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11080057 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19976 PRICE AVE CONTRACTOR:DADDARIO ROOFING PERMIT NO: 11080057 OWNER'S NAME: CHE HER-DAW AND JEAN Y 1734 WILLA WAY DATE ISSUED:08/08/2011 lILANNER'S PHONE: 4082532733 SANTA CRUZ,CA 95062 PHONE NO:(831)476-9109 L< LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class G 31 Lic.# 3 C-' MECH RESIDENTIAL COMMERCIAL Contractor �J 7 Date 6F) O I hereby arm that am lic ed under the provisions of CI apter 9 JOB DESCRIPTION:RE-ROOF TEAR OFF EXISTING WOOD SHAKE,INSTALL (commencing with Section 7000)of Division 3 of the Business&Professions NEW Code and that my license is in full force and effect. COMP SHINGLES EXISTING SHEATHING TO REMAIN CLASS A 40SQ 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. Sq.Ft Floor Area: Valuation:$22680 APPLICANT CERTIFICATION 1 certify that I have read this application and state that the above information is APN Number:36904013.00 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 permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non-point source regulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION. 9.18. Signature C Date O ( / Issued by ��-- 7 Dater —G/ 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 prior 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 obtaining an inspection,I agree to remove 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 Applicar►t: 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: I 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 Section 3700 of the Labor Code,for the performance of the work for which this compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& 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 I 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 the Cupertino Municipal Code,Chapter 9.12 and the Compensation laws of California. If,after making this certificate of exemption,I Health&Safety Code,Sections 25505,25533,and 25534. become subject to the Worker's Compensation provisions of the Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner r authorize ag t: O Date: Q t l 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, c, and expenses which may accrue against said City in consequence of the Lender's Address ag of this permit.Additionally,the applicant understands and will comply w,...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 6 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36904013 . 00 DATE ISSUED. . . . . . . : 08/08/2011 RECEIPT #. . . . . . . . . BS000014351 REFERENCE ID # . . . : 11080057 SITE ADDRESS . . . . . : 19976 PRICE AVE SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : CHE HER-DAW AND JEAN Y ADDRESS . . . . . . . . . . : 19976 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 22, 680 . 00 1. 00 0. 00 1.00 0. 00 1BSEISMICR VALUATION 22, 680 . 00 2 .27 0 . 00 2 .27 0. 00 1REROOFRES SQ FEET 40 . 00 560 . 00 0 . 00 560 . 00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 563 .27 0. 00 563 .27 0. 00 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 CUPERTlN4 (408)777-3228• FAX(408)777-3333 • building a cupertino.org PROJECT ADDRES+S""\ APN# C 19q-7 OWNER AC PHONE— ' - E-MAIL 17 STREET ADDRESS e2,I qq -7 f�? JEafT_JE ZIP �� /I FAX L/'C ANI_ o C7C� X1/1 PgNE/ `//o E-MAIL STRE ADDRESS STATE ZIP r• FAX ❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR CONTRACTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT R NAME LICENSE NUMBER LICENSE BUS.LIC.# CT= A � E-MAIL FAX V S ADDRESS CITY,STATE, , PHONE cu r r �,� c 9 c .5 o l o 3/ L _ ��'/B ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC.# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF FD or Duplex ❑ Multi-Family ROOF AREA: VALUATION: STRUCTURE: ❑ Commercial [ 'L- 6 EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES OD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY) REMOVE/REPLACE ❑YES �IFLN O, PLYWOOD ❑ h" ❑ v PLYWD ❑ OSB/`V PITCH. ROOF❑ No # AYERS: THICKNESS: ❑ 5/8" TYPE: ❑ CDX 12 CLASS: `� PROPOSED ROOF TYPE: ❑BUILT-UP ROOF If A KALT SHINGLES ❑WOOD SHAKES 4ia _ ❑OTHER IC _ES REPORT# DESCRIPTION OF WORK CC 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 constructs n. authorize representatives of Cupertino tc enter the above-id ntified p pert for inspection purposes. Signature of Applicant/Agent Date: ore SUPPLE NTAL bRMAION REQUIRED If building is associated with a Home Owner's Association,provide letter of approval from HOA. �- PP �pv�xIau == Yst>�n�vGr3nrl.xEVl�w� —Provide Planning approval to verify if there any restrictions. -A � -_ - -�3 - XP1T�sSS Provide copy of Manufacturer's Installation Specifications. Provide signed copy of Cupertino's Tear-Off Policy. _14= — cls�R:_ ReroofApp_2011.doc revised 03/02/11 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 19976 price ave. DATE: 08/08/2011 REVIEWED BY: bobs. APN: BP#: VALUATION: $22,680 ;'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. 1REROOFFRES 4,000 T7 I T I T NOTE: Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addn'1 in o. FEE ITEMS (twee Resolution 11-0531:; '. 1.-%1) FEE QTY/FEE MISC ITEMS Permit Fee: $560.00 Work Without Permit? 0 Yes (D No $0.00 Strom Motion Fee: IBSEISMICR $2.27 Select an Administrative Item Bld€>.Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $563.27 $0.00 TOTAL FEE: $563.27 Revised: 07/04/2011 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: 16( �' ��'e PERMIT# ! OWNER'S NAME: .- � c �_ PHONE# GENERAL CONTRACTOR: 0 c� BUSINESS LICENSE# ADDRESS: -77 ,6 ,'..? (a Gt:/,-, 152 CITY/ZIPCODE: Cod/?, ► 0c_ L G C l G *Our municipal code re wires all businesses working in the city to have a City of Cupert6io 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: Sig at re ate Please check applicable subcontractors and complete the following information: j/ 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 mbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date