12100028 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 11887 WOODIIILL CT CONTRACTOR:CASTILLO'S ROOFING PERNIIT NO: 12100028
OWNER'S NANIE: LUBIN GEE 1703 CATHAY DR DATE, ISSUED: 10/032012
OWNER'S 1'IIONE: 4082553898 SAN JOSE,CA 95122 PIIONE,NO:(408)251-3565
❑ LICENS11)CONPRACI''O/R'S DECLARATION JOB DESCRIPTION: RESIDE\fIAI,El CONINI ERCLU,
License Class Lic,b T,3�75(o RE-ROOF 18 SQ-TEAR OFF WOOD SHAKE, INSTALL
`- 3 /
30LB
Contra Date �O FELT, INSTALL GAF GRAND CANYON CLASS
hereby affi'm that I am licensed under the provisions of Chnpter 9
(cam menti ng with Section 7000)of Division 3 of the Business&Professions
Code and that my license is in full force and effect.
hereby affirm under penalty of perjury one of the following two 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. Sq.Ft Floor Arca: Valuation:$9500
1 have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the perfommnce of the work for which this
.\I'N Number:36604068.00 Occupanq•'I')pe:
,pcnnil is issued.
API'LICA,N 1'CER'I'I18C.\'PION'
I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct. l agree to comply with all city and county ordinances and state laws relating WITHIN ISO DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives ofthis city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAY F OM LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of die t
.granting of this permit. Additionally,the applicant understands and will comply Issued by: �G Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
SignalBir //T t�`�I DatAll 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.
❑ OWNER-BIALIIER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant, Date:
the following two reasons: ALI,ROOF COVERINGS TO BE CLASS"A"OR BETTER
1,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044, -
Business R Professions Code)
1,as owner Of the property,Bill exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sce.7044,Business d Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Health S Safety Code.Sections 25505.25533,and 25534. I will
hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code.Chapter 9.12 and the
declarations: Ilealth S Safety Code.Section 255312(a)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should 1 use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined b) the Bay Arco Air Quality Management District 1
performance oflhe work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code.Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Ilealth KS Safely Code.Secljons 505.1 533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
Owner or authorized agen
permit is issued. Dote%
I certify that in the performance of the work for which this permit is issued,I shall
not employ my 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 CONSTRUC`VION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,1 must I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or(his permit shall be deenied revoked. work's for which this permit is issued(Sec.3097,Civ CJ
Lender's Name
APPLIO\N'I'CERTIFICATION Lender's Address
1 certify that I have read this application:Bid 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 ,\RCIIITFCI"S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting of permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
AI)OWS: 11887 WOODHILL CT DATE: 10/03/2012 REVIEWED BY: MENDEZ
APN: RPg; VALUATION: $9,500
'TYPE: Minor Building Permit PLAN CIIECK TYPE: Re-roof
PRIMARY PENTAMATION 1SFDWLROOF
Use: SFD or Duplex PERMIT•rYPE: i
WORK
SCOPE
FEE 11) ROOF AREA
fS.r.t
1REROOFFRES 1,800
ddech. P/aa Checl- Plunth. Plan Check Elec•. Plan Check
Fit,,(* Permit Fe..: /'lamb.R.,mit Fe, f 5 P. n•n i.,
t.h d) !mp t hurc•r Pllm,,h:./• Orh,1 Fh.- In;t•
hhsp Month. Gap. Ilr L'Irc lots. te,
NO TE: estinrale does not inchule fees clue to other Departments(i.e. Planning, Public Works, Fire,Sanitary Seiner District,School
District,ele.). These fees are baser/on the hrelintinan information available and are onh•nn estimate Contact the Det or aildn7 info.
FEE ITEMS (Fee Resohaimh 11-053 Eff 711111) FEE QTY/FEE N'IISC ITEMS
l'lun ('heck Fie.
