11080039CITY OF CUPERTINO BUILDING PERMIT J
BUILDING ADDRESS: 19621 LA MAR CT I CONSTR CTOIO : R ECROOFING & I PERMIT NO: 11080039 I
OWNER'S NAME: JANO & GABRIELA BANKS 115230 CLYDELLE AVE I DATE ISSUED: 08/04/2011 I
ER'S PHONE: 4089969292
❑
LICENSED NSED CONTRACTOR'S DECLARATION
7__:
lassi Lic. # 21 ?'AtoDate rm Itat1 am liensed un er the provisions of Chapter 9
(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
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
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
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all -point sourc ulations per the Cupertino Municipal Code, Section
9.1 -
Date
Signature
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
1, as owner of the property, or my employees with wages as their sole compensation,
will do the work, and the structure is not intended or offered for sale (Sec.7044,
Business & Professions Code)
1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
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
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
permit is issued.
I certify that in the performance of the work for which this permit is issued, I shall
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 "fn 66in,
become subject to the Worker's Compensation provisions of therabor Code, I must
forthwith comply with such provisions or this permit shall be deed revoked.
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
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
and expenses which may accrue against said City in consequence of the
,ng of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Date
SAN JOSE, CA 95032 1 PHONE NO: (408)626-9320
BUILDING PERMIT INFO: BLDG r ELECT PLUMB r
MECH F RESIDENTIAL f_ COMMERCIAL
JOB DESCRIPTION: RE -ROOF REMOVE EXISITNG WOOD SHAKE & INSTALL
NEW
1/2# CDS, 2 LAYERS OF FELT & LIFETIME COMP
SHINGLES CLASS A 35SQFT
Sq. Ft Floor Area: I Valuation: $21000
APN Number: 36925042.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued b /' Dater— Y-1
RE -ROOFS:
All ro shall be inspected prior to any roofing material being installed. If a roof is
i ailed wiut f ' ing an inspection, I agree to remove all new materia for
inspection. ( %' `/� `✓ t
Signature of A imdnt.� X Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(x) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
i�O n author' d ag`e 1
� ` /`V Date: `I
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # : 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 36925042.00
DATE ISSUED.......: 08/04/2011
RECEIPT #......... BS000014307
REFERENCE ID # ...: 11080039
SITE ADDRESS 19621 LA MAR CT
SUBDIVISION ......
CITY CUPERTINO
IMPACT AREA ......
OWNER JANO & GABRIELA BANKS
ADDRESS 19621 LA MAR CT
CITY/STATE/ZIP ...: CUPERTINO, CA 95014-3372
RECEIVED FROM ....: R E ROOFING & CONST
CONTRACTOR PROCTOR, PAUL LIC # 20615
COMPANY R E ROOFING & CONSTRUCTION INC
ADDRESS ..........: 15230 CLYDELLE AVE
CITY/STATE/ZIP ...: SAN JOSE, CA 95032
TELEPHONE (408)626-9320
FEE
ID UNIT
QUANTITY
AMOUNT PD -TO -DT
----------
THIS REC NEW
----------
BAL
----------
13CBSC
-------------
VALUATION
----------
21,000.00
--------------------
1.00
0.00
1.00
0.00
13SEISMICR
VALUATION
21,000.00
2.10
0.00
2.10
0.00
1:2EROOFRES
SQ FEET
35.00
490.00
0.00
----------
490.00
----------
0.00
TOTAL
PERMIT
---------- ----------
493.10
0.00
493.10
0.00
METHOD
OF PAYMENT
AMOUNT
REFERENCE
--------------------
NUMBER
-----------------
CHECK
---------------
493.10
#3680
TOTAL
---------------
RECEIPT
493.10
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
CUPERTINO
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 R
(408) 777-3228 - FAX (4018) 777-3333 - building(5cupertino.org
PROJECT ADDRESS
AYN
)5 (o q
OWNER NAME
PHONE
AAM
1
STREET ADDRESS
CITY, STATE, ZIP
FAX
APPLICANT NA1,4E
PHONE 1 C
i-MAJL
STREET' ADDRESS
CITY STATE, ZIP
5,J I I
FAX Ll 7)
0 OWNEF, ❑ OWNER -BUILDER ❑ OWNER AGENT �,�TR CTOR 13 CONTRACTOR AGENT 11 ARCHITECT ❑ ENGINEER' 7 DEVELOPER 11 TENANT
CONTRACTOR NAME
iV
11 E NUMBER
LICENn TYPE
BUS. LIC.
