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11070034
CITY OF CUPERTINO BUILDING PERMIT 7 BUILDING ADDRESS: 10683 MINETTE PL CONTRACTOR:QUALITY FIRST HOME PERMIT NO: 11070034 IMPROVEMENTS OWNER'S NAME: LINDA MILLER 6545 SUNRISE BLVD STE 202 DATE ISSUED:07/06/2011 O'"'NER'S PHONE: 4089961943 CITRUS HEIGHTS,CA 95610 PHONE NO:(916)788-2921 G LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ RE-ROOF REMOVE EXISTING BUILDT UP FOAM ROOF AND License Class C—3Lic.# L._ APPLY DENSDECK AND INSTALL SELF ADHERING BASE, CAPSHEET,26 SQUARES. Contractor I vtip gt*ate b I hereby affirm that I am licensed under 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. 1 hereby affirm under penalty of perjury one of the following two declarations: Sq.Ft Floor Area: Valuation:$16440 1. 1 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. APN Number:37532040.00 Occupancy Type: 2. 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. .4 KK PERMIT EXPIRES IF WORK IS NOT STARTED APPLICANT CERTIFICATION WITHIN 180 DAYS OF PERMIT ISSUANCE OR I certify that I have read this application and state that the above information is correct. 1 agree to comply with all city and county ordinances and state laws relating 180 DAYS FROM LAST CALLED INSPECTION. 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, Issued 6y• Date: 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 regu tions per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature Date C 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 Signature of Appli;OOF t: Date: 1. .eby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL COVERINGS TO BE CLASS"A"OR BETTER t. 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 HAZARDOUS MATERIALS DISCLOSURE sale(Sec.7044,Business&Professions Code) 2 1,as owner of the property,am exclusively contracting with licensed contractors to I have read the hazardous materials requirements under Chapter 6.95 of the construct the project(Sec.7044,Business&Professions Code). California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I hereby affirm under penalty of perjury one of the following three declarations: Safety Code,Section 25532(a)should I store or handle hazardous material. i I have and will maintain a Certificate of Consent to self-insure for Worker's Additionally,should I use equipment or devices which emit hazardous air Compensation,as provided for by Section 3700 of the Labor Code,for the 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 performance of the work for which this permit is issued. Health&Safety Code,Sections 25505,25533,and 25534. 2. 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 Owner orori d age permit is issued. Date:_�W1 3 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 CONSTRUCTION LENDING AGENCY Compensation laws of California. If,after making this certificate of exemption,I I hereby affirm that there is a construction lending agency for the performance of work's become subject to the Worker's Compensation provisions of the Labor Code,I for which this permit is issued(Sec.3097,Civ C.) must forthwith comply with such provisions or this permit shall be deemed Lender's Name revoked. Lender's Address APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is ARCHITECT'S DECLARATION correct. 1 agree to comply with all city and county ordinances and state laws relating I understand my plans shall be used as public records. to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save Licensed Professional indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the ing of this permit.Additionally,the applicant understands and will comply with m-point source regulations per the Cupertino Municipal Code,Section 9.18. Signature Date CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 10683 minette place DATE: 07/06/2011 REVIEWED BY: bobs. A ,3 PN: -(� BP#: D �L j VALUATION: 1$16,440 }PERMIT TYPE: Minor Building Permit PLAN CHECK YPE: Re-roof PRIMARY SFD or Duplex PENTAMATION 1 SFDWLROOF USE: PERMIT TYPE: WORK remove built up foam roof, replace with ca sheet. SCOPE FEE ID ROOF AREA s.f. 1 REROOFFRES 2,600 NOTE. Thesefees are based on the preliminary information available and are on an estimate. Contact the De t or addh 7 info, FEE ITEMS (Fee Resolution 11-053 Fff. ' .