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11040101 CITY OF CtiPERTINO BUILDING PERMIT BUILDING ADDRESS: 7526 FALLENLEAF LN CONTRACTOR:DADDARIO ROOFING PERMIT NO: 11040101 OWNER'S NAME: CHUCK WU 1734 WILLA WAY DATE ISSUED:04/15/2011 VNER'S PHONE: 4089661288 SANTA CRUZ,CA 95062 PHONE NO:(831)376-9109 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL[] COMMERCIAL License Class 's Lic.# 7 RE-ROOF 41 SQUARES,TEAR OFF SHAKE INSTALL OSB AND Contractor la _ _ Date '` LIFETIME COMP I hereby of m the attII 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. 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:$17300 1 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:35928016.00 Occupancy Type: permit is issued. }}nn 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 FR ST CALLED INSPECTI N. 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 Issued by: Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature `�i Date,!:>A///,5 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 Applicant- I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERI GS 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. I 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(a)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,Sections 25505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date: 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,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 indemnify 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. sting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Lill Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: 75f-C-, �Gadkv� .a PERMIT# OWNER'S NAME: C�(Ac 1 PHONE# o !?&6- 1f-9E3 GENERAL CONTRACTOR: a i G jZoe ,`i)� BUSINESS LICENSE# ADDRESS: -71(a cau4e CITY/ZIPCODE: (a CA- `�56 Ga *Our municipal code requires all businesses working in the city to have a City of Cup rtino 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 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 lumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile 5 Ow r/ ntractor Signature Date REROOF TEAR-OFF POLICY COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE- CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228- FAX(408)777-3333 - building(E,cupertino.org PROTECT ADDRESS �r � �� / APN# OWNERNAME l+V(A PHONE %6_ /topE-MAIL STREET ADDRESS CITY, STATE,ZIP FAX C,--, ✓ 'h L) �, E-- CONTRACTOR N T6jj f d LICENSE NUMBER LICENSE TYPE BUS.LIC.# f?D COMPANY NAME E-MAIL FAX STREET ADDRESS 1 6 c / � `./�� CITY :Z tcke )4 �c6 t PHONE lSi I UNDERSTAND AND AGREE TO THE FOLLOWING: 1. The re-roof project shall comply with all applicable provisions of the 2010 California Codes. 2. An inspection request shall be scheduled the day before the inspection date. Please call (408)777- 3228 from 7:30 - 3:30pm (Mon-Thurs) or 7:30 - 2:30pm (Friday) to schedule the next day inspection. On the day of the inspection, a building inspector will be available within one hour for either a Tear-Off Inspection or Nailing Inspection if you call again on that day between the hours specified. 3. The following inspections are required: a. Tear-Off Inspection is required. Any and all dry-rotted wood shall be replaced prior to this inspection. Unless new plywood roof sheathing is proposed throughout, all the nails/fasteners shall be either completely knocked-down or removed prior to this inspection. b. If plywood is installed, a plywood Nailing Inspection is required. c. Progress Inspection is required when approximately 50% of roof covering is installed. 4. New roof coverings shall not be applied without first obtaining all inspection and written approvals from the building inspector. Any roofing which is applied without first obtaining an approved inspection will require the removal of all new material down to the sheathing so a proper inspection can be performed. 5. A final inspection and approval shall be obtained from the building inspector when the re-roofing is completed. To receive a final sign-off, the following items will be verified: a. Flat roofs shall have a minimum of I/4"per foot of slope and demonstrate there is no ponding. b. Listings from approved testing agencies for all pre-manufactured products used shall be available on-site to review at the time of the inspection. c. Proper spark arrestor installation. 