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11100209 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10839 BROOKWELL DR CONTRACTOR:SIMON SAYS ROOFING PERMIT NO: 11100209 OWNER'S NAME: TIAN YONGRAN AND YE DAN 3012 BECKLEY DR DATE ISSUED: 10/31/2011 OWNER'S PHONE: 4082032693 SAN JOSE,CA 95135 PHONE NO:(408)531-9700 L LICENSED CONTRACTOOR-74:9`'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT f— PLUMB License Class Lic.# V v ` 9 2Q r MECH RESIDENTIAL COMMERCIAL Contractor �� D lV Date !� �>� I I hereby affirm that I am licensed un r the provisions of Chapter 9 JOB DESCRIPTION:RE-ROOF TEAR OFF WOOD SHAKES,INSTALL 30 YEAR COMP SHINGLES CLASS A 22SQ (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 Sq.Ft Floor Area: Valuation:$9000 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:36921031.00 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. 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. c Issued by:T Date Signature E�g� G� t!n, Date OWNER-BUILDER DECLARATION RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for the following two reasons: inspection. 1,as owner of the property,or my employees with wages as their sole compensation, 7 7 L Ur –"2/2 will do the work,and the structure is not intended or offered for sale(Sec.7044, Signature of Applicant: Date: .X 4/! Business&Professions Code) / I,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534. 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 OwnerVF horize become subject to the Worker's Compensation provisions of the Labor Code,I must Dater `�G' forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of Wrk's I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.) correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address indemnify and keep harmless the City of Cupertino against liabilities,judgments, co-;,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION ng of this permit.Additionally,the applicant understands and will comply v.. _all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. Licensed Professional Signature Date CITY OF CUPERTINO 3 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36921031. 00 DATE ISSUED. . . . . . . : 10/31/2011 RECEIPT #. . . . . . . . • : BS000015187 REFERENCE ID # . . . : 11100209 SITE ADDRESS . . . . . : 10839 BROOKWELL DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : TIAN YONGJIAN AND YE DAN ADDRESS . . . . . . . . . . : 10839 BROOKWELL DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : SIMON SAYS ROOFING CONTRACTOR . . . . . . . : DARRYL SIMON LIC # 23053 COMPANY . . . . . . . . . . : SIMON SAYS ROOFING ADDRESS . . . . . . . . . . : 3012 BECKLEY DR CITY/STATE/ZIP . . . : SAN JOSE, CA 95135 TELEPHONE . . . . . . . . : (408) 531-9700 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 9, 000. 00 1. 00 0. 00 1. 00 0 .00 1BSEISMICR VALUATION 9, 000 . 00 0 . 90 0. 00 0 . 90 0. 00 1REROOFRES SQ FEET 22 .00 308 . 00 0. 00 308 .00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 309 . 90 0. 00 309. 90 0 . 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 309 EXTERIOR LATH 311 SCRATCH COAT 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 604 ROOF IN-PROGRESS 605 FINAL REROOF vv �c� REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 CUPERTtN4 (408)777-3228• FAX(408)777-3333 • buildino(5.cupertino.org PRO=ADDRESS - iy, ,q o K / p L J07A,# IL3 (oq �)a�_ OWNER NAME �X v PHO n j1 E-MAIL STREET ADDRESS �/ L CITY STATE ZIP FAX APPLICANT NAME TPHON]rE-MAIL STREET ADDRESS CITY,STATE, ZIP FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAMEC- I LICENS NUME LICENSE TYPE BUS.LIC.# 7j)qt COMPANY NAME � �(,/ E-MAIL FAX STREET ADDRESS C ST Z7 y�S p� '-+ _ PHONE ARCHITECI'/ENGINEER NAME LICENSE NUMBER �j- BUS.LIC.# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE usE of SFD or Duplex ❑ Multi-Family ROOF AREA: VALUATION: STRUCTURE: ❑ Commercial 2 Z co 74000 EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑o=(SPECIFY) REMOVE/REPLACE Q Y�FS IF NO, �J PLYWOOD h" ❑ PLYWD OSB T�C_11-_,Oy ROOF ❑ NO #LAYERS: +- THICKNESS: Elvs- TYPE: 13CDX '12 SS: `4 PROPOSED ROOF TYPE: ❑BUILT-UP ROOF CASPHALT SHINGLEs ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT# DESCRIPTION OF WORK: ,/- n6} �S(3 4-- A' 2 O / I`e By my signature below,I certify to each of the following: I am the perty 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 Lhave 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.ingconstructs . authoriz;representatives of Cupertino Lc,enter the above-identified proper,for inspection purposes. Signature ofApplicant/Agent Date: �� .,��� 2O11 SUPPLEMENTAL INFORMATION REQUIRED If building is associated with a Home Owner's Association,provide letter of approval from HOA. Provide Planning approval to vesfY If there any restrictions. s;= p� _ z p�AIDFO'r�nrurvrFw _Provide copy of Manufacturer's Installation Specifications. Ovide Signed copy of Cupertino's Tear-Off Policy. s = _ iT � - ReroofApp_2011.doc revised 03/02/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10839 brookwell dr. DATE: 10/31/2011 REVIEWED BY: bob s. APN: BP#: '"VALUATION: 1$9,000 ;'PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof PRIMARY SFD or Du lex PENTAMATION 1SFDWLROOF USE: P PERMIT TYPE: WORK tear off wood shakes install 30 year comp shingles. SCOPE FEE ID ROOF AREA s.f. 1REROOFFRES 2,200 F-1 L_J NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). Thesefees are based on the prelinina information available and are only an estimate. Contact the De t or addn'l info, FEE ITEMS (lee Resolution 11-055 Elf 7'x_11) FEE QTY/FEE MISC ITEMS F Permit Fee: $308.00 Work Without Permit? 0 Yes No $0.00 i Strong Motion Fee: IBSEISMICR $0.90 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $309.90 $0.00 TOTAL FEE: $309.90 Revised: 10/01/2011 REROOF TEAR-OFF POLICY COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333-building(aD-cupertino.org PROJECT ADDRESS OWNER NAME Td y-\ �^ f PHONE 2- O �/� E-MAIL STREET ADDRESS ,o) CITY, STATE,ZIP FAX CONTRACTOR NAMED ` „�J LICENSE NUMBER LICENSE TYPE BUS.LIC.# COMPANY NAMEY t I E-MAIL FAX STREET ADDRESS J2 CITY, TE,ZI ..� r PHONE 66 I UNDERSTAND AND AGREE TO THE FOLLOWING: 1. The re-roof project shall comply with all applicable provisions of the 2010 California Codes. 2. An inspection request can be scheduled up to the day before the inspection date. Please call (408)777- 3228 from 7:30 - 3:30pm (Mon-Thurs) or 7:30 - 2:30pm (Friday) to schedule the next day 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. Progress and 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. Progress Inspection is required when approximately 50% of roof covering is installed. 7. 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/" 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. 8. 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 of$126.00. 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 ar required to be installed in accordance with Sections R314 and R315 of the 2010 California Residential Code Signature of Applicant/Agent: Date: o -31— 26/ ReroofPolicy_2011.doc revised 02/16111 Building Department City Of Cupertino La 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 JOB ADDRESS: 0 12, W C L ERMIT# j 00 Z(� OWNER'S NAME: ero� PHONE# GENERAL CONTRACTOR: tu ,4 BUSINESS LICENSE # ADDRESS: 2 CITY/ZIPCODE: [� *Our municipal code requires all businesses w king 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 SUBCONT CTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. -- ` I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical F- 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 Owner/Contractor Signature Date