11100041CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10852 ALDERBROOK LN I CONTRACTOR: CASTILLO'S ROOFING I PERMIT NO: 11100041 I
OWNER'S NAME: PRAY- SILVER JANE TRUSTEE 1 1703 CATHAY DR I DATE ISSUED: 10/06/2011
OWNER'S PHONE: 6504655208
L LICENpS,ED CONTRACTOR'S DECLARATION
License Class [ Lic. # Z4 •�C>4f5 �
l
Contractor C4�ti(l0 "5 �rx ,-,� Date tp-
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:
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) 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.
Signature Date /0� % -1
OWNER- BUILDER DECLARATION
I ..creby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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
construct the project (Sec.7044, 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'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.
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, 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
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,
cots, and expenses which may accrue against said City in consequence of the
'ng of this permit. Additionally, the applicant understands and will comply
all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
SAN JOSE, CA 95122
PHONE NO: (408)251 -3565
BUILDING PERMIT INFO: BLDG J_ ELECT f— PLUMB I-
MECH f— RESIDENTIAL COMMERCIAL
JOB DESCRIPTION: RE -ROOF TEAR OFF WOOD SHAKE INSTALL NEW
ASPHALT
SHINGLES CLASS A 18SQ
Sq. Ft Floor Area: I Valuation: $7741
APN Number: 36920036.00 I Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 1 AYS OF PERMIT ISSUANCE OR
180 DA OM LAST CALLED INSPECTION.
Issued by: V r� // Date:
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. I --
Signature of Applicant: �.� ( Date: /C)_ _ l/
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 Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
Owner or Guth ed a en
g „r - Date:�� el
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
Lender's
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Signature Date I Licensed Professiona
3 ITEMS OF 3
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 36920036.00
DATE ISSUED.......: 10/06/2011
RECEIPT # ......... BS000014969
REFERENCE ID # ...: 11100041
SITE ADDRESS 10852 ALDERBROOK LN
SUBDIVISION ......
CITY CUPERTINO
IMPACT AREA ......
OPERATOR: patg
COPY # : 1
OWNER PRAY- SILVER JANE TRUSTEE
ADDRESS 10852 ALDERBROOK LN
CITY /STATE /ZIP ...: CUPERTINO, CA 95014
RECEIVED FROM
CONTRACTOR ...
COMPANY ......
ADDRESS ......
CITY /STATE /ZIP
TELEPHONE ....
CASTILLO'S ROOFING
JOSE CASTILLO LIC # 2585C
CASTILLO'S ROOFING
1703 CATHAY DR
SAN JOSE, CA 95122
(408)251 -3565
FEE ID UNIT
QUANTITY
AMOUNT
PD -TO -DT
THIS REC
---- - - - - --
NEW BAL
---- - - - - --
---- - - - - -- ------- - - - -
1BCBSC VALUATION
-- ---- - - - - --
7,741.00
---- - - - - --
1.00
---- - - - - --
0.00
1.00
0.00
1BSEISMICR VALUATION
7,741.00
0.77
0.00
0.77
0.00
1REROOFRES SQ FEET
18.00
252.00
0.00
- - --
252.00
---- - - - - --
0.00
---- - - - - --
TOTAL PERMIT
---- - - - - --
253.77
---- - -
0.00
253.77
0.00
METHOD OF PAYMENT
--------------- --
CHECK
TOTAL RECEIPT
AMOUNT
---------------
253.77
---------------
253.77
VOICE ID DESCRIPTION
-- - - - - -- ---------------------- - - - - --
309 EXTERIOR LATH
601 ROOF TEAR OFF
REFERENCE NUMBER
--------------- - - - --
#17375
VOICE ID DESCRIPTION
-- - - - - -- ---------------------- - - - - --
311 SCRATCH COAT
602 ROOF PLYWOOD NAIL
604 ROOF IN- PROGRESS 605 FINAL REROOF
CUPERTINO
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
(408) 777 -3228 • FAX (408) 777 -3333 • building a cupertino.org
PROJECT ADDRESS ! S (� y \ _ V_
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APN #
OWNER NAME �' ` . i,
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STREET ADDRESS O CITY, STATE, ZIP U +) iJ / t / V�'�7
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.. FAX
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APPLICANT NAME
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PHONE �.
