11080058 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19970 PRICE AVE CONTRACTOR:DADDARIO ROOFING PERMIT NO: 11080058
OWNER'S NAME: HSU FAN AND MILLIE 1734 WILLA WAY DATE ISSUED:08/08/2011
t,"'NER'S PHONE: 4082557777 SANTA CRUZ,CA 95062 PHONE NO:(831)476-9109
L LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class C-15!1 ic.# y13v'7'3 —t
MECH RESIDENTIAL COMMERCIAL
Contractor Date cy � �' r'
I hereby a irm that I am 1' ensed under the provisions of Chapter 9 JOB DESCRIPTION:RE-ROOF TEAR OFF SHAKE INSTALL NEW LIFETIME
(commencing with Section 7000)of Division 3 of the Business&Professions COMPOSITION EXISTING PLYWOOD TO REMAIN CLASS A
Code and that my license is in full force and effect. 39SQ
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:$21290
permit is issued.
APPLICANT CERTIFICATION APN Number:36904014.00 Occupancy Type:
1 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 PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
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 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulations er the Cupertino Municipal Code,Section
9.18.
Issued by:- Date:
Signature Date 04!0(
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: installed without first obtaining an inspection,I agree to remove all new materials for
I,as owner of the property,or my employees with wages as their sole compensation, inspection.
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code) )ign�at[yre of Appli n. Date: `
1,as owner of the property,am exclusively contracting with licensed contractors to 1
construct the project(Sec.7044,Business&Professions Code). A L ROOF COVERINGS TO BE CLASS"A"OR BETTER
I hereby affirm under penalty of perjury one of the following three
declarations: HAZARDOUS MATERIALS DISCLOSURE
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 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. 1 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. contaminants as defined by the Bay Area Air Quality Management District I will
I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534.
Compensation laws of California. If,after making this certificate of exemption,I
become subject to the Worker's Compensation provisions of the Labor Code,I must Owner or authorizes ag nt:
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 is I hereby affirm that there is a construction lending agency for the performance of vork'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
�. o all non-point source regulations per the Cupertino Municipal Code,Section
9.18. 1 understand my plans shall be used as public records.
Signature Date Licensed Professional
CITY OF CUPERTINO
3 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN 36904014 . 00
DATE ISSUED. . . . . . . : 08/08/2011
RECEIPT #. . . . . . . . . : BS000014351
REFERENCE ID # . . . : 11080058
SITE ADDRESS . . . . . : 19970 PRICE AVE
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . .
OWNER HSU FAN AND MILLIE
ADDRESS . . . . . . . . . . : 19970 PRICE AVE
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-3339
RECEIVED FROM . . . . : DADDARIO ROOFING CO
CONTRACTOR . . . . . . . : EDGAR MONTOYA LIC # 26245
COMPANY DADDARIO ROOFING
ADDRESS 1734 WILLA WAY
CITY/STATE/ZIP . . . : SANTA CRUZ, CA 95062
TELEPHONE . . . . . . . . : (831) 476-9109
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 21, 290 .00 1. 00 0. 00 1 .00 0. 00
1BSEISMICR VALUATION 21,290 . 00 2 .13 0 . 00 2 .13 0 . 00
1REROOFRES SQ FEET 39. 00 546 . 00 0 . 00 546 .00 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 549. 13 0. 00 549.13 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 1, 112 .40 #1176
---------------
