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11060074 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21074 GREENLEAF DR CONTRACTOR:JERRY BRENDLI PERMIT NO: 11060074 OWNER'S NAME: JERRY BRENDLI 21074 GREENLEAF DR DATE ISSUED:06/10/2011 O"'VNER'S PHONE: 4082532721 CUPERTINO,CA 95014 PHONE NO: 1. LICENSED CONTRACTOR'S DECLARATIONF BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# MECH F RESIDENTIAL COMMERCIAL Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:TEAR OFF EXISTING BUILT UP ROOF,REPLACE W/FOAM (commencing with Section 7000)of Division 3 of the Business&Professions INSULATION ABD NEW BUILT UP ROOF. 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 Sq.Ft Floor Area: Valuation:$15000 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:32628003.00 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section xx / 9.18. Issued by, - Date: Signature Date OWNER-BUILDER DECLARATION RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is I hereby affirm that 1 am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for the following two reasons: inspection. 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, Signature of Applicant: Date: Business&Professions Code) 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 HAZARDOUS MATERIALS DISCLOSURE declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534. 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 Owner o orize nt: become subject to the Worker's Compensation provisions of the Labor Code,I must Date: A-10. forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.) correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address indemnify and keep harmless the City of Cupertino against liabilities,judgments, and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION ng of this permit.Additionally,the applicant understands and will comply w..,i all non-point source regulationsthe Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. nn Licensed Professional Signature Date OWNER-BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333- building(abcupertino.org Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: SITE ADDRESS T_APN BP# OWNER NAME . �Qy$� � OWNER ADDRESS &�U�P,�il' C-C)f&VJ') t) ��rq DESCRIPTION OF WORK: Tr—,�OFF= TAR— A`CW rV fZ_ 900F Rc PtACe UJfbLY v R&rru AravE foo F=� We are providing you with an Owner-Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner-Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION (DIRECTIONS:Please read and initial each statement below to signify you understand or verify this information.) . I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner- der" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner-Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner-Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. 2. I understand building permits are not required to be signed by property owners unless they are responsible for t construction and are not hiring a licensed Contractor to assume this responsibility. I understand as an"Owner-Builder" I am the responsible party of record on the permit. I understand that I may j4teci myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. understand Contractors are required by law to be licensed and bonded in California and to list their license b rs on permits and contracts. 5. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the al value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer' under state and federal law. 11 4I understand if I am considered an "employer' under state and federal law, I must register with the state and Keral government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. idiceines 7. I understand under California Contractors' State License Law, an Owner-Builder who builds single-family ntial structures cannot legally build them with the intent to offer them for sale, unless all work is performed by ed dsubcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for financial or personal injuries sustained by any subsequent owner(s)that result from any latent construction defects in the workmanship or materials. OwnerBuilderForm 2010.doc revised 04/14/10 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 ELI] Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST Of JOB ADDRESS: "7-10 74Y a1025x/GeAor-OJ2 PERMIT# OWNER'S NAME: VE74CY i6;A5VVtV4-1' PHONE# -- 1- 2- GENERAL CONTRACTOR: BUSINESS LICENSE# ADDRESS: CITY/ZIPCODE: *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. Dp I am not using any subcontractors: TO� 6.V-7V 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 Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile 6 W11 er/Contractor 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 • buildingQcupertino.org PROTECT ADDRESSCU Pa(ur7�(� ^ # OWNER NAME ,MF.y 0311 TI f�L.� PHONE(Y01)2,5-3—27 21 E-mA`L J H 8IZAE l DL I klyf IHOCI.COM STREET ADDRESS �(IO7C( (5,tif571EX�,L*17 Pq CITY, STATE,ZIP 0U�� �11 Q q 0 f FAX CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE HUS.LIC.# COMPANY NAME E-RAM FAX STREET ADDRESS CITY,STATE,ZIP PHONE 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 IR314 and R315 of the 2010 California Residential Code. Signature of Applicant/Agent: Date: ReroofPolicX_ 011.doc revised 02/16/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION MAPN: DDRESS: 21074 greenleaf dr. DATE: 06/10/2011 REVIEWED BY: bobs. BP#: "VALUATION: 1$15,000 'PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof PRIMARY SFD or Duplex PENTAMATION 1SFDWLROOF USE: PERMIT TYPE: WORK tera off exisitnq built up roof, replace with foam insulation abd new built up roof. SCOPE FEE ID ROOF AREA s.f. 1 REROOFFRES 1,300 NOTE: Theseees are based on the preliminary Information available and are only an estimate. Contact the De t or addn'1 info, FEE ITEMS (Pe Resolution 09-051 Ef. 7.-7(7) FEE QTY/FEE MISC ITEMS Permit Fee: $169.00 Work Without Permit? Yes No $0.00 Strom Motion Fee: IBSEISMICR $1.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $171.50 $0.00 TOTAL FEE: 1 $171.50 Revised: 04/29/2011 REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333•buildingacupertino.org PROJECT ADDRESS 7v N , y ]�� �l APN# OWNER NAME &L EN DL PHONE([��Ob)Z S3_'L I ZJ E-MAIL JH $Ce_I Dl.► Yid KOO,aV STREET ADDRESS s)//yR/(L / n rr��CITY, STATE,ZIP P a1(2 V N 0 A(? []C'0� FAX ME APPLICANT NAK� PHONE 253 c ��i72 E-MAIL JHSW, �PC( e Y/Al)• (OM � STREET ADDRESS .�7 n.,(/ (�LICr-^1 i!e�� D� CITY,STATE,zff C V P 64In N tt CA- c(DI FAX OWNER ❑ OWNER--BUILD-EIR l�❑-KOWNER"AGENT 1❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC.# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE ARCI I=CT/ENGINEER NAME LICENSE NUMBER BUS.LIC.# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF IId'AFD or Duplex ❑ Multi-Family ROOF AREA: VALUATION: e' STRUCTURE: ❑ Commercial DO 'L EXISTING ROOF TYPE: W BU' ILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY) REMOVE/REPLACES IIN0, PLYWOOD ❑ %z" ❑ PLYWD ❑ OSB PITCH: ROOF ElNO #LAYERS: THICKNESS: El5/8" TYPE: 11 COX 12 CLASS: A PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER FUU M ICC-ES REPORT# DESCRIPTION OF WORK: TE?R O F 1= t�i:7 1 ST I iJ l—' Roo r— ROWO F W f�bLY 0 M T U AW E flM 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 buildiny,3pnstruction. I a th�ri LppSesentatives of Cupertino tc enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTXVINFTION REQUIRED .' moi± cg` s}E �ry' _If building is associated with a Home Owner's Association,provide letter4. t'� `�� E` "" ttoUNcsLxP of approval from HOA. p -rsE-cora x =sem T:AN REvIEW5 Provide Planning approval to verify if there any restrictions. U;Mss ❑ - raricrLANvIEw h _Provide copy of Manufacturer's Installation Specifications. ❑ �� ,� ❑ � � K Pr's" Ovide signed copy of Cupertino's Tear-Off Policy. - z ❑ oT>�R ReroofApp_2011.doc revised 03/02/11