-'I l) FEE QTY/FEE MISC ITEMS Permit Fee: $364.00 Work Without Permit? 0 Yes No $0.00 Strom Motion Fee: 1BSEISMICR $1.64 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $366.64 $0.00 TOTAL FEE: $366.64 Revised: 07/01/2011 CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: suew COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . . 37532040 . 00 DATE ISSUED. . . . . . . : 07/06/2011 RECEIPT # . . . . . . . . . : BS000013976 REFERENCE ID # . . . : 11070034 SITE ADDRESS . . . . . : 10683 MINETTE PL SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : LINDA MILLER ADDRESS . . . . . . . . . . : 10683 MINETTE PL CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : GC ANDERSON CONTRACTOR . . . . . . . : GC ANDERSON LIC # 30398 COMPANY . . . . . . . . . . : QUALITY FIRST HOME IMPROVEMENT ADDRESS . . . . . . . . . . : 6545 SUNRISE BLVD STE 202 CITY/STATE/ZIP . . . : CITRUS HEIGHTS, CA 95610 TELEPHONE . . . . . . . . : (916) 788-2921 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 16,440 . 00 1 . 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 16,440 . 00 1 . 64 0 . 00 1 . 64 0 . 00 1REROOFRES SQ FEET 26 . 00 364 . 00 0 . 00 364 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 366 . 64 0 . 00 366 . 64 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 366 . 64 VISA-OVER PHONE --------------- TOTAL RECEIPT 366 . 64 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 ELI] Telephone: 408-777-3228 CUPERTINO Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST AF JOB ADDRESS: IC66.T PERMIT# OWNER'S NAME: `� ��- PHONE # `lle- -W - 74j-2-1 GENERAL CONTRACTOR: BUSINESS LICENSE # ADDRESS:dS#S- :5--,r Se v :; i -'S'�-hi c A CITY/ZIPCODE: G .s Het ,W-s, c A :)S-(.(o *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: Signature Date Please check applicable subc ntractors 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 4, REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333 •buildin4(cr�.cuoertino.org PROJECT ADDRESS 10683 ^ APN# �J L`_ 7 0'L16 Ve OWNER NAME Z_ A41 PHONE E-MAIL STREET ADDRESS /0693 ,u t--e e f4kee. CITY, STATE,ZII' �A �O tE FAX APPLICANT NAME "0.��/C IL1 r`t !} PHONE STREET ADDRESS CrI-Y,STATE, ZIP FAX q, Gr b' O�S' nt+-�7► ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME a-%d- , 0 v•-gam LICENSE NUMBER LICENSE TYPE BUS.LIC.# r COMPANY NAME LO-ICA-4-1 /c�'�';i-- E-MAIL FAX STREET ADDRESS GSA Ste. 161�rt1 CITY STATE,ZIP PHONE ARCHITECT/ENGWEER NAME LICENSE NUMBER BUS.LIC.# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF SFD or Duplex ❑ Multi-Family ROOF AREA: VALUATION: STRUCTURE: ❑ Commercial ZG l6 ICZ EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES OTHER(SPECIFY) Fb�� REMOVE/REPLACE 5.YES IF NO, ' PLYWOOD ❑ %" ❑ _ PLYWO ❑ OSB PITCH: ROOF ❑NO #LAYERS: TTHICKNESS: ❑ 5/8" TYPE: ❑ CDX 12 CLASS: A PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER /riY�( ICC-ES REPORT# DESCRIPTION OF WORK: P CGC Pt-7 r 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 buildin onstruction. I authorize.representatives of Cupertino tc enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: ,t��l SUPPLE AL INFORMATION REQUIRED o ICI tiSE i y � - _If building is associated with a Home Owner's Association,provide letter - N TSEovxiNaL� of approval from HOA. C�3 pv R I>�FcQIIIvrEx� ❑ BuuvINGPr Art REVIX _Provide Planning approval to verify if there any restrictions. t];�xPR�ss ❑:�IaNNn�c PLAxREVIEw . � _;,ovi�de oviopy of Manufacturer's Installation Specifications. 1]'; - - ❑.= D>rT signed copy of Cupertino's Tear-Off Policy. ©'oTa>It. ReroofApp_2011.doc revised 03/02/11