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12120007 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10211 S DE ANZA BLVD CONTRACTOR:WESTSHORE ROOFING PERMIT NO: 12120007 INC OWNER'S NAME: MIKENARDY LLC 2245-A FORTUNE DR DATE ISSUED: 12/04/2012 OWNER'S PHONE: 4087250299 SAN JOSE,CA 95131 PHONE NO:(408)694-0060 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL U COMMERCIAL License Class C Lie.# 7<3: 7 22. I COMM.RE-ROOF 150 SQ REMOVE AND REPLACE COMP Contracto MaVDate 1 t SHINGLES,CLASS A I hereby affirm that I am licensed'under/the provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. I 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 Area: Valuation:$5255 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 APN Number:35910060.10211 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAY M LAST CALLED INSPE ION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the C granting of this permit. Additionally,the applicant understands and will comply Issued by: Date: with all non- oint source regulations per the Cupertino Municipal Code,Section 9.18. I 1 RE-ROOFS: Signature Date ` l All roofs shall be inspected prior to any roofing material being installed.If a roof is installed without first obt 'ning an inspection,I agree to remove all new materials for inspection. ❑ OWNER-BUILDER DECLARATION L I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Dater the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I,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&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(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 I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with thffupertino unicipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sectio ,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date: permit is issued. I certify that in the performance of the work for which 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 California. If,after making this certificate of exemption,1 CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address I certify that I have read this application and state that the above information 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 ARCHITECT'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 this 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 REROOF PERMIT APPLICATION A/ COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION bD 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 \� CUPERTINO (408)777-3228• FAX(408)777-3333•buildingecuoertino.om \� 1,071/ y PROTECT ADDRESS5, O [f V �I ✓ - APNk �Sq 1(D V(C,ry�) XOWNERNAME VO,K4� ,5ktetih ' XP lT/ / &MAIL STREETADDRESS 6¢7 -rant' vAY. CITY, STATE,ZIP II/'04�L N Vie r„/ FAX CONTACT NAME PHONE Vie STREET ADDRESS CITY,STATE,ZIP FAX ❑OWNER ❑ OWNER-BUIDER ❑ OWNERAGENT ❑ CONTRAMR ❑CONTRACrORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTORNAME I,0 eo roo n LICENSE NUMBER 78 722I LICENSETYPE c-'301 BUS.LIC.# X COMPANY NAME RS C40vt 11au(WESPS��P@ jCj0VJC0FAX 100 451-02-?,j STREET ADDRESS2245 , 1 fbrtuno_ Oke CITY,STATE,ZIP /o1 /J o PH'4 ✓ .lL •T o 45b-coc>o ARCHTTECT/ENGIJEERNAME LICENSE NUMBER BUS.LIC.# COMPANY NAME EMAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑ SFD or Duplex ❑ Multi-Family ROOF AREA: VALUATION: J srRucruRE: Commercial / 5-co SQF� , 2J5:1� EXISTING ROOF TYPE: ❑BUB.T-UP ROOF ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHR4GLES ❑OTHER(SPECIFY) REMOVE/REPLACE YES IFNO, PLYWOOD ❑ w ❑ PLYWD ❑OSB Pam: ROOF ❑ 0 # ❑ 5/S" TYPE ❑ DX '12 CLASSA PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT# DESCRIFTIONOFWORK: F(?PUOVeyUI,-, vt ConcP rco� sc�-.er �e _ L/1 S By my signature below,I certify to each of the following: lam the property owner or authorized agent to act on the property owner's behalf I have read this application and the