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11040181CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10411 STERLING BLVD CONTRACTOR:POIMPROVEMENTS FIRST HOME I PERMIT NO: 11040181 I OWNER'S NAME: AVIS CHAFFEE 16545 SUNRISE BLVD STE 202 1 DATE ISSUED: 04/26/2011 I O 'R'S PHONE: 4082536750 ❑ LICENSED CONTRACTOR'S DECLARATION License Class C 5 DA Lie. # �%vn e cok-e_'C\-k Contractor (1),1nmoi %\cS� _k bn e DRte 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. 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 Section 3700 of the Labor Code, for the performanct of the work for which this permit is issued. 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 upon the above mentioned property for inspection purposes. (We) agree to save 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 with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature 1-k1VVV_q��1 C711i L OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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 sale (Sec.7044, Business & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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. 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 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 CITRUS HEIGHTS, CA 95610 1 PHONE NO: (916) 788-2921 BUILDING PERMIT INFO: BLDG I— ELECT PLUMB f— MECH RESIDENTIAL COMMERCIAL JOB DESCRIPTION: RE -ROOF REMOVE EXISTING TAR & GRAVEL ROOF, REPAIR MINOR DRY ROT REROOF WITH GAF LOW SLOPE SELF ADHERING BASE PLY CAP SYSTEM CLASS A 30SQ Sq. Ft Floor Area: I Valuation: $14500 APN Number: 37526001.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued b—. Date: G% 2,1— Ll RE -ROOFS: 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. Signature of Applicant: Date:�pf ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air 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 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. ner r aut�or' gent_ i Date:1 APPLICANT CERTIFICATION I certify that 1 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 inr'—nify and keep harmless the City of Cupertino against liabilities, judgments, C cnd expenses which may accrue against said City in consequence of the gra—mg of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I I understand my plans shall be used as public records. Signature Date Licensed Professional 3 ITEMS OF 3 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 37526001.00 DATE ISSUED.......: 04/26/2011 RECEIPT #.........: BS000013296 REFERENCE ID # ...: 11040181 SITE ADDRESS .....: 10411 STERLING BLVD SUBDIVISION ...... CITY .............. CUPERTINO IMPACT AREA ...... OWNER ............: AVIS CHAFFEE ADDRESS ..........: 10411 STERLING BLVD CITY/STATE/ZIP ...: CUPERTINO, CA 95014 OPERATOR: patg COPY # : 1 RECEIVED FROM ....: QUALITY FIRST HOME 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 ---------- 14,500.00 ---------- 1.00 ---------- 0.00 ---------- 1.00 0.00 1BSEISMICR VALUATION 14,500.00 1.45 0.00 1.45 0.00 1REROOFRES SQ FEET 30.00 390.00 0.00 390.00 0.00 ---------- TOTAL PERMIT ---------- 392.45 ---------- 0.00 ---------- 392.45 0.00 METHOD OF PAYMENT ----------------- CHECK TOTAL RECEIPT : AMOUNT --------------- 392.45 --------------- 392.45 VOICE ID DESCRIPTION -------- ---------------------------- 309 EXTERIOR LATH 601 ROOF TEAR OFF REFERENCE NUMBER -------------------- #2412 VOICE ID DESCRIPTION -------- ---------------------------- 311 SCRATCH COAT 602 ROOF PLYWOOD NAIL 604 ROOF IN -PROGRESS 605 FINAL REROOF CITY OF CUPERTINO i TTT TCTTMAT(1R— III TII.iIIN(i' IIIVICI0N LaADDRESS: 10411 sterling blvd DATE: 04/26/2011 REVIEWED BY: bobs. APN: BP#: `'VALUATION: 1$14,500 y°PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re -roof PRIMARY SFD or Duplex_T__ P PENTAMATION 1 SFDWLROOF PERMIT TYPE: USE: 19 WORK remove exisitnq tar and gravel replace with cap system. SCOPE FEE ID ROOF AREA s.L 1REROOFFRES 3,000 NOTE: These fees are based on the preliminary information available and are only an estimate. Contact the Dept /or addn'l tnjo. FEE ITEMS (Fee Resolution 09-051 I ff. 7/1"1.0) FEE QTY/FEE MISC ITEMS Permit Fee: $390.00 F-1 Work Without Permit? 0 Yes E) No $0.00 Strong Motion Fee: 1BSEISMICR $1.45 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $392.45 $0.00 TOTAL FEE: F $392.45 Revised: 04/01/2011 ;UPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: D'4kk PERMIT # / r? d / OWNER'S NAME: L' PHONE # GENERAL CONTRACTOR: - BUSINESS LICENSE # ADDRESS: p CITY/ZIPCODE: S' CiA 9 10 *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. 1 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 Linoleurn / 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 CUPERTINO REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildingacupertino.ong t t (-)q (Ak I PROJECT ADDRESSO APN 15 � d b 1 OWNER NAME PH E-MAIL STREET ADDRESS. CITY, ATE, ZIP Q� FAX APPLICANT PHONE,'^ „1 E MA) ` Kee 10 Yw -1 U ITRYT C STATE, ZIP \- _ 1L ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CO CTOR N LICENSE NUMBER LICEN BUS. LIC. # `1q COMPANY NAME E-MAIL F)6e8 STREE ADDRESS C ,STATE,Z P111. LAS SOLV\V�Se- v i ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC. # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF II SFD or Duplex ❑ Multi -Family ROOF AREA: VALUATION: ❑ Commercial 3(2) � STRUCTURE: EXISTING ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES OTHER (SPECIFY)- REMOVE /REPLACE YES IF NO, PLYWOOD ❑ 9i' ❑ PLYWD 13OSB PITCH � ROOF ❑ NO # LAYERS: THICKNESS: 5/8" ElCDX . 12 CLASS: A C--1 F� PROPOSED ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES OTHER IMES REPORT # DESCRIPTION OF WORK: N vf,e - V l 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 building construction. I authorize rr entatives of Cupertino to enter the abov-idennti£ed properr for inspection purposes. Signature ofApplicanUAgent: Date:Zk SUPPLEMENTAL INFORMATION REQUIRED If building is associated with a Home Owner's Association, provide letter raE cotnv�l C] BIII1 DIlYG�LAN REYIEW _ of approval from HOA.Tx Provide Planning approval to verify if there any restrictions. ❑ _ _ Provid y of Manufacturer's Installation Specifications. EXrx�ss STANDatRD prpNNJNGPLANREC'IER ❑ ETRE REPT y _� rovide signed copy of Cupertino's Tear -Off Policy. y ReroofApp_2011.doc revised 03/02/11 X