TOTAL RECEIPT 1, 112 .40
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
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO, CA 95014-3255
CUPERTINO (408)777-3228• FAX(408)777-333,3 • buildino(a cupertino.org
PROJECT ADD jr AFN# G 9 l.i LI 0 1
�- \i �J
OWNER NAME �`
STREET PHONE v Zff_ 77-17
77 7 E MAIL
(ADDRESCITY, STATE,Z�IPS� FAX
C (� C� C 7-G "Ti v (rid C ?C j
APPLICANT NAME PHONE E-MAIL
STREET ADDRESS CITY,STATE,ZIP FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT 13 CONTRACTOR 91-CONTRACTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAMlQ LICENSE NUMBER LICENSE TYPE BUS.LIC.#
41
COMPANY NAMEE-MAIL FAX
Yr ('1 Poe 'Y!c
STREET'ADDRESS / CITY,STATE,ZIP PHONE
-716 CCL. , I Q e"1// 'el - /C
ARCHITECTIENGINEER NAME LICENSE NUMBER BUS.LIC.#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF SFD or Duplex ❑ Multi-Family ROOF AREA _- VALUATION:
STRUCTURE: ❑ Commercial 3
EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY)
REMOVE/REPLACE IF NO, PLYWOOD ❑ 'h" ❑ PLYWD ❑ OSB/,0 PITCH ROOF
❑ NO #LAYERS: ��ee.,,� THICKNESS: 135/8" TYPE: 11CDX / 12 CLASS: A
PROPOSED ROOF TYPE: 11BUILT-UPROOF 415HALT SHINGLES 1)WOOD SHAKES ElWOOD SHINGLES ElOTHER ICC-ES REPORT#
DESCRIPTION OF WORK
CA
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 constructio . I a thor' representatives of Cupertino to enter the above- nti ied open;for inspection purposes.
Signature of ApplicanVAgent: Date:
SUPPLEMENTAL<TORMA ION REQUIRED
_If building is associated with a Home Owner's Association,provide letter
of approval from HOA.
_Provide Planning approval to verify if there any restrictions. -
SS�� — — x ALIIFt;Pre'rr�t��W
_Provide copy of Manufacturer's Installation Specifications.Provide signed signed copy of Cupertino's Tear-Off Policy.
ReroofApp_2011.doc revised 03/02/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 19970 price ave. DATE: 08/08/2011 REVIEWED BY: bobs.
APN: BP#: "VALUATION: 1$21,290
`°PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD or Duplex PENTAMATION 1SFDWLR00F
USE: PERMIT TYPE:
WORK tear off exisiting wood shake install new comp shingles existing sheathing to remain.
SCOPE
FEE ID ROOF AREA
s.f.
1 REROOFFRES 3,900
NOTE. Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addn'l info,
FEE ITEMS (Fee Resolution 11-05;f ff 'L-"11) FEE QTY/FEE MISC ITEMS
Permit Fee: $546.00
F-71
Work Without Permit? 0 Yes No $0.00
i
Strong Motion Fee: IBSEISMICR $2.13 Select an Administrative Item
131d7 Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: 1 $549.13 $0.00 TOTAL FEE: $549.13
Revised: 07/04/2011
REROOF TEAR-OFF POLICY
La 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-build i ng(a)-cuperti no.org
PROJECT ADDRESSI e " , 1 C �^ APN#
JL1
OWNER NAME PHONE l , ? j_ E-MAIL
Sc i 7U
STREET ADDRESS CITY, STATE,ZIP FAX
C". -1 r .,o c c#9 1156 i
CONTRACTOR NAMR- J_I LICENSE NUMBER LICENSE TYPE BUS.LIC.#
(( �� a,r l d poo) n
COMPANY NAME t, C \ ( E-MAIL FAX
STREET ADDRESS / ` C /. �n �C CITYST tTE, v�Q O PH NE : n�
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 detectors are required to be installed in accordance with Sections R314 and R315 of
the 2010 California Residential Code.
Signature of Applicant/Agent: �- C Date: �U(
ReroofPo1icv_201 Ldoc revised 02/16/11
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: 1'1'7-7c) ct e— PERMIT# v
OWNER'S NAME: "11` 4cLk PHONE# L - — 777
GENERAL CONTRACTOR: k d da f i'd vC ,'k)c BUSINESS LICENSE#
ADDRESS: "j Q C' , 0 (t44C 2 CITY/ZIPCODE: a; • C'4 950 I D
*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: - ell
Si ature ate
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
Pjofnbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date