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11070167 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESv: 10560 N FOOTHILL BLVD CONTRACTOR:CURT FLETSCHER PERMIT NO: 11070167 ROOFING INC OWNER'S NAME: PAPPAS M L TRUSTEE 354 MONTICELLO AVE DATE ISSUED:07/22/2011 WNER'S PHONE: 4082457692 SAN JOSE,CA 95125 PHONE NO:(408)267-2679 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIALE] License Class C Lie.# Sy w `�� 10560-10562-RE-ROOF 36 SQUARES REMOVE SHAKE ROOF Contractor l Date�� INSTALL RADIANT BARRIER 30LB FELT NEW FLASHING I hereby affirm that I am licensed under the provisions of Chapter 9 LIFETIME CLASS A (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:$15400 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 APN Number:32613021.00 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 FYLAST CALLED INSPEC IO . indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the 7 / : G granting of this permit. Additionally,the applicant understands and will comply Issued byDate: ` with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. J RE-ROOFS: Signature Date 2�/� 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. OWNER-BUILDER DECLARATION \ I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: 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 project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will I 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(x)should I 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 I 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,Sectio 505, 533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Owner or authorized agent: Date: 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,I 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 ,mnify 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. �.tenting of this permit.Additionally,the applicant understands and will comply w.,h all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date CITY OF CUPERTINO 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 32613021. 00 DATE ISSUED. . . . . . . : 07/22/2011 RECEIPT #. . . . . . . . . : BS000014156 REFERENCE ID # • . . : 11070167 SITE ADDRESS . . . . . : 10560 N FOOTHILL BLVD SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : PAPPAS M L TRUSTEE ADDRESS . . . . . . . . . . : 10560 N FOOTHILL CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-0803 RECEIVED FROM . . . . : CURT FLETSCHER CONTRACTOR . . . . . . . : CURT FLETSCHER LIC # 22227 COMPANY . . . . . . . . . . : CURT FLETSCHER ROOFING INC ADDRESS . . . . . . . . . . : 354 MONTICELLO AVE CITY/STATE/ZIP . . . : SAN JOSE, CA 95125 TELEPHONE . . . . . . . . : (408) 267-2679 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 15,400 . 00 1 . 00 0 .00 1 . 00 0 . 00 1BSEISMICR VALUATION 15,400 . 00 1 .54 0 . 00 1 . 54 0 . 00 1BUSLIC FLAT RATE 1 . 00 115 . 00 0 . 00 115 . 00 0 " 00 1REROOFRES SQ FEET 36 . 00 504 . 00 0 . 00 504 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 621. 54 0 . 00 621 . 54 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 621. 54 visa --------------- TOTAL RECEIPT 621 . 54 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 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: 6 L, PERMIT# 1(Q 6 �0 OWNER'S NAME: PHONE # VV GENERAL CONTRACTOR: -i BUSINESS LICENSE # ADDRESS: fj, G CITY/ZIPCODE: ",,4 d_) , 5-1--A *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. r- I am not using any subcontractors: - Signature Date 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 n Roofing r f Septic Tank Sheet Metal Sheet Rock Tile Owner Contractor Signature Date a REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333 • buildingacupertino.org I1b PROJECT ADDRESS % APN# �/_ 13 o.>1 . O NAME TV PHONE C>-)445 -7 -MAIL STREET ADDRESS �! CITY, STATE,ZIP FAX 10 tJbi AP I ANT N J:K7 ` ( P r E-MAIL f S AD RESS C1T Y, ZIP FAX 1 7 A/ � LJ ❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CO CTO. LICENSE LICENSE �_, BUS.LIC.#C;2- � CO N ^ E-MAIL FAX ✓�. Y, STREET ADDRESS C TATE,Z2._ PHONE. 3 s- v �_ i - L ARCH]7ECT/ENG1NEER NAME LICENSE NUMBER BUS.LIC.# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ,)ieSFD or Duplex ❑ Multi-Family ROOF AREA: VALUATION: STRUCTURE: ❑ Commercial �7t 36 o� EXISTING ROOF TYPE: ❑BUILT-UP ROOF Elf-+ASPHALT SHINGLES WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY) REMOVE/REPLACEr/gHM IF NO, 1 PLYWOOD EDW, PLYWD OSB PITCH ROOF ❑ NO #LAYERS:L THICKNESS: ❑ 5/8" J!2 TYPE: ❑ CDX :12 CLASS: A PROPOSED ROOF TYPE: ❑B=-UP ROOF 'ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT# DESCRIPTION OF WORK I� � u By my signature below,1 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.�Ihne 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 co tructionhorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: ` Date:JAI- C PLEMENTAL INFORMATION REQUIREDa If building is associated with a Home Owner's Association,provide letter P�ATr � auI sLlp r` ` of approval from HOA. - } PP QvRra� BUII,DING-PIiAA RE Provide Planning approval to verify if there any restrictions. �xrt�cS - '❑ G PL}17�RE P _Provide copy of Manufacturer's Installation Specifications. L] _ Provide signed copy of Cupertino's Tear-Off Policy. _ ❑ff �T> t ReroofApp_2011.doc revised 03/02/11