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11080223 , CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 11097 LINDA VISTA DR CONTRACTOR:NEIGHBORS PERMIT NO: 11080223 ROOFING AND GUTTERS ONVNEII'S NAME: CONSTANT ANDREW J AND LEEANN H 6251 RADIANT DR DATE ISSUED:08/31/2011 NER'S PHONE: 4086247136 SAN JOSE, CA 95123 PHONE NO:(408)472-3869 ❑ LICENSED CONTRACTOR'S DECLARATIONF_ BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class C Z Lic. MECH RESIDENTIAL COMMERCIAL Contractor Al e1�L�`'r r4,44 Date 5,�7�I ,1.0 CC I .JOB DESCRIPTION: RE-ROOF 30 SQUARES,REMOVE EXISTING SHAKE ROOF hereby affirm that 1 am licensed under the provisions of Chapter 9 INSTALL 1/2 INCH OSB ONE LAYER 30LBS FELT AND (commencing with Section 7000)of Division 3 of the Business&Professions INSTALL PRESIDENTIAL COMP.CLASS A Code and that my license is in full force and effect. 1 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. Sq.Ft Floor Area: Valuation:$14500 1 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 APN Number:35606017.00 Occupancy Type: permit is issued. AL. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION. indcnmiitj and keep harmless the City of Cupertino against liabilities,judgments, , costs,and expenses which may accrue against said City in consequence of the Date: 4 13146111 goranting of this permit. Additionally,the applicant understands and will comply Issued by: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature ^yiZ Date Ck­3f—Z.OI/ All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection,I agree to remov2 all new materials for inspection. ❑ OWNER-BUILDER DECLARATION r - / Signature of Applicant: ���,�Tf2 Date: 20 r' I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALI,ROOF COVERINGS TO BE CLASS"A"OR BETTER I,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 HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). 1 have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will 1 hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533,and 25534. Section 3700 of the Labor Code,for thep erformance of the work for which this ) Owner or authorized agent:�/J�,l����1�-Z Date: 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 exemption,1 CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,1 must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 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 -on the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION nmiify and keep harmless the City of Cupertino against liabilities,judgments, ._sts.and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. "ranting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date CITY OF CUPERTINO 3 ITEMS OF 6 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec : Twp : Rng: Sub: Blk: Lot : APN . . . . . . . . : 35606017 . 00 DATE ISSUED. . . . . . . : 08/31/2011 RECEIPT # . . . . . . . . . BS000014626 REFERENCE ID # . . . : 11080223 SITE ADDRESS . . . . . : 11097 LINDA VISTA DR SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER CONSTANT ANDREW J AND LEEANN H ADDRESS 11097 LINDA VISTA DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : NEIGHBORS ROOFING CONTRACTOR . . . . . . . : ROBERTO LOPEZ LIC # 27063 COMPANY NEIGHBORS ROOFING AND GUTTERS ADDRESS 6251 RADIANT DR CITY/STATE/ZIP . . . : SAN JOSE, CA 95123 TELEPHONE . . . . . . . . : (408) 472-3869 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 14, 500 . 00 1 . 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 14 , 500 . 00 1 .45 0 . 00 1 .45 0 . 00 1REROOFRES SQ FEET 30 . 00 420 . 00 0 . 00 420 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 422 .45 0 . 00 422 .45 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 844 . 90 2514 --- -- ---------- TOTAL RECEIPT 844 . 90 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: 11097 linda vista dr. DATE: 08/31/2011 REVIEWED BY: APN: BP#: "VALUATION: 1$14,500 PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof PRIMARY SFD or Duplex PENTAMATION 1 SFDWLROOF USE: I I PERMIT TYPE: WORK replace wood shake roof with comp shingles. SCOPE FEE ID ROOF AREA s.f. 1REROOFFRES 3,000 NOTE: Thesefees are based on the preliminary information available and are only an estimate. Contact the Dept-for addh 7 info. FEE ITEMS (Fee Resolution 11-053 I ff '-1.-%1) FEE QTY/FEE MISC ITEMS Permit Fee: $420.00 Work Without Permit? 0 Yes E) No $0.00 i Strong Motion Fee: IBSEISMICR $1.45 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $422.45 $0.00 TOTAL FEE: $422.45 Revised: 07/04/2011 REROOF PERMIT APPLICATION -- COMMUNITY DEVELOPMENT DEPARTMENT- BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINa (408)777-3228• FAX(40,8)777-3333 •building a.cupertino.org tib X223 PROTECT ADDRESSCj r-C,)LC APN I lca,-L- � a ) � ).ems - OWNER NAMEPHONE Ar,dyJ , `fEc �jz"4 - 1 E-MAII. STREET ADDRESS CITY, STATE,ZIP FAX +` J CtJ r- 4 l Y" APPLI T�TAME PHONE E-MAIL Z� �E).G _ STREET ADDRESS CITY,STATE,ZIP FAX C. 1 S \ yi� C7,- El 7,❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGN EER ❑ DEVELOPER ❑TENANT CO CTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC.# C' COMPANY N E-MAIL FAX STREET ADDRE_r CITY,STATE,ZIP PHONE .. ARCHITECTIENGINEER NAME LICENSE NUMBER BUS.LIC.# <,-o,6 f1C COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF SFD or Duplex ❑ Multi-Family ROOF AREA: VALUATION: STRUCTURE: ❑ Commercial EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES IB W DOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY) REMOVE/REPLACE YE YES IF NO, PLYWOOD 13 'h" ❑ PLYWD I\OSB %,u PITCH ROOF � ❑NO *LAYERS: THICKNESS: ❑ 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 6's cQ in �- 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 information I have provided is correct I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction.JI authorize.representatives of Cupertino to enter the above-identified property for inspection purposes. Signature ofApplicant/Agent �Z�'i /� / ?'E'er" Date: �_ 1 . i- N_bu_'F SUPPLEMENTAL INFORMATION REQUIRED � -��m.10=115 --,--� If building is associated with a Home Owner's Association,provide letter _ of approval from HOA. m t 2B� r� ey Provide Planning approval to verify if there any restrictions. - Provide copy of Manufacturer's Installation Specifications. Provide signed copy of Cupertino's Tear-Off Policy. = r - ���- Reroof4pp_2011.doc revised 03/02/11 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 CUPERTINO Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: 116 1 f PERMIT# Q OWNER'S NAME: PHONE # GENERAL CONTRACTOR: BUSINESS LICENSE # = 6,�G�'� ADDRESS: Z-ccs E -- CITY/ZIPCODE: r i *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 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: 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