13010110CITY OF CUPERTINO BUILDING PERMIT I .
is 10000 TORRE AVE'.
OWNER'S NAME: TORRE AVENUE PROPERTIES
OWNER'S PHONE:4088622341
LICENSED -CONT CTOR'S `ARATION
License Class Gc #
Contractor h Date, .- Z
I hereby affirm that I am licensed 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.
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.
APPLICANT CERTIFICATION
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) We to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accme against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point sow regulations per Cu ertino Municipal Code, Section
9.18. /7 - :'e? �
❑ - OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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 (See.7044,
Business & Professions Code).
I, as owner of the property, am exclusively contracting withlicensedcontractors to
construct the project (Sec.1044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
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.
I have and will maintain Worker'sCompensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
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. It; 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 be deemed revoked.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
comet. 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
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
111
CONTRACTOR: STATEWIDE ROOFING PERMIT NO: 13010110
INC
5542 MONTEREY RD DATE ISSUED: 01/22/2013
SAN JOSE, CA 95138 PHONE NO: (408)288-8680
JOB DESCRIPTION: RESIDENTIAL U COMMERCIAL"
52 SQ'S INSTALL OVERLAY .60 MIL TPO.ROOFING
SYSTEM
Sq. Ft Floor Area: I Valuation: $28700
APN Number: 36902030.00 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FR T CALLED INSPECTIO
C./ RE -ROOFS:
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 Applicant: Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the -.
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Mun pa Code, Chapter 9.12 and
cy
the Health & Safety Code, Seo0�5ry2 =553
Owner or authorized
CONSTRUCTION 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, Civ C.)
Lender's Name
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records. -
Licensed
CUPERTINO
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 O�,
(408) 777-3228 • FAX (408) 777-3333 • buildingo()cuoertino.org ^ O\
PROJECT ADDRESS 10000 Torre Avenue
APN % , o Z - 03 d
msµ-
OWNERNAME Apple, Inc. �iG e_* 6,t
PHONE
0141
E-MAIL
STREET ADDRESS 1 Infinite Loop
CITY, STATE, ZIP Cupertino, CA 95014
FAX (408) 255-2337
CONTACT NAME Michael Courtney
PHONE 408-286-7828
E-MAIL mcourtney@swroof.net
STREET ADDRESS 5542 Monterey Road, #201
CITY, STATE, ZIP San Jose, CA 95138
FAX 408-286-7820
❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT IX CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME Michael Courtney
LICENSENUMBER 803926
LICENSE TYPE C39
BUS. LIC. ft 23509
COMPANY NAME Statewide Roofing, Inc.
EMAIL mbotill@swroof.net
FAX 408-286-7820
STREET ADDRESS 5542 Monterey Road, #201
CITY, STATE, ZIP San Jose, CA 95138
PHONE 408-286-7828
ARCHITECTIENGINEER NAME
LICENSE NUMBER
BUS. LIC. #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ SFD or Duplex ❑ Multi -Family
STRUCTURE: K Commercial
ROOF AREA:
5,200 sq ft
VALUATION:
$28,700
EXISTING ROOF TYPE: INBUILT-UPROOF ❑ ASPHALT SHINGLES 11 WOOD SHAKES ❑WOOD SHINGLES ❑ OTHER (SPECIFY)
REMOVE/REPLACE IINYFS
❑ NO
IF NO,
#LAYERS:
PLYWOOD I S" ❑
THICKNESS: ❑ 516"
PLYWD ❑OSB
TYPE: IN CDX
PITCH:
25 '12
ROOF
CLASS: A
PROPOSED ROOF TYPE: IX BUILT-UP ROOF ❑ ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER
ICC -ES REPORT #
DESCRIPTION OF WORK:
Install a .60 mil TPO overlay roofing system.
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 I have provided is corre . I hW read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relati buildin o . thorize representatives of Cupertino to enter the above -identified property for spec ion purposes.
Signature ofApplicanUAgen Date: Z �3
SUPPLEMENTAL INFORMATION REQUIRED
_ If building is associated with a Home Owners Association, provide letter
of approval from HOA.
Provide Planning approval to verify if there any restrictions.
_ Provide copy of Manufacturer's Installation Specifications.
Provide signed copy of Cupertino's Tear -Off Policy.
OFFICE USE ONLY
PLANCHECKTYPE
ROUTINGSLIP
OVER-THE-COUNTER
!!!❑ EXPRESS
❑ STANDARD
❑ BUILDING PLAN REVIEW
❑ PLANNING PLAN REVIEW
❑ FIRE DEPT
❑ OTHER:
A� Reroq(App_201 Ldoc revised 03/16/11
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
JAI
ADDRESS: 10000 TORRE AVE DATE: 01/22/2013
APN: 369 02 030 BP#:
REVIEWED BY: MELISSA
VALUATION: $28,700
*PERMIT TYPE:, Building Permit
Plumb. Plan Check
PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building
USE:
Plumb. Pv"il Fee:
PENTAMATION 1COMMLROOF
PERMIT TYPE:
WORK
52 SQ'S INSTALL OVERLAY .60 MILL TPO ROOFING SYSTEM
SCOPE
AIech. Imp. Fee:
Plumb. Insp. Fee.'
NOTE., This estimate does not include fees due to other Departments (le. Planning, Public Works, Fire, Sanitary Sewer District, School
Dictriet eto-)- Theca faec are hnced on the nroliminam infarma8nn avnilohle and are anly an ecdmate_ Confarl the Dent for addo'l info:
FEE ITEMS (Fee Resolution 11-053 E . 711112)
FEE
QTY/FEE
hfech. Plan Check'-
Plumb. Plan Check
Elec. Plan Check
- Xleck Permit Fee:. -
Plumb. Pv"il Fee:
Elec. Permit Pee:
Other,11ech. Insp.
Other Plumb Imp.07-
Other Elec. Insp. Li
AIech. Imp. Fee:
Plumb. Insp. Fee.'
Elec. Insp, Fee:
NOTE., This estimate does not include fees due to other Departments (le. Planning, Public Works, Fire, Sanitary Sewer District, School
Dictriet eto-)- Theca faec are hnced on the nroliminam infarma8nn avnilohle and are anly an ecdmate_ Confarl the Dent for addo'l info:
FEE ITEMS (Fee Resolution 11-053 E . 711112)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
E250 s.f. Re -roof
$534.00 IREROOFCOM
Suppl. PC Fee: Q Reg. Q OT
FO.0
Thrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee -.0 Reg. Q OT
0,0
Ins
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
-
Construction Tax:. -
Administrative Fee:
7-1
Work Without Permit? 0 Yes Q No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential G
Building or Structure
i
Trm,el Documentation Fees:
Strong Motion Feer IBSEISMIC0
$6.03
Select an Administrative Item .
Bldg Stds Commission Fee: IECESC
$2.00
MMI
$8.031
$534.001,4
542.03
�. \ Revised: 10/01/2012