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11080182 CITY OF CUPERTINO BUILDING PERMIT Bt ILDING ADDRESS: 18610 STARRETT CT CONTRACTOR:ROSSETTAS PERMIT NO: 11080182 ROOFING OWNER'S NAME: MARK FLANIGAN 401 LINCOLN AVE DATE ISSUED:08/24/2011 /NER'S PHONE: 4086401024 SAN JOSE, CA 95126 PHONE NO:(408)294-4400 1:r LICENSED CONTRACTOR'S DECLARATION 1� f— I— v BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class '-3� Lic.4 -7t _qC CL,( F_ I— F_ /� r� MECH RESIDENTIAL COMMERCIAL Contractor � (L,ci"'"'r 1 Date ^ Z� I` 1 hereby affirm that 1 am licensed under the provisions of Chapter 9 01 1 JOB DESCRIPTION: RE-ROOF 16 SQUARES,INSTALL FINE SHEET,INSTALL IB 50 MIL SINGLE PLY ROOF (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. Sq.Ft Floor Area: Valuation:$8000 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:37526029.00 Occupancy Type: permit is issued. 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. 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 Issued bDate:CC with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature �{� _Date `` t( 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 remove all new materials for inspection. u OWNER-BUILDER DECLARATION / l Signature of Applicant: Y�lln-- Date: 1 hereby affirm that 1 am exempt from the Contractor's License Law for one of the following two reasons: ALL 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) I_as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the pro.ject(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 1 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 1 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 the performance of the work for which this �� , Ir Owner or authorized agent: b'Y4'r�- 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,I 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 upon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION unify and keep harmless the City of Cupertino against liabilities,judgments, .;.and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting 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 FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 18610 Starret Ct. DATE: 08/24/2011 REVIEWED BY: jsg APN: BP#: S__� 'VALUATION: 1$8,000 'PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof PRIMARY SFD or Duplex PENTAMATION 1 SFDWLROOF USE: PERMIT TYPE: WORK SCOPE FEE ID ROOF AREA s.f. 1 REROOFFRES 1,600 NOTE. Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addn 7 info, FEE ITEMS (f ee Resolution 11-053 ljf.' ' 1.-11) FEE QTY/FEE MISC ITEMS Permit Fee: $224.00 Work Without Permit? 0 Yes E) No $0.00 Strong Motion Fee: IBSEISMICR $0.80 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $225.80 $0.00 TOTAL FEE: 1 $225.80 Revised: 07/04/2011 REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 CUPERTINQ I (408)777-3228• FAX(408)777-3333 • building a cupertino.om //,g0 PROTECT ADDRESS Q 6 t o APN# 17� h OWNER NAME '/ TX17 PHONE E-MAIL 6Yo 1U7L� STREET ADDRESS i CITY, ATE FAX D 01 014 6/y APPLICANT N I�, PHONE E-MAIL _ _J(R L`;fd STREET ADDRESS t , ' CITY,STT,ZIP �� FAX `1 Q hCQ L ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT rCONTRACrOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR N 1 /� LICENSE .F,Y ? `. LICEe! BUS.LIC. COMPANY NAMEl Z \ E-MAIL FAX _ 77 u ca y ME STREET ADDRESS , N C 4 y` CITY S7 AE (��2�j PF�OU U 2q 4_ +J \GO ARCHITECT/ENGINEER NALICENSE NUMBER BUS.LIC.# '1 COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF 755-SFD or Duplex ❑ Multi-Family ROOF AREA: VALUATION: STRUCTURE: ❑ Commercial U(w EXISTING ROOF TYPE: KBUII-T-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES 5itTHER(SPECIFY) REMOVE/REPLACE ❑YES IF NO, PLYWOOD ❑ %" ❑ PLYWD ❑ OSB PITCH: ROOF ❑ NO #LAYERS: THICKNESS: ❑ 5/8" TYPE: ❑ CDX 2-:12 CLASS: A PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ®OTHER C Ii ICC-ES REPORT# DESCRIPTION OF WORK 1 4 ro 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 cons I autho ' representatives of Cupertino tc enter the above entifr d propertyfor inspection purposes. Signature of Applicant/Agent '� j � Date: 2�/ 2 SUPPLEMENTAL INFORMATION 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. _Provide copy of Manufacturer's Installation Specifications. _Provide signed copy Of Cupertino's Tear-Off Policy. � _� M Reroof2pp_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: 0 PERMIT# /0 -5a OWNER'S NAME: ar cae f PHONE# t(C� 2-4y- Y (00 GENERAL CONTRACTOR -�1c r BUSINESS LICENSE # ADDRESS: yo l (.i 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 ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Z t Signature ate 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