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STREET ADDRESS � b.7 ! l j \ r
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CITY, STATE, ZIP _ G Q CA �S i
FAX
❑ OWNER ❑ OWNER- 1331J/ILDER OWNER AGENT 1 CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
LICENSE NUMBER Z ^ Li ` k
LICENSE TYPE
BUS. LIC. #
COMPANY NAME C7V( 1 fl
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E-MAIL lL � '745 ( l) ' C'(�jyl
FAX
STREET ADDRESS —7 ``__
17 CJ�j ol%k �r
CITY, STATE, ZIP (� /�
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PHONE _
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ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC. #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF or Duplex ❑ Multi- Family
STRUCTURE: ❑ Commercial
ROOF AREA:
' s
VALUATION:
EXISTING ROOF TYPE: ❑ BUILT -UP ROOF 90ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER (SPECIFY)
REMOVE /REPLACE 9YFS
El No
I IF NO, ^
# LAYERS: °'�
PLYWOOD ❑ W. ❑
THICKNESS: El /8
PLY WD ❑�, /OSB
TYPE: lu CDX
PITCR.
' i Z
ROOF
CLASS: A
PROPOSED ROOF TYPE: ❑ BUILT -UP ROOF WAS.-HALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER
ICC -ES REPORT #
i,
DESCRIPTION OF WORK T r 12-
d Q —T_ cJ 1 1 ",b 2t "o
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 ' �authorize.representatives of Cupertino tc enter the above - identified propert; For inspection purposes.
Signature ofApplicant/Age Date:
SUPPLEMENTAL INFORMATION REQUIRED
_ If building is associated with a Home Owner's Association, provide letters
of approval from HOA.,
Provide Plannin g approval to verify if there any restrictions.
Provide copy of Manufacturer's Installation Specifications.
Lzt-lovide signed copy of Cupertino's Tear -Off Policy.
.- -^
ReroafApp_2011.doc revised 03102111
��,�� CITY OF CUPERTINO
I CI FF.F ESTIMATOR — BUILDING DIVISION
imlADDRESS: 10852 alderbrook In.
FEE
DATE: 10106/2011
REVIEWED BY: bobs.
APN:
BP #:
"VALUATION: 1$7,741
'PERMIT TYPE: Minor Building Permit
PLAN CHECK TYPE: Re -roof
PRIMARY
USE: SFD or Duplex
PENTAMATION 1 SFDWLROOF
PERMIT TYPE: A
WORK
tear off wood shake install new asphalt shingles
SCOPE
FEE ID ROOF AREA
s.f.
1 REROOFFRES 1,800
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
I)ictrirt_ Pte L ThvcP fees are haced on the nrelindnary information available and are only an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution I1-053 I . 7,'U11)
FEE
QTY/FEE
MISC ITEMS
Permit Fee:
$252.00
f 1
_T__Ti
Work Without Permit? 0 Yes 0 No
$0.00
i
Strom Motion Fee: IBSEISMICR
$0.77
Select an Administrative Item
Blda Stds Commission Fee: 1BCBSC
$1.00
SUBTOTALS: >
$253.77
$0.00
TOTAL FEE:
$253.77
Revised: 10/01/2011
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014 -3255
Telephone: 408 - 777 -3228
U P E RT I N O Fax: 408 - 777 -3333
CONTRACTOR / SUBCONTRACTOR LIST f
JOB ADDRESS: og �
b f ocl� i, �a,,
PERMIT
V
OWNER'S NAME: ���� ►lve
_
PHONE # 6
GENERAL CONTRACTOR: a
BUSINESS LICENSE #
ADDRESS: `R03 ' a �r
CITY /ZIPCODE: ' �►-�� `' S12Z
*Our municipal code requires all Businesses working in the city to have a City of Cupertino nusmess ncense.
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: r4g�- -
ell Signature Date
Please check applicable subcontractors and complete the following information:
�
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
lumbing
'
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner / Contractor Signature
/C) -(e---) - ((
Date