11070067CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10883 CANYON VISTA DR
OWNER'S NAME: BARBARA BEYDA
?R'S PHONE: 4082575003
❑ LICENSED CONTRACTOR'S DECLARATION
License ClassLic. # 14 C1 '7'-1
Contractor �
I hereby affir'rrt�lr�t amEen es dvunder the provisions of Chapter 9
(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
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
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
upon the above mentioned property for inspection purposes. (We) agree to save
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
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Signature�- —7Date ` �
r
L OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
1, 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
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
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.
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
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.
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
upon the above mentioned property for inspection purposes. (We) agree to save
i"'-'mnify and keep harmless the City of Cupertino against liabilities, judgments,
and expenses which may accrue against said City in consequence of the
. of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Signature Date,
CONTRACTOR: SORENSON & ASSOCIATES PERMIT NO: 11070067
ROOFING INC
PO BOX 786 1 DATE ISSUED: 07/15/2011
BRENTWOOD, CA 94513
PHONE NO: (925) 626-7682
BUILDING PERMIT INFO: BLDG f— ELECT F PLUMB I—
MECH r- RESIDENTIAL r COMMERCIAL
JOB DESCRIPTION: REROOF, 24 SQ, INSTALL ONE OVERLAY OF SINGLE PLY
DURO LAST OVER EXISTING B.U.R. ROOF
Sq. Ft Floor Area: I Valuation: $12082
APN Number: 35602052.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by:
Date:
RE -ROOFS:
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.
Signature of Applicant: \ �a_te: t.)—
ALL
.)—
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
Date: I ` l.S I i
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of Hork's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 10883 canyon vista dr. DATE: 07/11/2011 REVIEWED BY: bobs.
APN: C� BP#: -VALUATION: 1$12,082
Y°PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re -roof
PRIMARY SFD or Du lex PENTAMATION 1 SFDWLROOF
USE: P PERMIT TYPE:
WORK install one overlay of single p1V duro last.
SCOPE
FEE ID ROOF AREA
s.f.
1 REROOFFRES 2,400
NOTE: These fees are based on the preliminary in ormation available and are only an estimate. Contact the Dept -for addn 7 into.
FEE ITEMS (Fee Resolution 11-453 lsff %%1,%111 FEE QTY/FEE MISC ITEMS
Permit Fee: $336.00
Work Without Permit? 0 Yes 0 No $0.00
Strong Motion Fee: IBSEISMICR $1.21 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC 1 $1.001 L
SUBTOTALS: 1 $338.211 $0.00 TOTAL FEE: 1 $338.21
Revised: UI/U4/ZUI1
CUPERTINO
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building cDcupertino.org
PROJECT ADDRESS
7APN #'22
OWNER NAME
PHONE
E-MAIL
STREET ADDRESS
CITY, STAT ZIP
.�
FAX
APPLICANT NAME
PHONE
l �,
E-MAIL
STREET ADDRESS
CITY, STATE, ZIP
i:S
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME LICENSE NUMBER
SO c\c . F le In% Lke-A __� LA
LICENSE TYPE
BUS. LIC. #
_n,7,
COMPANY NAME r
E-MAIL
FAX 1
STREET ADDRESS
CITY, STATE, ZIP
L
PHONE
ARCHTPECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC. #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ SFD Or Duplex ❑Multi -Family
STRUCTURE: ❑ Commercial ' ALV -Lt
ROOF AREA:
0 1
VALUATION:
11, u&2,
EXISTING ROOF TYPE: BUILT-UP ROOF ❑ ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER (SPECIFY)
REMOVE /REPLACE 11 YES
12 NO
IF NO,
# LAYERS:
PLYWOOD ❑ %" ❑
THICKNESS: ❑ 5/8"
PLYWD ❑ OSB
TYPE: ❑ CDX
PITCH:
:12
ROOF
CLASS: `�
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 hav 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 rel ng to building constructlo asorl esentatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORMATION REQUIRED
_ If building is associated with a Home Owner's Association, provide letter
of approval from HOA.
Provide Planning approval t0 verify if there any restrictions.
Provide copy of Manufacturer's Installation Specifications.
Provide signed copy of Cupertino's Tear -Off Policy.
ot+ci; USE ONLY'u:
PLAN CHECK TYPE
ROUTING SLIP
❑ OVER-THE-COUNTER,
❑ EXPRESS
❑"` STANDARD
❑ BUILDING PLAN. REVIEW
❑ PLANNING PLAN REVIEW
❑ 'FIRE DEPT
❑- OTHER:
ReroofApp_2011.doc revised 03/02/11
Date: May 16, 2011
Project: Rancho Deep Cliff H.O.A.
Location: Cupertino, CA
Subject: Re -roofing (4) Units as listed below with
50 -mil, white Dura -Last single -ply.
To: Lyle Peddicord
Company: Compass Management
77 Las Colinas Lane
San Jose, CA 95119
Fax: 408-226-3406
Phone: 408-226-3300
From: Larry Sorenson
TOTAL THIS ESTIMATE: $ 52,485.00
a' -/L -/(
Date
'te
14
D to
A P PPWX) fiT S/ IG J !k g der
Sorenson & Assoc. Roofing, Inc. reserves the right to withdraw any proposal 15 or more days outstanding.
Page 2
3 ITEMS OF 12
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 35602052.00
DATE ISSUED.......: 07/15/2011
RECEIPT #.........: BS000014051
REFERENCE ID # ...: 11070067
SITE ADDRESS .....: 10883 CANYON VISTA DR
SUBDIVISION ......
CITY .............. CUPERTINO
IMPACT AREA ......
OPERATOR: patg
COPY # : 1
OWNER ............: BARBARA BEYDA
ADDRESS ..........: 10883 CANYON VISTA DR
CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-3908
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
-------- ----------------------------
309 EXTERIOR LATH
601 ROOF TEAR OFF
VOICE ID DESCRIPTION
-------- ----------------------------
311 SCRATCH COAT
602 ROOF PLYWOOD NAIL
604 ROOF IN -PROGRESS 605 FINAL REROOF