11080074 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10411 BUBB RD CONTRACTOR:APEX ROOFING PERMIT NO: 11080074
OWNER'S NAME: BERG MARY A AND CARL E TRUSTEE& 1804 ROME WAY DATE ISSUED:08/09/2011
n' `ER'S PHONE: 4086876076 SAN JOSE,CA 95124 PHONE NO:(408)294-7511
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB
�
License Class 0,3� Lic.# 40 L 7 1
+II [_�� MECH RESIDENTIAL r- COMMERCIAL �
Contractor � —�ry Date
I hereby affirm Sat I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REMOVE WOOD SHINGLE SIDING&REPLACE WITH NEW
(commencing with Section 7000)of Division 3 of the Business&Professions WOOD
SHINGLE CLASS A 25SQFT
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:$15848
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is APN Number:35720010.10411 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 perm:. Additionally,the appy/undersds and will complyWITHIN 180 DAYS OF PERMIT ISSUANCE OR
with all non-points rce regulationsper the cipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION.
9.18.Signature �/Z-ham Issued by: Date:
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 pri 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 obtain' an inspection,I gree to re ove 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 A plicant: 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:
1 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 th Cupertino Municipal Code,Chapter 9.12 and the
Compensation laws of California. If,after making this certificate of exemption,I Health Safety Code,Sec' ns 25505,25533,and 25534.
become subject to the Worker's Compensation provisions of the Labor Code,I must
i
Ow or uthorized a int:
forthwith comply with such provisions or this permit shall be deemed revoked. -GG1 Date:
a
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 work'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,
and expenses which may accrue against said City in consequence of the Lender's Address
ig of this permit.Additionally,the applicant understands and will comply
wun 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
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35720010 . 10411
DATE ISSUED. . . . . . . : 08/09/2011
RECEIPT #. . . . . . . . . : BS000014369
REFERENCE ID # . . . : 11080074
SITE ADDRESS 10411 BUBB RD
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : BERG MARY A AND CARL E TRUSTEE
ADDRESS 10411 BUBB RD
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : APEX ROOFING
CONTRACTOR BENNY SMITH LIC # 29627
COMPANY APEX ROOFING
ADDRESS . . . . . . . . . . : 1804 RONIE WAY
CITY/STATE/ZIP . . . : SAN JOSE, CA 95124
TELEPHONE (408) 294-7511
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----
1BCBSC VALUATION 15, 848 . 00 1 . 00 0. 00 1. 00 0. 00
1BSEISMICR VALUATION 15, 848 .00 1.58 0 . 00 1 .58 0 .00
1REROOFRES SQ FEET 25 . 00 350. 00 0. 00 350 . 00 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 352 .58 0 . 00 352 .58 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CASH 352 .58
---------------
TOTAL RECEIPT 352 .58
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
MDDRESS: 10411 bubb rd. DATE: 08/09/2011 REVIEWED BY: bob s.
PN: BP#: 'EVALUATION: $15,848
Y'PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD or Duplex PENTAMATION 1SFDWLR00F
USE: p PERMIT TYPE:
WORK
SCOPE
FEE ID ROOF AREA
s.f.
1REROOFFRES 2,500
F-1 I-- Li 0 L
NOTE: These ees are based on the preliminary in ormation available and are only an estimate. Contact the De t or addh 7 info.
FEE ITEMS (Fee Resolution.11-053 Fff.7/1,,"]1) FEE QTY/FEE MISC ITEMS
Permit Fee: $350.00
Work Without Permit? 0 Yes No $0.00
Strom Motion Fee: IBSEISMICR $1.58 Select an Administrative Item
Bldg,Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $352.58 $0.00 TOTAL FEE: 1 $352.58
Revised: 07/04/2011
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
(a-cupertino.org
PROJECT ADDRESS (� APN#
OWNER NAME PHONE E-MAIL
STREET ADDRESS CITY, STATE,ZIP FAX
CONTRACTOR NAME LICEN E NUMBER LICENSE PE BUS.LIC.k
COMPANY NAME f E-MAIL 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'/" 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 understa[4J and agree to comply with the re-roof policy stated above. I also understand that
smoke detectors and carbon mono e detectors are r uired to b installed in accordance with Sections R314 and R315 of
the 2010 California Residential e.
Signature of Applicant/Agent: Date:
Rerootpolicv_2011.doc revised 02/16/11
6'
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO, CA 95014-3255
CUPERTINO (408)777-3228• FAX(408)777-3333• building(d)cupertino.org
PROJECT ADDRESSAPN
4 0 a tk VP g ® ; # l�y I v I
OWNER NAME L PHONE'E7`�o 7 E-MAIL
STREET ADDRESS CITY, STATE,ZIP FAX
PHO
APPLICANT NAME NE `� A IL ds.
4
STREE ADDRESS ! CITY,STATE, ZIP + FAX
0 1� 4 rJ o PC l Z
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❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME ( R Ll E NUMB LIC SE TYPE BUS.LIC.# TI Z,-7ME _ 1�
COMPANY NAE-MAII FAX
eKn. C.S.C,Owl.
STREET ADDRESS CTST ZIF' 5 _ PHONE��J tel!
ARCHITECT/ENGINEER NAME LICENSE NUMBER G BUS.LIC.#(J�
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑ SFD or Duplex ❑ Multi-Family ROOF AREA: VALUATION:
STRUCTURE: M-Commercial❑ b��
EXISTING ROOF TYPE::// BUILT-UP ROOF 13 ,.
ASPHALT SHINGLES ❑WOOD SHAKES DOD SHINGLES OTHER.(SPECIFY)
REMOVE/REPLACE 9066 IF NO, PLYWOOD ❑ h" ❑ PLYWD ❑ OSB PITCH OF
El No #LAYERS THICKNESS: El 5/8 TYPE: ❑ CDX 12 CLASS: A
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES WOOD SHINGLES ❑OTHER ICC-ES REPORT#
DESCRIPTION OF WORK \ `
® �l
By my signature below,I certify to c of the following: I am properly owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I ve rovided is correct. I hav ead the D ription of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relatin to uilding construction. I au orize.repr fives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent j l / Date: - to
SUP AL INFO TION REQUIRED ` _ =� �, � -r
If building is associated with a Home wner's Association,provide letter � -OG
of approval from HOA. po x � xEY>!
- —
Provide Planning approval to verify if there any restrictions.
�x�ss - ,���
Provide copy of Manufacturer's Installation Specifications. ''.
rovide signed copy of Cupertino's Tear-Off Policy. _ �QOT�
ReroofApp_2011.doc revised 03/02/11
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: I 1 �� PERMIT# X440
Ll
OWNER'S NAME: 0W_61 PHONEY 4W d��P
GENERAL CONTRAC R: &VcpoF�hlBUSINESS LICENSE # 2q4 o�q
ADDRESS: 'p CITY/ZIPCODE: os e ai eiSIL
*Our municipal code requires all busine es 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: -
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 /AA 21
Septic Tank
Sheet Metal
Sheet Rock
Til
Owner/Contractor Signature Date