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