6. NOTE: If you call for a tear-off or plywood nailing inspection and the work is not complete, you will be charged a re-inspection fee of$126.00. The re-inspection fee shall be paid before another inspection can be scheduled. By my signing below,I certify each of the following is true: I am the property owner or authorized agent to act on the property owner's behalf. I understand and agree to comply with the re-roof policy stated above. I also understand that smoke detectors and carbon monoxide detectors are required to be installed in accordance with Sections R314 and R315 of the 2010 California Residential Code. Signature of Applicant/Agent: Date: 15 g , ReroofPolicy_2011.doc revised 02/16/11 CITY OF CUPERTINO 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 35928016 . 00 DATE ISSUED. . . . . . . : 04/15/2011 RECEIPT #. . . . . . . . . : BS000013195 REFERENCE ID # . . . : 11040101 SITE ADDRESS . . . . . : 7526 FALLENLEAF LN SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . . OWNER CHUCK WU ADDRESS 7526 FALLENLEAF LN CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : DADDARIO ROOFING CONTRACTOR . . . . . . . : EDGAR MONTOYA LIC # 26245 COMPANY . . . . . . . . . . : DADDARIO ROOFING ADDRESS 1734 WILLA WAY CITY/STATE/ZIP . . . : SANTA CRUZ, CA 95062 TELEPHONE . . . . . . . . : (831) 476-9109 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 17, 300 . 00 1. 00 0 .00 1 . 00 0. 00 1BSEISMICR VALUATION 17, 300 . 00 1 . 73 0 .00 1 . 73 0 . 00 1BUSLIC FLAT RATE 1 . 00 115 . 00 0 . 00 115 . 00 0 .00 1REROOFRES SQ FEET 41 .00 533 . 00 0 . 00 533 . 00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 650. 73 0 .00 650 .73 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 650 . 73 1066 --------------- TOTAL RECEIPT 650.73 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 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 7526 fallenleaf In. DATE: 04/15/2011 REVIEWED BY: bobs. APN: BP#: "VALUATION: $17,360 ,,PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof PRIMARY SFD or Duplex PENTAMATION 1SFDWLR00F USE: PERMIT TYPE: wORK tear off ex. wood shake install comp shingles SCOPE FEE ID ROOF AREA s.f. 1 REROOFFRES 4,100 77, LJ Li NOTE: Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addh 7 info, FEE ITEMS (P'ee Resolution 09-051 E;.' 1.11,10) FEE QTY/FEE MISC ITEMS Permit Fee: $533.00 Work Without Permit? 0 Yes E) No $0.00 Strong Motion Fee: IBSEISMCR $1.74 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $535.74 $0.00 TOTAL FEE: $535.74 Revised: 01/15/2011 REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333 •buildingd)cupertino.org 01 PROJECT ADDRESS75 v 6 T-411 Q + ✓ APN#�rjLyar �G I OWNER NAME L / p�j6- 120CJ E-MAIL o Ch�► CK Wu y ' TQ STREET ADDRESS CITY,STATE,ZIP FAX CA 0 Cpc q 0 .5 APPLICANT NAME PHONE E-MAIL STREET ADDRESS ��//yy CITY,STATE,ZIP FAX 11 OWNER ❑ OWNER-BUILDER 11 OWNER AGENT �CDNTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR LICENSE NUMBER LICENSE TYPE BUS.LIC.# COMPANY NAME E-MAII FAX STREET ADDRESS E� CITY,STATE,ZIP PHONE -7 !fo i 401a ve � ; Vie_ Cu (cc e 1750 /e) 931 7L/ -9<0 Y ARCI IITECr/ENGR,EER NAME LICENSE NUMBER BUS.LIC.# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF 2�,SrFD or Duplex ❑ Multi-Family ROOF AREA: VALUATION: STRUCTURE: ❑ Commercial Y EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY) REMOVE/REPLACE �ES IF NO, 1 PLYWOOD ❑ h" �_ PLYWD OSB PITCH: ROOF ❑ NO #LAYERS: THICKNESS: ❑ 5/8" TYPE: ❑ COX •12 CLASS: A PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ASPHALT SINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT# DESCRIPTION OF WORK: _ cam. 1/- c 'cT vL S 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 building constru 'o I authorize representatives of Cupertino tc enter the above-id ntified open;for inspection purposes. Signature of Applicant/Agent: <. Date: CIv �f7 SUPPLEMENTAL INFORMATION REQUIRED airlclSa "lb � _ If building is associated with a Home Owner's Association,provide letter "� PLAIR cHECKTYPE z-F ouTING SLIP, A _ of approval from HOA. x tia> c � �Ut>DIN%aT.Ait Reim uv *-"' Provide Planning approval to verify if there.any restrictions. Cj Exii�ss ❑ PLANNING PLAN REY5,5 IER Provide copy of Manufacturer's Installation Specifications. Q snxDnxD _Provide signed copy of Cupertino's Tear-Off Policy. ReroofApp_2011.doc revised 03/02/11