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11060173 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22272 CUPERTINO RD CONTRACTOR:CASTILLO'S ROOFING PERMIT NO: 11060173 OWNER'S NAME: KLEIN BERNARD AND PAULA P TRUS 1703 CATHAY DR DATE ISSUED:06/20/2011 CA"4ER'S PHONE: 4082577444 SAN JOSE,CA 95122 PHONE NO:(408)251-3565 Li LICENSED CONTRACTOR'S DECLARATIONF 4, f� �nBUILDING PERMIT INFO: BLDG ELECT PLUMBLicense Class Lic.# _X)q5(° MECH f— RESIDENTIAL COMMERCIAL Contr Date I hereby affirm th I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:RE-ROOF TEAR OFF REPLACE WITH COMP SHINGLES (commencing with Section 7000)of Division 3 of the Business&Professions CLASS Code and that my license is in full force and effect. A 25SQFT I hereby affirm under penalty of perjury one of the following two decla a ansa' 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 Sq.Ft Floor Area: Valuation:$12000 permit is issued. APPLICANT CERTIFICATION APN Number:32650030.00 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Issued by: `� Date: Sign Date 1 I OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for I,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Si at a �p Ii;4 Date: 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 declarations: HAZARDOUS MATERIALS DISCLOSURE 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 I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain 1 have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534. Compensation laws of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code, O mer o aut orized agent: ' forthwith comply with such provisions or this permit shall be deemed revoked. Dater APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address C' and expenses which may accrue against said City in consequence of the Z ig of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION w%a,all non-point source regulations per the Cupertino Municipal Code,Section 9.18. I understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 22272 cupertino rd DATE: 06/20/2011 REVIEWED BY: bobs. APN: I BP#: -VALUATION: 1$12,000 R�PERMITTYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof PRIMARY SFD or Du lex PENTAMATION 1SFDWLR00F USE: -7P PERMIT TYPE: WORK tear off replace with com shin les. SCOPE FEE ID ROOF AREA s.f. 1REROOFFRES 2,500 77 77 F-1 -t_ Li Li NOTE. Theseees are based on the prelindnary information available and are only an estimate. Contact the Dept-for addh 7 info. FEE ITEMS (F�e.Resolution 09-051 f,—.. 7/1,,"10) FEE QTY/FEE MISC ITEMS Permit Fee: $325.00 Work Without Permit? 0 Yes No $0.00 Strong Motion Fee: IBSEISMICR $1.20 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: 1 $327.20 $0.00 TOTAL FEE: 1 $327.20 Revised: 04/29/2011 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCO TRACTOR LIST JOB ADDRESS: RMIT# ( ® _ OWNER'S NAME: t PHONE# S GENERAL CONTRACTOR: BUSINESS LICENSE# ADDRESS: ODE: Cl *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. I I am not using any subcontr Signature Date Please check applicable subcontractors and complete the following information: 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 Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Co ctor Signature Date i c) 1 J7 3 REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 CUPEFtTINO (408)777-3228• FAX(408)777-3333•building i7a cupertino.org PROJECT ADDRESS APN# � OWNER NPHONE_o^,C I E-MAIL r Iv `L4] j.( STREET ADDRESS ! CITY, STATE,ZIP V y APPLICANT NAME(I Ile `I PHONE , E-MAIL Sr STREET ADDRESS cm'STACIE,ZIP �� n FAX f,� C. ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ONTRACrOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGrNEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME()a LICENSE NUMBER Z P�'`Cj� LICE E BUS.LIC.# COMPANY NAME U E-MAIL FAX STREET ADDRESS l C TATE,Z /\ l �Z PHONF..(7� ARCHITECT/ENGINEER NAME l: LICENSE NUMBER [) J BUS.LIC.'# COMPANY NAME E-MAII FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF SFD or Duplex ❑ Multi-Family ROOF AREA: VALUATION: STRUCTURE: ❑ Commercial EXISTING ROOF TYPE: / BUILT-UP ROOF -rJ ASPHALT SHINGLES El WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY) REMOVE/REPLACE DYES IF NO, PLYWOOD ❑ W, ❑ _ PLYWD E] OSB PITCH: ROOF 13 NO #LAYERS: THICKNESS: 135/8" TYPE: 13CDX '12 CLASS: A PROPOSED ROOF TYPE: eBUILT-UP ROOF ASPHALT SHINGLES ElWOOD SHAKES ElWOOD SHINGLES ElOTHER ICC-ES REPORT# DESCRIPTION OF WORK: ✓ I �' C� i AV alims` r ' 4 L c� -Sh ce:b 04�n'Pe I n ,By my signaturebelow,I certify to each of the f llong: 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 relatin to buildi c nstruction. I authorize representatives of Cupertino to enter the above-iden Pied p ope ;for inspection purposes. Signature of Ap Date: SUPPLEMENTAL)NFORMATION REQUIRED ' ;4:,,-.. ., n>? rs-,Z", awgo ftq m _If building is associated with a Home Owner's Association,provide letter PIA CM T` E '� 7 RorJmvc sI IP '11 of approval from HOA. ❑ c PLAN R u1EW_ r` YERTEE G07TNTER� Provide Planning approval to verify if there any restrictions. (] Exz'R�ss ❑ rLANInvr;rLANvIEw . r —Provide copy of Manufacturer's Installation Specifications. ❑ � � 3 t❑ quit n�PT iff E 's Tear-Off Policy. U. Provide signed copy of CupertinoAII�R k , N ReroofApp_2011.doc revised 03/02/11