S'uppl. PC Fee
1'h mol,./ddec•h.lEler
Permit Fee: $270.00
Suppl. Insp Fie
P/urnh,'d lerh.1p'lec•
Phtmh.-a•lrrh.,Elec Permit Fee.
Construr•linn Tax:
Adminislrulive/-ee:
Work Without Permit? O Yes (D No $0.00
•I dvunced Planning Fees:
Truvel Uucunhenlatiun Fees: A
Strom, Motion Pee: IBSEISMICR $0.95 Select an Administrative Item
Blda Stds Commission Fee: IBCBSC $1.00
sw TOTALS: $271.951 $0.001 TOTAL FEE: $271.95
Revised: 10/01/2012
ilk
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO,CA 95014-3255
CUPERTINO (408)777-3228 • FAX (408)777-3333• buildingOcupertino.oro
PROJECT ADDRESS '�� Q APN Y
o t
OWNCRNAAIE PHONEQC�_ 5%QCL /E-MAIL
�i
STREET ADDRESS\ I � h1 CITY, STATQQii((.7 -(- _y
CONTACT NAAIE G PHONE^s I ',�\l]EE.MAIL
STREET ADDRESS ` 1\ llJ CITY,STATE. ZIP
Ery` -n Cci
❑OWNER . ❑ OW TR BJUILDER ❑ OWNERAGE.W CONTRACTOR ❑CONTRACTORAGENT ❑ RCHITECr ❑ENGINEER` ❑ D[I ILOPER ❑TENANT
CONTRACTORNAAIE/J/� \ �.,I LICENSENUNBER Z -�/ LICENSF.TYP BUS.LIC.9
1./'I, 6- (Jl-� ✓ Io
COMPANY NAME E-MAIL FA%
STREET ADDRESS n/ \ \ CIT',STATE,ZI'P- 'IL C '(,/�I� PHONE � .' /"—
ARCHITECT/ENGINEERNAME ` l LICENSENUMBER /� BUS:LIC.a YJ�
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF FD or Duplex ❑ Ivlultl-FBOIII) ROOF AREA: VALUATION: /111
STRUCTURE: ❑ Commercial
EXISTING ROOF TYPE: ❑BUILTUPROOF ❑ASPBALTSHINOLES U'OOD SHAKES ❑WOODSHINGLES ❑OTHER(SPECIFY)
REMOVE IItEPLACE 1'ES IFNO. D PLYWOOD ❑ w- El PLYlYD ❑OSB PITCH: ROOF
❑ NO w LAYERS' I 'NES ❑ 5/P' Y E ❑ D ' '(2 LASS' A
PROPOSED ROOF TYPE: ❑BUILT-UPROOF ASP)IALTSHINGLES ❑N'O/ODSHAKrs 13 WOOD SHINGLES ❑OTHER ICC-ES REPORT
DESCRIPTION OF lYORR:
J h s�� // �Lf/� �'J%W�r����.r�`Vs�o� ���ua/• .�,(� Lir%s>S;�
By my signature below,1 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 I have provided i correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and sta(O�aasrula'ng to h ddi onstol Tn. I authorize representatives of Cupenino to enter the above-iddee� fntid pr n for inspection purposes,
Signature of Applical7.i (� Date: ✓ /
SUPPLEMENTAL It ORNIATION REQUIRED OFFICE USEONLY
—If building is associated with a 1-ome OW'ners Association,provide letter - Pua'CHECK TYPE RBlrrmc SLH`
of approval from IIDA. 0..oveli.TBriCOuXTF.R. O: BUILDING VLAN,NEVIEW
Provide Planning approval to verify if there an)'restrictions. LO EXPRESSr1.An'mNr.PLAN REVIEW
Provide copy of Manufacturer's Installation Specifications. O STANDARD '�' F'IREDEF'r
Provide signed copy of Cupertino's"fear-OR Policy. OTHER:
Reroof 1pp_201 Ldoc revised 03116/11