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11100047
CITY OF CUPERTINO BUILDING PERMIT EEfCEONTRACETOR. ,PERMIT NO: 11100047 1UILDING ADDRESS: 22338 REGNART RD DATE ISSUED: 10/07/2011 IWNER'S NAME: ANDREWS SUSAN C AND STEPHEN C ��%'cPHONE NO: )WNER'S PHONE: 4089721348 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB .icense Class 1 Lic.# © 0 MECH F RESIDENTIAL COMMERCIAL 'ontractor b JC t V-1Date L> ' JOB DESCRIPTION:RE-ROOF TEAR OFF WOOD SHAKE INSTALL COMP l hereby affirm that I am licensed under the provisions of Chapter 9 SHINGLES (commencing with Section 7000)of Division 3 of the Business&Professions CLASS A 48SQ 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 Sq.Ft Floor Area Valuation:$18000 permit is issued. APPLICANT CERTIFICATION Occupancy Type: I certify that I have read this application and state that the above information is APN Number:36640009.00 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 WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply with all n:06;urcKCupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPEC/TIION./ 9.18. Date: A(f- 9 G� Signature Date / Issued by: �— OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: to remove all new materials for I,as owner of the property,or my employees with wages as their sole compensation, installed without first obtai in in will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection. Business&Professions Code) Signature of Applicant: Date: 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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 HAZARDOUS MATERIALS DISCLOSUR Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain I have and will maintain Worker's Compensation Insurance,as provided for by 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. Additionally,should I use equipment or devices which emit hazardous air permit is issued. ntaminants as ct I I certify that in the performance of the work for which this permit is issued,I shall maintain compliance i h the Cupertino Municipal Code,Chapter 9.12 a d thell not employ any person in any manner so as to become subject to the Worker's Healt p e Sections 25505,25533,and 2 534. Compensation laws of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provision;of the Labor Code,I m aut ge t: forthwith comply with such provisions or this permit shall be deemed revoked. Date: APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information isI hereby affirm that there is a construction lending agency for the performance of work's correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address and expenses which may accrue against said City in consequence of the ,ng of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION .,...�all non-point source regulations per the Cupertino Municipal Code,Section 9.18. I understand my plans shall be used as public records. Signature Date g Licensed Professional Ocn m C C k _ V D DID v' O m < z m m G7 v CA O z O 0 m D � F . Z O '- O G) D N W Z m r O co O Z v m 2 v N D m --4 m Z O m N T — ' Z D CD Z ncm NZ ` N _ _. _ m _ rm I � Cpmcn -� V m N z T O Z ' l -n O O s Z (A Fes, —73 C \ � r% ---- Nr 1 d ( I � I I b 0011 c re $�eo•A x -A C3- n`- ? ? cNCZ Fn > cb cn m r > 0CD � A � m� A ro O 1, O DzC = vmNN O m -1 'T- '�"� 7- —CF .R �n z _,s_,. (FIND � n M �- --t; - O 000 > D �o O Q?, p n 0D70m n .�. 7) mm2 —r tT, 1� ►'� ! r D D nmmr cf' a T mm v 0 U) > N+ D / r SCS N n 311� z / co m � D m m Z ...,.� 0 , ,� _ --► z v v r m, 0 TJ .e.. Y �_� 3 lip" pC m v 700 v < D M v' O m < Z m O m O � O m O Z O 70 D F .Z O OG) D N co0 ` m� D — r- 0 O r, O Z m Z co N > m � -AmZ O m N N - ' Z > C O u CEn � C 0 m I � < C M +ck'n� m z O `� T O Z 9 I -1 Z cn 77 Va r"� —\ i ,r m 00 I b s00 o I ewe _.T- Z oz � N 37 Z � CTI < 0n� 0z � � cb M �� DOOODzlla A m� A N rSl O O D Z C = .. w a A a M 0 01 m D G o � CX Oy Ir a O o o� 3 was, 0 r- Icd ek, ;3 a ° 0 Co :3 6 � 05 rt cp � mmZ � � om �Q < nmmr - © a� .� � CL A ° ci ®kA cn O� Om » -- � j -{ �` � 0Dui :3C n = 7o N �- �; 3 y R7 c cDi� t .� -.-' i' < 00 m W =_ 0 n v up cn 93 C cn Q 7V CD 0 D �- f J w O ° " z C i� -- T) CITY OF CUPERTINO 3 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36640009. 