information I ve 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 state laws relatin ilding construction. I authorize representatives of Cupertino to enter the above- ntiti property for inspection purposes. Signature of Applicano'Agent: Date:-12—,N � 7 SUPPLEMENTAL INFORMATIONREQUIItED If building is associated with a Home Owners Association,provide letter PLs`e�ctcTycEg - r': NovrlNc v � iSx var,. of approval from HOA. weit_Tt -co ., "stnLDuo FL.ANREV)[E _Provide Planning approval to verify if there any restrictions. x gI p ' 'd pLeY*N'REE' tp Provide copy of Manufacturer's Installation Specifications. DEPT a f� —Provide signed copy of Cupertino's Tear-OffPolicy. ReroofApp_201 Ldoc revised 03116111 REROOF TEAR-OFF POLICY COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION ALBERT SALVADOR, P.E.,C.B.O., BUILDING OFFICIAL C U P E RT I N O 10300 TORRE AVENUE-CU PERTI NO, CA 95014-3255 (408)777-3228•^FAX(408)777-3333- buildina(cocupertino.ora PROJECT ADDRESS ,//(9? / Q /y„ ? I./ r �Q APNG4� OWNER NA20E a/ n I l-Ateiil.. , 1✓` (V PHONE 23 671-3,522 I 352 E-MAIL STREET ADDRESS/.✓L(�( �A 1.I J CITY,STATE,ZIP.e�n& , i e. / ! FAX CONTRACTOR NAIAE ��fh�t(f O�W� F LICENSE NUNMER�p��V�� (' I/ ILIfCEEN/SE/TYPPPEC�/] BUS.LIC.9 COMPANY NAME �.IVV`� 4(:) V� G�C EMAIl. Q,O_. I�^�, J�1fP(2 (CI,OUQ' FAX�IJ�r {.��D'f 2✓ STREET ADDRESS 2-7&y /I L.�,A�, � C Ty.STATE.ZIP,t r(�a� !V PHONE f-OF J4 b —0 22a o 7JJ r{ II((1UND+`-ERSTAND AND AGREE TO THE FOLLOWING: 1. The re-roof project shall comply with al] 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/d' 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 scheduled. 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 t ctors are required to be installed in accordance with Sections 8314 and R315 of the 2010 California Resident'al Code. I I / 1 Z Signature of Applicant/Agen . Date: l l RerooJPolicy_2012.doc revised 10/7/12 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION :C11 ADDRESS: 922 er Dr DATE: 12/04/2012 REVIEWED BY: mendez APN: BP#: 'VALUATION: $5,255 *PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof PRIMARY Commercial Building PENTAMATION 1COMMLROOF USE: PERMIT TYPE: WORK RE-ROOF 150 SQ REMOVE AND REPLACE COMP SHINGLES CLASS SCOPE FEEID ROOF AREA S.f. 1REROOFCOM 1,500 hteeh. Plan Check Phunb, Plan C'hcek Elea Plan Check rLledt. Permil Fee: Plumb. Permit Eire•: flee. Permit Fee: Other Wch. Insp. Other Plumb Insp. Other Elee.Insp. Li .Meeh. Insp. ree: Plumb. htsp.Fee: Elce.Insp.fee: NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District etc.). These ees are based on the. relimina in ormadon available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff Z1/12J FEE QTY/FEE MISC ITEMS Plan Check Fee: Suppl. PC:'Fee Plumh./Mech./Elec: Permit Fee: $367.00 Suppl. hisp Fee Plumb./Me ch./Elec Plumh.IMech.10ec Permit Fee: Construction Tar: Administrative Fee: Work Without Permit? ® Yes O No $0.00 Advanced Planning,Fees: Travel Documentation Fees: Strong Motion Fee: 1BSEISMCO $1.10 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 $369.10 $0.00 TOALFEE:r. $369.10 Revised: 10/01/2012 Building Department City Of Cupertino 10300 Torre Avenue Cupertino,CA 95014-3255 Telephone: 408-777-3228 C U P E RTI NO Fax: 408-777-3333 CONTRACTOR/SUBCONTRACTOR LIST JOB ADDRESS: /OZ(,c,.. , ; Za PERMIT# OWNER'S NAME: av -4 e\n PHONE# GENERAL CONTRACTOR: o e K0 NC BUSINESS LICENSE# ADDRESS: a-q75 - "( U CITY/ZIPCODE• aot ASP CO- My-f-- *Our municipal co-- .-,-..-- all busiaesses 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 S CONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors:: Z ` — Signature Date Please check applicable subcontractors and complete the following information: ✓ SUBCONTRACTOR BUSINESS NAME 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 Z +Z �� Owner/-t'ontractor Signature Date