11070066 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22456 RANCHO DEEP CLIFF DR CONTRACTOR:SORENSON&ASSOCIATES PERMIT NO: 11070066
ROOFING INC
OWNER'S NAME: SCHETTLER DANIEL J AND BIRGIT I TRU PO BOX 786 DATE ISSUED:07/15/2011
ER'S PHONE: 4084546301 BRENTWOOD,CA 94513 PHONE NO:(925)626-7682
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class %7:�,C{ Lic.# R.3Lt 01 r— r
MECH RESIDENTIAL COMMERCIAL
Contractor --_�XAcC%LJ NSQ'-C wAtt Date '_ —S
I hereby affirm that am linsed an�er the provisions of Chapter 9 JOB DESCRIPTION:REROOF,21 SQ INSTALL ONE OVERLAY OF SINGLE PLY
(commencing with Section 7000)of Division 3 of the Business&Professions DURIO LAST OVER EXISTING B.U.R.ROOF
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:$10955
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
APN Number:35602054.00 Occupancy Type:
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-po' rce regulations per the Cupertino Municipal Code,Section
9.18. { Issued by: Date:
Signa Date 1
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 oan inspection,I agree to remove all new materials for
the following two reasons: inspection.
1,as owner of the property,or my employees with wages as their sole compensation, 4 (�
will do the work,and the structure is not intended or offered for sale(Sec.7044, Signature of licant: T��___Date:
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE
declarations:
I 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.
Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air
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 exemp. I O ner or,a rized age ;r
become subject to the Worker's Compensation provisions of the Labor Code,I must Date:_
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 vwrk'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� " nnify 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
gi,nuing 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
CITY OF CUPERTINO
3 ITEMS OF 12 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN 35602054 . 00
DATE ISSUED. . . . . . . : 07/15/2011
RECEIPT #. . . . . . . . . BS000014051
REFERENCE ID # . . . : 11070066
SITE ADDRESS . . . . . : 22456 RANCHO DEEP CLIFF DR
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER SCHETTLER DANIEL J AND BIRGIT
ADDRESS 22456 RANCHO DEEP CLIFF 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 10, 955 .00 1. 00 0 . 00 1.00 0. 00
1BSEISMICR VALUATION 10, 955 .00 1.10 0. 00 1 .10 0 .00
1REROOFRES SQ FEET 21. 00 294 . 00 0. 00 294 .00 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 296.10 0. 00 296 .10 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 1, 310 .73 #0630
---------------
TOTAL RECEIPT 1, 310. 73
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
, E) (D(ow
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 22456 rancho deep cliff dr. DATE: 07/11/2011 REVIEWED BY: bob s.PN:
3 BP#: EVALUATION: $10,955 -�
A �� O
*PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD or Duplex PENTAMATION 1SFDWLR0OF
USE: PERMIT TYPE:
WORK install one overlay of single ply duro last.
SCOPE
FEE ID ROOF AREA
s.f.
1 REROOFFRES 2,100
T-T
NOTE: These fees are based on the preliminary in ormation available and are only an estimate. Contact the Dept for addn 7 info.
FEE ITEMS FEE QTY/FEE MISC ITEMS
Permit Fee: $294.00
Work Without Permit? 0 Yes G No $0.00
i
Strom Motion Fee: IBSEISMICR $1.10 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $296.10 $0.00 TOTAL FEE: $296.10
Revised: 07/04/2011
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO, CA 95014-3255
CUPERTIND (408)777-3228• FAX(408)777-3333•building(a1cupertino.org
PROJECT ADDRESS APN
OWNER NAME P ONE E-MAIL
b.elV"tSe* tet, '-(
STREET ADDRESS CITY, STATE,ZIP, FAX
NE
APPLICANT NAME PHOE-MAIL P ? r
STREET ADDRESS CITY,STATE,ZIP I FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ;4 CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAMELICENSE NUMBER LICENSE TYPE BUS.LIC.#
c'r \I,-i .1 L < L
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
ARCHITECT/ENGINEER 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 f�f, �� /' _�--
EXISTING ROOF TYPE: 4 BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY)
REMOVE/REPLACE ❑YES IF NO, PLYWOOD " ❑
PL ❑ OSB PITCH: ROOF
'NO #LAYERS: r THICKNESS: ❑ 5/8" TYPE: " -CDX CLASS:
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF El ASPHALT SHINGLES 11 WOOD SHAKES ❑WOOD SHINGLES ❑OTHER il
ICC-ES REPORT#
DESCRIPTION OF WORK: l
��. .. Y 1 7, P ,
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 ave ' 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 u n ction. I orize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date: �T1`
SUPPLEMENTAL INFORMATION REQUIRED `F OFFICE USE'ONLY
_✓ 1I building is associated with a Home Owners Association,provide letter PLAN CHECK TYPE OUTING SLIP
Of approval from HOA. OVER-THE-COUNTER BUILDING PLAN REVIEW
_Provide Planning approval to verify if there any restrictions. ❑ EXPRESS ❑ PLANNING PLAN REVIEW
_Provide copy of Manufacturer's Installation Specifications. ❑ STANDARD ❑ FIRE DEPT
Provide signed copy of Cupertino's Tear-Off Policy. ❑ "OTHER: i
ReroofApp_201 1.doc revised 03/02/11