13010029 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21114 GREENLEAF DR CONTRACTOR:QUALITY FIRST HOME PERMIT NO: 13010029
IMPROVEMENTS
OWNER'S NAME: TAKANO TAIKO 6545 SUNRISE BLVD STE 202 DATE ISSUED:01/03/2013
OWNER'S PHONE: 4087258264 CITRUS HEIGHTS,CA 95610 PHONE NO:(916)788.2921
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL Ll COMMERCIAL
License Class^p Lie.# RE-ROOF 38 SQ-REMOVE EXISTING COMP,REPLACE W/
Gp t;�1 Fhra r TIMBERLINE HD CLASS A
Contractor MvnE- S+��rova..+e- 'Date 3 /Z
1 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:
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. Sq.Ft Floor Area: Valuation:$18845
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 for which this APN Number:32628098.00 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 WITHIN80 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 DA=LAST M 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 the
Date:
granting of this permit. Additionally,the applicant understands and will comply Issued by:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signaturee�� Date 3 /Z 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.
❑ OWNER-BUILDER DECLARATION 1013 /-,—
Signature of Applicant Date: /
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: ALL OOF 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&Professions Code)
1,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. 1 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 the Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 255 ,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date: 11311�--
permit is issued.
1 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,I 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.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 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 PERMT APPUCAMON
COM&NITY DEVELOPNFMMr DEPARTWW•BUILDING DIVISION
10300 TORRE AVENUE"CUPB:MNO,CA 95014-3255
CUPERTINO (40B)777-3228"FAX(408)777-3333"Lxi1cIngCd)xyerfinD.ag
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SIRIICIURE ❑ Oormlercial 3900 t!J l v, sqS
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By
try sggaturebelow,Icatifytoeach ofthefollowfi* I mtbe property ommer or autbonzedagent to act on the property ownerIs behalf. IhavereadtWs
application and the mfornation i havepmvidedis correct I haveneaddn Description ofWodc and verify it is aaavate. Iagree to comply with all applicable local
aditances and state laws relating to building 'oa Iautlacruereprsateaves of Cupertino to enter the above-identified poperty for uEpection ptapases.
Signatnae ofApplicanVAgatt Date 2
SUPP ALnquuAATioNRBQumEA S .i`s €tg3 9 I'P'Ii-" ai � 7: `,t '';t..p..,I WDM
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If Madding is associated with aHome Owraa's Association provide letter
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of approval ficin HOA
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Provide Plam ing approval to verify iftlaae any restrtetiors
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Provide copy of Mantffachaa's Installation Specifice<iaas. m ,:y R❑.._ te'''a{£� •.a
Provide sig ied oopy of mm's Tear-0ff'PDlicya
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Rai fApp 2011.doc revised 03,76111
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 21114 GREENLEAF DR DATE: 01/03/2013 REVIEWED BY: MENDEZ
APN: BP#: `VALUATION: $18,845
*PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD or Duplex PENTAMATION 1SFDWLR00F
USE: PERMIT TYPE:
WORK
SCOPE
FEE ED ROOF AREA
s.f'.
1REROOFFRES 3,800
:;,9'.fN3
Xlech.Plan Check Plumb,Plan Check Elec.Plan Check
,btech. Permit Fee: I Plumb.Permit Fee: I Elec. Permit Fee:
Other Meeh.Ins. Other Plumb In.sp. Li Other Elee.Insp.
A(ech.Insp. Fiat: Plumb. Insp.Fee: Elec.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 prefinntlina in ormation available and are only an estimate. Contact the Dept for addn'1 info.
FEE ITEMS(Fee Resolution 11-053 Eff. LLI21 FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Suppl. PC Fee
Plumb./dlech./Elec
Permit Fee: $570.00
Supp/. InspFee
Plumb.11lech./13lee
Plumb.4fecb./0ee Permit Fee:
Construction Tarr:
Administrative Fee:
Work Without Permit? 0 Yes O No $0.00
Advanced Plarminsg Fees:
Travel Doctunentation Fees:
Strong Motion Fee: 1BSEISMICR $1.88 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00
In mo. $572.88 $0.00AL FEE $572.88
Revised: 10/01/2012
At REROOF TEAR-OFF POLICY
0 COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
CU P E RTI N O 10300 TORRE AVENUE-CUPERTINO, CA 95014-3255
(408)777-3228-FAX(408)777-3333-buildinoCo)cuoertino.oro
PROJECT ADDRESS APN M
OWNERNAME ko
PHO E-MAB.
STREETADDRESs 1 'taiNerl W1VL Cr1Y, STATE,ZIP � ' FAX
CONTRACrORNAMEt I r LICENSENUNMER 2 1 13
LICENSE TYPE BUS.LIC.9
CCIWANYNAME (-f`�. — E-MAIL FAX
nsl
STREET ADDRESS n� r M CITY,STATE,ZIP qPHONE
Cly- `7Soo$ 40g 329 16
I UNDERSTAND AND AGREE TO THE FOLLOWING:
1. The re-roof project shall comply with ali 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 1/4" 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 detectors are required to be installed in accordance with Sections R314 and R315 of
the 2010 California Residential Code.
Signature of Applicant/Agent: Date: /
ReroofPo1icy_2012.doc revised 10/7/12
s Building Department
�t
r. City Of Cupertino
10300 Torre Avenue
Rvr. Telephone: 408-777-3228
C O P E RT I N O Fax: 408-777-3333
CONTRACTOR f SUBCONTRACTOR LIST
JOB ADDRESS: Zf ltE Dry v2 PERMIT#
OWNER'S NAME: ,. PHONE# 7-Z 5—— 8
GENERAL CONTRACTOR. Ck `ll , 4 <- FS, ss BUSINESS LICENSE#
ADDRESS: -94/4"w. e rt CITY/ZIPCODE: Ca 6_U `Too
*Our municipal code requires>"businesses;worldng 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 CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors: I
Signature liate
Please check applicableasubco 'actors and complete the following information:
t/ SUBCONTRACTOR' BUSINESS NAME BUSINESS LICENSE #
Cabinets & Millwork '
Cement Finishing
Electrical
Excavation
Fencing r`
Flooring/Carpeting
Linoleum/Wood
Glass/Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting/Wallpaper<;
Paving
Plastering
Plumbing
Roofing
Septic Tank is
Sheet Metal
Sheet Rock
Tile
Owner l Contrabfor'Siignature Date