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11040056 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 18691 CRABTREE AVE CONTRACTOR:WESTSHORE ROOFING PERMIT NO: 11040056 INC OWNER'S NAME: ROBERT MARTINEZ 2245-A FORTUNE DR DATE ISSUED:04/08/2011 ( 3R'S PHONE: 4084205860 SAN JOSE,CA 95131 PHONE NO:(408)694-0060 LICENSED CONTRACTOR'S DECLARiATION BUILDING PERMIT INFO: BLDG ELECT F PLUMB License Class ,� V Liffe.`,#,� _((��p�)2_/ Contractor LUYcS qD K.FIyi'll''�Date O$ ZD)I MECH� RESIDENTIAL COMMERCIAL I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:RE-ROOF REMOVE EXISTING TAR&GRAVEL ROOF, (commencing with Section 7000)of Division 3 of the Business&Professions INSTALL DENS DECK&OSB INSTALL IB SINGLE PLY ROOF CLASS A Code and that my license is in full force and effect. 25SQ 1 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. Sq.Ft Floor Area: Valuation:$16462 APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is APN Number:37525049.00 Occupancy Type: 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, PERMIT EXPIRES IF WORK IS NOT STARTED costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply WITHI0 DAYS OF PERMIT ISSUANCE OR with all non-point source regulations per the Cupertino Municipal Code,Section 180 DA OM LAST CALLED INSPECTION. 9.18. �( Signature Date f��p° D Issued by: U �/ Date: L OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS: the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is 1,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I agree to remove all new materials for will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection. Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: N Date: Qq W11 construct the project(Sec.7044,Business&Professions Code). 1 hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE 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 read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain Section 3700 of the Labor Code,for the performance of the work for which this compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Safety Code,Section 25532(a)should I store or handle hazardous material. permit is issued. Additionally,should I use equipment or devices which emit hazardous air I certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District I will not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Compensation laws of California. If,after making this certificate of exemption,I Health&Safety Code,Sections 25505,25533,and 25534. 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. Owner or authorized a e /yNU Date: J! APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY 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 I hereby affirm that there is a construction lending agency for the performance of work's to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.) upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name i-' -nify and keep harmless the City of Cupertino against liabilities,judgments, tnd expenses which may accrue against said City in consequence of the Lender's Address gr.rting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION 9.18. I understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO 3 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 37525049.00 DATE ISSUED. . . . . . . : 04/08/2011 RECEIPT #. . . . . . . . . : BS000013135 REFERENCE ID # . . . : 11040056 SITE ADDRESS . . . . . : 18691 CRABTREE AVE SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : ROBERT MARTINEZ ADDRESS 18691 CRABTREE AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : WESTSHORE ROOFING CONTRACTOR . . . . . . . : PAUL FOWLER LIC # 21417 COMPANY . . . . . . . . . . : WESTSHORE ROOFING INC ADDRESS . . . . . . . . . . : 2245-A FORTUNE DR CITY/STATE/ZIP . . . : SAN JOSE, CA 95131 TELEPHONE . . . . . . . . : (408) 694-0060 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 16,462 . 00 1. 00 0. 00 1.00 0. 00 1BSEISMICR VALUATION 16,462 .00 1.65 0. 00 1.65 0. 00 1REROOFRES SQ FEET 25 . 00 325. 00 0. 00 325 .00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 327.65 0. 00 327.65 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 680. 89 #10325 --------------- TOTAL RECEIPT 680.89 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 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 18691 Crabtree ave DATE: 04/08/2011 REVIEWED BY: larry s APN: BP#: "VALUATION: $16,462 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration /Repair PRIMARY SFD or Duplex PENTAMATION 1SFDWLR00F USE: I PERMIT TYPE: WORK remove existing tar and gravel roof, install dens deck and osb. install ib single ply roof. SCOPE NOTE. Thesefees are based on the preliminaty information available and are only an estimate. Contact the De t or addn'1 info, FEE ITEMS (twee.Resolution 09-051 Ziff. 7/1,10) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 2,500 s.£ Re-roof Suppl.PC Fee: G Reg. 0 OT 0.0 1 hrs $0.00 $325.00 IREROOFRES PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp.Fee.0 Reg. 0 OT 0.0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 77 Acoustical Fee: 0 Yes 0 No $0.00 0 Work Without Permit? 0 Yes 0 No $0.00 0 Planning Fee: $0.00 Select a Non-Residential 0 Building or Structure 0 Strotw Motion Fee: IBSEISMICR $1.65 Select an Administrative Item L Bld€'•Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $2.65 $325.00 TOTAL FEE: r $327.65 Revised: 01/15/2011 REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408)777-3228• FAX (408) 777-3333•buildingacupertino.org ,UPERTINO PROJECT ADDRESS G t APN k (_�%,-5 -,) i� OWNER NAMEO D _l I \ ��` PHONE O y �/� j� 36 OTE-MAIL A STREET ADDRESS / `r HV C Y, STATE,ZIP A 1� ^ i L� FAX A' A- CONTACT NAME �V^ PHONE E-MAIL STREET ADDRESS +� CITY,STATE, ZIP FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CQNTRACTOR NAME N' F 4jL LICENSE NUMBER �5y LICENSE TYPEC_ BUS.LIC.# COMPANY NAME ,,TS��O ',2 1 `oot & E-MAIL (]1�< 0 0 C1'^ FAX bZ3-3 STREET ADDRESS -1� I v.1 c n� < C A CITY,STATE,ZIP SA� `OC L � ' �i�� PHONE W8-154­0200 Z)8p Ly5!r 0 r]/yj> ARCHITECT/ENGINEER NAME 'V C !/ J C LICENSE NUMBER `J JC j 1 BUS.LIC. 1/ 7 (' G lJ� COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE OF SFD or Duplex ❑ Multi-Family ROOF AREA: VALUATION: STRUCTURE: ❑ Commercial 2 L r 7 2 EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY) REMOVE/REPLACE 'gYES IF NO, PLYWOOD Ti9" ❑ PLYWD )KOSB PITCH: 1 ROOF 11 NO #LAYERS: THICKNESS: 115/S" TYPE: ❑ CDX }+'��1 CLASS: APROPOSED ROOF TYPE: ❑BUILT-UP ROOF 11 ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES t OTHER .-T L ICC-ES REPORT# DESCRIPTION OF WORK: _F IN 6RAvtt- dOF IIVs AL FN 'A ,Tt4r N TNS-TXLL - 4- R OO-- 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. 1 have read this application and the information 1 hav 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 t ilding c struction. I authorize representatives of Cupertino to enter the above-i ntified roperty for inspection purposes. Signature of Applicant/Agent: Date: Q 9 2d 1./ I A I SUPPLEMENTa INFORMATION REQUIRED OFFICE USE ONLY If building is associated with a Home Owner's Association,provide letter PLAN CHECK TYPE ROUTING 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: ReroofApp_201 1.doc revised 03/16/11