13030153CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10430 PINEVILLE AVE
CONTRACTOR: CUPERTINO ROOF, INC
PERMIT NO: 13030153
OWNER'S NAME: LUND LEONARD H AND MARGARET R
1052 KELLY DR
DATE ISSUED: 03/28/2013
OWNER'S PHONE: 4082570768
SAN JOSE, CA 95129
PHONE NO: (408)973-9427
JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIAL E]
LICENSED CONTRACTOR'S DECLARATION
License Class C Lie. #
TEAR OFF (E) WOOD SHAKE, INSTALL NEW LIFE TIME
V �R2�-CK.? '�G r / 3
3 -
COMP SHINGLE (2500 SQ FT)
Contractor Date . tp
I hereby affirm that I am licensed unAr 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
Sq. Ft Floor Area:
Valuation: $11000
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
APN Number: 36913039.00
Occupancy Type:
permit is issued.
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 DAY RMIT 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 F CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
Date:
granting of this permit. Additionally, the applicant understands and will comply
ssue
with a - oint source regulations per the Cupertino Municipal Code, Section
9.18.
Date
RE -ROOFS:
Signature
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtat-tin an inspection, I agree to remove all new materials for
inspection.
❑ OWNER -BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
ALL ROOF COVERINGS 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 complian a Cupertino Municipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health &Safety Code, Section t5505,25533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
_2
Date:
permit is issued.
Owner or authorized agent:
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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
ARCHITECT'S DECLARATION
costs, and expenses which may accrue against said City in consequence of the
I understand my plans shall be used as public records.
granting 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
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
NOTE. This estimate does not include fees due to other Departments (La Planning, Public Works, Fire, Sanitary Sewer District, School
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FEE ITEMS (Fee Resolution 11-053 E . 7/1/122
10430 PINEVILLE AVE
DATE: 03/28/2013
REVIEWED BY: MELISSA
JimADDRESS:
APN: 36913 039
BP#:
"VALUATION:
1$11,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY
USE: SFD or Duplex
Other ;lfech. Insp.
PENTAMATION
PERMIT TYPE: 1 SFDWLROO
WORK
TEAR OFF E WOOD SHAKE INSTALL NEW LIFE TIME COMP SHINGLE 2500 SQ FT
SCOPE
Elec. Insp. Fee:
NOTE. This estimate does not include fees due to other Departments (La Planning, Public Works, Fire, Sanitary Sewer District, School
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FEE ITEMS (Fee Resolution 11-053 E . 7/1/122
FEE
QTY/FEE
4
Plan Check Fee:
�1ech. Plan ('heck
Plumb. Plan Check
Eiec. Plan Check
Fh. Permit Fee:
Plumb. Permit Fee:
Flee. Permit Fes:
Other ;lfech. Insp.
Other Plumb Insp.Li
Other Flec. Insp.
ilech. Insp. Fee:
Plumb. Insp. Fee:
Elec. Insp. Fee:
Permit Fee:
$0.00
Suppl. Insp. Fee -.(D Reg. 0 OT
0 0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
wISM
NOTE. This estimate does not include fees due to other Departments (La Planning, Public Works, Fire, Sanitary Sewer District, School
T;..t«:..t ..f.. � TG,,..,, f'.,�n n«., Ennnd ..... fbn .nl;s.,. nFnr nf)nn nvnilnhlo and nro nnhf nn actimnty_ ('nntnrt t{f0 Wont fnr O/I/%n °% 1H f2
FEE ITEMS (Fee Resolution 11-053 E . 7/1/122
FEE
QTY/FEE
4
Plan Check Fee:
�1ech. Plan ('heck
Plumb. Plan Check
Eiec. Plan Check
Fh. Permit Fee:
Plumb. Permit Fee:
Flee. Permit Fes:
Other ;lfech. Insp.
Other Plumb Insp.Li
Other Flec. Insp.
ilech. Insp. Fee:
Plumb. Insp. Fee:
Elec. Insp. Fee:
NOTE. This estimate does not include fees due to other Departments (La Planning, Public Works, Fire, Sanitary Sewer District, School
T;..t«:..t ..f.. � TG,,..,, f'.,�n n«., Ennnd ..... fbn .nl;s.,. nFnr nf)nn nvnilnhlo and nro nnhf nn actimnty_ ('nntnrt t{f0 Wont fnr O/I/%n °% 1H f2
FEE ITEMS (Fee Resolution 11-053 E . 7/1/122
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
2,500 s.f.
$375.00
Re -roof
1REROOFRES
Suppl. PC Fee: (E) Reg. Q OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee -.(D Reg. 0 OT
0 0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax:
Administrative Fee:
Work Without Permit? ® Yes No
$0.00
Advanced Planning Feer
$0.00
Select a Non -Residential
Building or Structure
I
Travel Doeumentation Fees:
Strong Motion. Fee: IBSEISMICR
$1.10
Select an Administrative Item
BldgStds Commission Fee: IBCBSC
$1.00
-,;,_
$2.10
$375.00 ' mE`
$377.10
• Revised: 01/01/2013
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
(408) .777-3228 - FAX (408) 777-3333 • building a(-cupertino.org
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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 can be scheduled up to one business day before the requested inspection date.
Please call (408) 777-3228 from 7:30-3:30pm (Mon-Thurs) or 7:30-2:30pm (Friday) to schedule
inspection. For Tear -Off and Nailing Inspections, you must also call on the day of the inspection only.
after that phase of the work is completed. The building inspector will be available within one hour.
Final Inspections will be given a two hour window.
3. 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.
4. If plywood is installed, a plywood Nailing Inspection is required.
5. Roofing. shall not be applied without first obtaining all prior 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.
6. A Final Irispection.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, vents painted, gutter/downspouts installed, debris removed.
7. 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. The re -inspection fee shall be paid before another inspection can be
scheduled..
By my signing below, I c ac of the
property owner's b9hE ff. I<understand and
smoke detectors, Jed carbon monoxide detf
the 2010 Califoinla Residential Code.
Signature of Apolicant/Agent:
ving is true: I am the property owner or authorized agent to act on the
to comply with the re -roof policy stated above. I also understand that
are required to be installed in accordance with Sections R314 and R315 of
Date: 3 — 2 S — 01
ReroofPoliey_2012.doe revised 10/7/12