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
ARCj-=CT/ENG1NEER NAME
LICENSE NUMBER
BUS. LIC. 4
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
usE of SFD 91 Duplex El Multi -Family
ROOF AREA:
VALUATIO
4
L)—C-6_m"rnerciaI
STRUCTURE:
EXISTING ROOF TYPE: 13 BUILT-UP ROOF ❑ ASPHALT SHINGLES _WOOD SHAKES DWOOD SHINGLES ❑ OTHER (SPECIFY)
REMOVE /REPLACE �
� IF NO,
❑P
YWD EJ OSB
Prrci�,_
_ :12
/A
❑ NO
# LAYERS:
❑/8
=El gCI)X
CLASS: *�
PROPOSED ROOF TYPE: ❑ BUILT-UP ROOF ASPHALT SHINGLES El WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER
ICC -ES REPORT #
DESCRIPTION OF WORK-
�v,j
j
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the info ave provided correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state law4 relating ��iIA4n c' iom I _05 representatives of Cupertino to enter the abo iden0fied ropeiry for inspection purposes.
;I�K RZ,� repres
9 �o
-c-Orre'
Signature ofApplicant/Appt 1 Date:
777t77
SUPPLEMENTAL INFORMATION REQUIRED
If building is associated with a Home Owner's Association, provide letter
EF
= vMWTRWMA
of approval from HOA.
Provide Planning approval to verify if there any restrictions.
371.-
Provide copy of Manufacturer's Installation Specifications.
. . . . . . . . . . .
Provide signed copy of Cupertino's Tear -Off Policy.
ReroofA,pp.201 I.doc revised 03102111
CITY OF CUPERTINO
1PIPIPi. F.CTlMATnU — RITII,I)ING DIVISION
imADDRESS:
19621 la mar ct.
DATE: 08/04/2011
REVIEWED BY: bobs.
APN:
BP#:
"VALUATION: 1$21,000
*PERMIT TYPE: Minor Building Permit
PLAN CHECK TYPE: Re -roof
PRIMARY SFD or Duplex
USE: P
PENTAMATION 1 SFDWLROOF
PERMIT TYPE:
WORK
re lace exisiting wood shake and add new comp shingles
SCOPE
FEE ID ROOF AREA
s.f.
1REROOFFRES 3,500
NOTE. These fees are based on the preliminary information available and are only an estimate. Contact the Uept for aaan't tnjo.
FEE ITEMS (Fee Resolution 11-053 f; ff 7-1. "112 FEE QTY/FEE MISC ITEMS
Permit Fee: $490.00
Work Without Permit? 0 Yes No $0.00
A
StronpMotion Fee: IBSEISMICR $2.10 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $493.10 $0.00 TOTAL FEE: 1 $493.10
Revised: 07/04/2011
REROOF TEAR -OFF POLICY
Is 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
' r�
PROJECT ADDRESS iC'1 � `� l� f� V`
I i -l1
APN #
OWNER NAME' 1 ; 7 i `•
PHONEj
- iq
E-MAIL
STREET ADDRESS �c.� i /�
��.21 �, �
CITY, STATE, ZIP' �, �.� -r� i=•,
FAX
CONTRACTOR NAME +? i
LICENSE NUMBER i _ i C
LICENSE TYPE. �, 2
BUS. LIC. # ? , ,
COMPANY NAME
E-MAIL
FAX 'r
STREET ADDRESS
L
CITY, STATE, ZIP
PHONE• 2.
c) 1 J
I UNDERSTAND AND AGREE TO THE FOLLOWING:
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 m , x--i&.4etectors.a uired,to be installed in accordance with Sectigns 8314 and R315 of
the 2010 California Residential Code �,; .'3_ _ ��
i
Signature of ADDlicant/AjZent: _;'� / - Date: i
ReroofPolicv_201 Ldoc revised 02/16/11
CUPERTINO
CONTRACTOR / SUBCONTRACTOR LIST
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
Fax: 408-777-3333
JOB ADDRESS:; " ' )L
PERMIT # Z
CGS
OWNER'S NAME:'}„ ; ; ''
PHONE #
Cl `ci Z
GENERAL CONTRACTOR: l
BUSINESS LICENSE #
�]
ADDRESS: } �`) 3 1 i 1
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 BCONTRACTORS HAVE OBTAINED A CITY QF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
�-Signature Date
Please check applicable subcontractors and complete the following information:
Owner / Contractor Signature
Date
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