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12120087 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10480 ANN ARBOR AVE CONTRACTOR:C&C ROOFING PERMIT NO: 12120087 OWNER'S NAME: SAUL CHAIKIN 89 S 21 ST DATE ISSUED: 12/17/2012 OWNER'S PHONE: 4082550722 SAN JOSE,CA 95116 PHONE NO:(408)298-1868 ❑ LICENSED CONTRACTOR'S DECLARATIONF BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# Zq - F f— MECH RESIDENTIAL COMMERCIAL Contractor C 1j-6 a,C , t Date /L - ;2- -/ I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REMOVE SHAKE ROOF OF GARAGE INSTALL 1/2 CDX (commencing with Section 7000)of Division 3 of the Business&Professions REROOF Code and that my license is in full force and effect. 50 YEAR COMP 9 SQFT CLASS A 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. 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 permit is issued. Sq.Ft Floor Area: Valuation:$6400 APPLICANT CERTIFICATION 1 certify that I have read this application and state that the above information is APN Number:32628019.00 Occupancy Type: 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 indemnify and keep harmless the City of Cupertino against liabilities,judgments, PERMIT EXPIRES IF WORK IS NOT STARTED costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non-point source regulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION. 9.18. Signature ��t��O�i���s�..—Date12 -/ - Z Issued b _ Date;/Z_— 7 ❑ OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS: the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is 1,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I agree to remove all new materials for will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection. Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: � ,��� � _y. Date: /�-/ -`� construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE 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 read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& 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. permit is issued. Additionally,should I use equipment or devices which emit hazardous air 1 certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District I will not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Compensation laws of California. If,after making this certificate of exemption,I health&Safety Code,Sections 25505,25533,and 25534. 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. Ower or authorized a nt: -� Date:_LL�1 Z APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY 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 I hereby affirm that there is a construction lending agency for the performance of wrk's to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.) upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the Lender's Address granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION 9.18. I understand my plans shall be used as public records. Signature Date Licensed Professional REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPER`t`INO (408)777-3228• FAX(408)777-3333•build ingecupertino.orcl PROJECT ADDRESSAPN# �L J /0'/- 90 h♦^ ,-^ OWNER NAME PHONE E-MAIL STREET ADDRESS CITY, STATE,ZIP FAX CONTACT NAME C PHONE E-MAIL STREET ADDRESS CITY,STATE,ZIP FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ® CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME L'� 2'/C LICENSE NUMBER l/S 1` G LICENSE TYPE BUS.LIC.# COMPANY NAME E-MAIL G' 6 G'- /'O(►;,c/lu STREET ADDRESS CITY,STATE,ZIP . r , PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC.# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF P'SFD or Duplex ❑ Multi-Family ROOF AREA: VALUATION: STRUCTURE: ❑ Commercial r EXISTING ROOF TYPE: ❑BUILT-UP ROOF ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY) REMOVE/REPLACE YES IF NO, PLYWOOD A" ❑ PLYWD ❑ OSB PITCH: 7 ROOF NO #LAYERS, THICKNESS: 135/8" TYPE: CDX '12 CLASS: A PROPOSED ROOF TYPE: ❑BUILT-UP ROOF HI T SHINGLES ❑WOOD SHAKES C1WOOD SHINGLES 11OTHER ICC-ES REPORT# A DESCRIPTION OF WORK: Ear a a' r e4 � 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 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 relating to build/in;construction. I authorize repr/eseatatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: /����G���f L _G_ .L�. Date: 12 SUPPLEMENTAL INFORMATION REQUIRED otcE USE ONLY _If building is associated with a Home Owners Association,provide letter P»CIIE�Tlw- '°° xouitx SUP of�f approval from HOA. �TI1W-COUNTER l�D*d PIAN REVIEW •'Provide Planning approval to verify if there any restrictions. [] ExrREss, L7 PI AHTNINGPLANREVIEW IZ-60-vide copy of Manufacturer's Installation Specifications. .STAND RD: D FIRE DEPT, , r"Provide signed copy of Cupertino's Tear-Off Policy. OTR ReroofApp_2011.doc revised 03/16/11 CITY OF CUPERTINO FEE ESTIMATOR— BUILDING DIVISION ADDRESS: 10480 ann arbor ave. DATE: 12/17/2012 REVIEWED BY: bobs. APN: BP#: *VALUATION: 1$6,400 q*PERMITTVPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY SFD or Duplex PENTAMATION 1 SFDWLROOF USE: p PERMIT TYPE: WORK SCOPE Ot '—Aii' Ll 11<,i 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: p .c? ,,,n, ,¢2 s PERMIT# 00 OWNER'S NAME: L, v PHONE# ? cr9 GENERAL CONT TOR: G �� r BUSINESS LICENSE# ADDRESS: T CITY/ZIPCODE:�u � e'` ' *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 CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: rl! ��--/ z 2 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 1`2 Owner/Contractor Signature Date