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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 tf ❑ 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