00 DATE ISSUED. . . . . . . : 10/07/2011 RECEIPT #. . . . . . . . . : BS000014980 REFERENCE ID # . . . : 11100047 SITE ADDRESS . . . . . : 22338 REGNART RD SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : ANDREWS SUSAN C AND STEPHEN C ADDRESS . . . . . . . . . . : 22338 REGNARD RD CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-4825 RECEIVED FROM . . . . : OSCAR RUIZ CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096 COMPANY . . . . . . . . . . : TBD - TO BE DETERMINED ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : , TELEPHONE . . . . . . . . : FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 18, 000 . 00 1. 00 0 . 00 1.00 0 .00 1BSEISMICR VALUATION 18, 000 .00 1. 80 0 . 00 1.80 0. 00 1REROOFRES SQ FEET 48 .00 672 . 00 0. 00 672 .00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 674 .80 0. 00 674 .80 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 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 22338 regnart rd. DATE: 10/07/2011 REVIEWED BY: bobs. APN: BP#: "VALUATION: 1$18,000 "PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof PRIMARY SFD or Duplex PENTAMATION 1 SFDWLROOF USE: PERMIT TYPE: WORK tear off wood shake install comp shingles. SCOPE FEE ID ROOF AREA s.f. 1 REROOFFRES 4,800 Li I NOTE: This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). Thesefees are based on therelinrina information available and are only an estimate. Contact the De t or addn 7 info, FEE ITEMS (I ee Res©lotion 11-053 Elf "Iill) FEE QTY/FEE MISC ITEMS Permit Fee: $672.00 Work Without Permit? C) Yes 0 No $0.00 i Strong Motion Fee: IBSEISMICR $1.80 Select an Administrative Item Bldfz Stds Commission Fee: IBCBSC $1.00 7 SUBTOTALS: $674.80 $0.00 TOTAL FEE: $674.80 Revised: 10/01/2011 REROOF PERMIT APPLICATION - COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 CUPERTIN4 (408)777-3228• FAX(408)777-3333 • buildingCc cupertino.org PR07ECT ADDRESS g Z3,3 pr �' AFN# OWNER NAME n d r l w S PHONE 2- /.3 1/ E-MAIL STREET ADDRESS Q CITY, STATE,ZIP FAX APPLICANT NAME PHONE E- O� l'Q STREET ADDRESS - STA ZIP FAX ❑ OWNER ❑ OWNER-BUILDER ❑ OWNERAGEM NTP-ACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR N LICENSE NUMB LICEE TYPE BUS.LIC.# ( �O�r7 C /�G/ C� � COMPANY NAMEE-MAIL ^ c FAX STREET ADDRESSCITY,STATE PHONE c /� /F S� -i3S d 5S ARCHITECr/ENGIIIIEER NAME LICENSE NUMBER BUS.LIC.# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF FD or Duplex ❑ Multi-Family ROOF AREA: VALUATION: STRUCTURE: ❑ Commercial U U / C) EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY) REMOVE/REPLACE NYES IF NO, PLYWOOD ❑ ''A" ❑ _ PLYWD ❑ OSB PITCH: ROOF NO #LAYERS: THICKNESS: ❑ 5/8" TYPE: 13 CD '12 CLASS: A PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT# DESCRIPTION OF WORK re Y;14 LS By my signature below,I certify to each of ollowing: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information a provid e ct�I a read the Description of Work and verify it is accurate. I a e to omply with all applicable local ordinances and state laws g to bu'din c _ ezi�e representatives of Cupertino Lc;enter the above-iden'fed roperr;for inspection purposes. Signature ofApplican gent �!3 Date: SUPP NTAL INFO TION REQUIRED _If building is associated with a Home Owner's Association,provide letter ^— _ - r ._oL? s X19 of approval from HOA. _Provide Planning approval to verify if there any restrictions. Provide copy of Manufacturer's Installation Specifications. Z1. GO E'rovide signed copy of Cupertino's Tear-Off Policy. - — _Cr — 1 ReroofApp_2011.doc revised 03/02/11 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 (&cupertino.org PROJECT ADDRES 7APN# 9 Aa OWNER NAME PHONE E-MAIL © STREET ADDRESS CITY, STATE,ZIP FAX 5�» CONTRACTOR NAME LICENSE MBER / LICENSE YPE3 BUS.LIC.# 11 i C /e;-'1 COMPANY NAME „ E-MAIL r FAX STREET ADDRESS CITY,STATE,ZIP PHONE 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 Ti yrs are Te-- to-be-nstalled in accordance with Sections R 7// nd R315 of the 2010 California Residential Cod Signature of Applicant/Agent: Date: Reroolpolicv_2011.doc revised 02/16/11 Building Department City Of Cupertino [LEI 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:ZZ33e .e �.,igaj e-.e PERMIT# OWNER'S NAME: L' (,j17 /t e w%_S PHONE# >3 `/ GENERAL CONTRACTOR: l)42 (.r o ✓i BUSINESS LICENSE # ADDRESS: 3 /3 CITY/ZIPCODE: *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 AL BCflN ACRS HAVE OBTAINED A CIT�-V- F CUPERTINO BUSINESS LICENSE. , I am not using any subcontractors: /�' ' /� _- Signature Date Please check applicable subcontractors and complete the following information: V 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 Owner/Contractor Signature Date