11070064 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10873 CANYON VISTA DR CONTRACTOR:SORENSON&ASSOCIATES PERMIT NO: 11070064
ROOFING INC
OWNER'S NAME: MCDONNELL CHARLES G AND CATHY D PO BOX 786 DATE ISSUED:07/15/2011
iER'S PHONE: 4084904984 BRENTWOOD,CA 94513 PHONE NO:(925)626-7682
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT I— PLUMB
License Class__( - �j Lic.# qt49.3W0 MECH RESIDENTIAL COMMERCIAL
Contractor t�t�',s., �,�SCL�c� cS Date `T-( - 1 II
V, .<<; JOB DESCRIPTION: REROOF,24 SQ,INSTALL ONE OVERLAY OF SINGLE PLY
I hereby affirm that I am f,C el,l Aer %e provisions of Chapter 9 DURO LAST OVER EXISTING BUR 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.
I have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Floor Area: Valuation:$12082
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. anc Occu Type:
APN Number:35602051.00 P Y
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 PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes. (We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION.
granting of this permit. Additionally,the applicant understands and will comply
with all non- oint source regulations per the Cupertino Municipal Code,Section
9.18. Issued by: Date:
Signature Date 7-I -
L OWNER-BUILDER DECLARATION RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed.If a roof is
I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for
the following two reasons: inspection. �� _
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, Signature of Applicant: l Date: `(
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE
declarations:
1 have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the
Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material.
Additionally,should I use equipment or devices which emit hazardous air
Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534.
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,I rier-dr�uthoriz t1a_t: ( r
become subject to the Worker's Compensation provisions of the Labor Code,I must Date:_J" �S
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of Hork's
I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.)
correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address
i-' -unify and keep harmless the City of Cupertino against liabilities,judgments,
and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION
I -ring of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records.
9.18.
Licensed Professional
Signature Date
V
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 �0
CUPERTINa (408)777-3228• FAX(408)777-3333 • building(�cugertino.org
PROJECT ADDRESS APN# 2
OWNER NAME
PHONE J E-MAIL
G s d ,
STREET ADDRESS CITY, STAVE,ZIP FAX
APPLICANT NAME PHONE E-MAIL
C.
S ET ADDRESS CITY,STATE, ZIP FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT XCONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC.#
L
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
ARCHITBCT/ENGRgMR NAME LICENSE NUMBER BUS.LIC.#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF Or Duplex ❑ Multi-Family ROOF AREA: VALUATION:
E] `,
STRUCTURE: Commercial P`o-k, �L
EXISTING ROOF TYPE: BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ElWOOD SHINGLES ❑OTHER(SPECIFY)
REMOVE/REPLACE ❑YES IF NO, PLYWOOD Jd%" ❑ PLYWD ❑ OSB PITCH: ROOF
ONO #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:
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 d 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 bu] ctio honze.representatives of Cupertino tc enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORMATIQN UIRED f y cr>>�',QE_
- v
_ f building is associated with a Home Owner's Association,provide letter C>? ex TYPE _ Mg 'tRouxu�
of approval from HOA. I R r�-oC bNx�R ^81 ING PT ALV REvmw
Provide Planning approval to verify if there any restrictions. a'
r
EXPRESS ❑: PLANNDVG PLAN
Provide copy of Manufacturer's Installation Specifications. L] gT, p; ❑ FIR DEPT
/Provide signed co of Cu ertino's Tear-Off Policy. ❑ _ T
>m PY P
ReroofApp_2011.doc revised 03/02/11
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 10873 canyon vista dr. DATE: 07/11/2011 REVIEWED BY: bobs.
APN: 3 (�a dS) I BP#: 'VALUATION: 1$12,082
°PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD or Duplex PENTAMATION 1SFDWLR00F
USE: I I PERMIT TYPE:
WORK install one overlay of single ply duro last.
SCOPE
FEE ID ROOF AREA
s.f.
1 REROOFFRES 2,400
NOTE. Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addn7 info.
FEE ITEMS (Fee Resolution 11-053 Ff,�' ?'1.-"11) FEE QTY/FEE MISC ITEMS
Permit Fee: $336.00
Work Without Permit? 0 Yes No $0.00
A
Strom Motion Fee: IBSEISMICR $1.21 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: 1 $338.21 $0.00 TOTAL FEE: $338.21
Revised: 07/04/2011
REROOF TEAR-OFF POLICY
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 ing(d-)cuperti no.org
PROJECT ADDRESS APN#
OWNER NAME PHONE E-MAIL
STREET ADDRESS CITY, STATE,ZIP FAX
^7
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC.#
t
COMPANY NAME E-MAIL FAX _
f c
STREET ADDRESS ! ITY,STATE,ZIP PHONE
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 m e detectors are required to be installed in accordance with Sections R314 and R315 of
the 2010 California Residential
Signature of Applicant/Agent: Date:
ReroofPolicv 2011.doc revised 02/16111
CITY OF CUPERTINO
3 ITEMS OF 12 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN 35602051. 00
DATE ISSUED. . . . . . . : 07/15/2011
RECEIPT #. . . . . . . . . : BS000014051
REFERENCE ID # . . . : 11070064
SITE ADDRESS . . . . . : 10873 CANYON VISTA DR
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : MCDONNELL CHARLES• G AND CATHY
ADDRESS 10873 CANYON VISTA DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : SORENSON & ASSOCIAT
CONTRACTOR LARRY SORENSON & HILARIO BASTI LIC # 32054
COMPANY . . . . . . . . . . : SORENSON & ASSOCIATES ROOFING
ADDRESS . . . . . . . . . . : PO BOX 786
CITY/STATE/ZIP . . . : BRENTWOOD, CA 94513
TELEPHONE . . . . . . . . : (925) 626-7682
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 12, 082 .00 1. 00 0. 00 1. 00 0. 00
1BSEISMICR VALUATION 12, 082 . 00 1.21 0 . 00 1 .21 0. 00
1REROOFRES SQ FEET 24 .00 336 . 00 0. 00 336 . 00 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 338.21 0. 00 338 .21 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