? O Yes 0 No $0.00 Advanced Planning Few': Travel Documentation Fees: Strong Motion Fee: IBSEISAllCR $1.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: 1 $752.50 $0.00 TOTAL FEE: F$752,501 Revised: 10/0112012 REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333•buildirm(Mcuoertino.ora PROJECT ADDRESS Lin) A C-T. APS N OWNER NAME —FERE ' ^_,CAS PHONE / �.�n�.D��� E.MAIL �CL QW)" STREET.ADDRESS Io36o Luc)LA Cf 4-) CITY. STATE,ZIP CU 1N01CA99 01 FAX (O� CONTACT NAME �l PHONE E-MAIL S Ql'Y'tC GS q Z STREET ADDRESS CITY,STATE,ZIP FAX IXOwTIER ❑ ON'NFR-BUfIDFR ❑ 0AWERAGENT ❑ CONTRACTOR ❑CONTRACTORAGFM ❑ ARCHITECT ❑WGINEER ❑ DEvIELOPER ❑TENANT CONTRACTOR NAME 2 LICENSE UIEft LICENSETIPE BUS.LIC.0 COMPANY NAACE E.- C41L FAX STREET ADDRESS �1 CITY,STATE,ZIP PHONE ARCHITECTIENOPIFERNAME A/ /J LICENSENUMBER BUS,LIC.0 COMPANY NM(3 Yr E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF 2 ;,SFD or Du&x Cl blulti-Family, ROOF AREA: VALUATION: STRUCTURE: ❑ Commercial �,( gp:f61, XJ5" DUQ EXISTING ROOF TYPE: 13 BUILT-UP ROOF ❑ASPHALTSHWOLFS .,tWOODSHAKFS ❑WOODSHMGLES ❑OTHER(SPECIFY) REMOVE/REPLACE t'ES IF N0, PLYWOOD F'y l5' ❑ PLYWD OSB PITCH: ROOF ' ❑ r R ' c : ❑ trs- TYP ❑ rnX :12 CLASS A PROPOSED ROOF TYPE: ❑BUILT-UP ROOF KASPHALT SHINGLES ❑WOOD SHAKES ❑Wool)SHMGLFS ❑OTHER ICC-ES REPORT 6 DESCRIPTION OF WORK: �F��F ID35(;- 1o3bo LtoLA R 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 We information I have provided is correct. _j,jaavc read the Description ofWork and verify it is accurate. I agree to comply with all applicable local ordinances and slate laws relating W buildui ' [iru&rize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date:--LD/ zs %-2-- SUPPLEMENTAL -LSUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY. - _If building is associated with a Home Owners Association,provide letter PIAN CHECK TYPE ROMING sur _ of approval from HOA. r,OVER-THE-COUNTER BUILDING PLAN REVIEW _Provide Planning approval to verify if there any restrictions. ❑ eYraEss ❑ PLnNmNr,PLAN xevrew - _Provide copy of Manufacturer's Installation Specifications. ❑ STANDARD ❑ THREE nem Provide signed copy of Cupertino's Teal'-Off Policy. ❑ -01111714: - Reroofdpp_2011.doc revised 03/16111 REROOF TEAR-OFF POLICY COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION ALBERT SALVADOR, P.E.,C.B.O., BUILDING OFFICIAL CUPERTINO 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 (408)777-3228 • FAX(408)777-3333• buildina(a)cuoertino.oro PROJECT ADDRESS 10350- Io3lo0 l_Eo LA Cj' I APNY 3-IS-00-o25 OWNER NAME PHONE EMAIL TORR LActc 5�6Z �5o.9�il�.oZeF STREET ADDRESS lO 1,D 1— LA ��l C. STATE,ZIP �Z FAX 3 Lf� � rlaLo cq 95014 CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC.P COMPANY NAME E-MAB. FAX STREET ADDRESS CITY,STATE,ZIP PHONE 1 UNDERSTAND AND AGREE TO THE FOLLOWING: i. The re-roof project shall comply with all applicable provisions of the 2010 California Codes. 2. 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. 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 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 1/477 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. 7. 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 schedule(]. By my signing below, i certify each of the following is true: I am the property owner or authorized agent to 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 R315 of the 2010 California Residential Code. Signature of Applicant/Agent: Date: 16 Ii ReroofPo1icy_2012.doc revised 10/7/12 OWNER-BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333 • buildinara)cuaertino.oro Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: SITE ADDRESS b'�S�q (03(,o APN � -�Y _ D BPp OWNER NAME -�Pi'll L�L S l� OWNER ADDRESS U3b0 UtGW CT-* 1 C lJ�,17G;M N40,CA ggot, DESCRIPTION OF WORK: We are providing you with an Owner-Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner-Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION (DIRECTIONS:Please read and initial each statement below to signify you understand or verify this information.) _1. 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner- Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material personally, 1, as an Owner-Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner-Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. _th2. 1 understand building permits are not required to be signed by property owners unless they are responsible for e construction and are not hiring a licensed Contractor to assume this responsibility. _3. 1 understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit fled in his or her name instead of my own. _4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. —5. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the Total value of my construction is at least five hundred dollars($500), including labor and materials, I may be considered an"employer" under state and federal law. 6. 1 understand if I am considered an "employer" under state and federal law, I must register with the state and Federal government,withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. _7. 1 understand under California Contractors' State License Law, an Owner-Builder who builds single-family residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. _8. 1 understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s)that result from any latent construction defects in the workmanship or materials. OwnerBuilderFornI 1010.doc revised 04114110 _9. 1 understand I may obtain more information regarding my obligations as an "employer"from the Internal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB)at 1-800-321-CSLB (2752)or www.csib.ca.gov for more information about licensed contractors. _10. 1 am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the party legally and financially responsible for proposed construction activity at the site address listed above. _11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner-Builders as well as employers. _12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors'State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner-Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. CONSTRUCTION LENDING AGENCY (DIRECTIONS:Please complete the following construction lending agency information.) I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) Lender Name: Lender Address: Before a building permit can be issued,this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note:A copy of the property owner's driver's license, form notarization, or other verification acceptabC l�he city may be required to be presented when the permit is issued to verifythe property owner's signature.. Property Owner's Signature: Dale: to/i Z --------------- --------- . (NOTE: The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner-Builder). AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s)to act as my agent(s)to apply for, sign, and file the documents necessary to obtain an Owner-Builder Permit for my project. Scope of Construction Project (or Description of Work): Project Location or Address: Name of Authorized Agent: Tel No Address of Authorized Agent: I declare under penally of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note:A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: OirnerBuilrlerForm 2010.doerevisedoanano