11060214 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10421 LAS ONDAS WAY CONTRACTOR:M C ROOFING PERMIT NO: 11060214
OWNER'S NAME: SALLY ALLEN 14800 MCVAY AVE DATE ISSUED:06/28/2011
OWNER'S PHONE: 4085311131 SAN JOSE,CA 95127 PHONE NO:(408)729-3436
C� LICENSED CONTRACTOR'S DECLARATIONF
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class — Lic.#
MECH RESIDENTIAL f- COMMERCIAL�
Contractor / Date f
I hereby affirm tha am licensed under the provisions of Chapter 9 JOB DESCRIPTION:RE-ROOF TEAR OFF SHAKES INSTALL 7/16 OSB WITH
(commencing with Section 7000)of Division 3 of the Business&Professions 30LB
FELT&40YEAR COMP CLASS A 24SQ
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 performance of the work for which this Sq.Ft Floor Area: Valuation:$10300
permit is issued.
APPLICANT CERTIFICATION APN Number:36929042.00 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 regu tions per the Cupertino Municipal Code,Section
9.18.
Issued b Date: d<' Z<T�1j
Signatur �' Date
s=
OWNER-BUILDER DECLARATION
RE-ROOFS:
1 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
1,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) Signature of Applican �
� 6� �-Date: �8:/
1,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
1 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
I 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,I must Ow r �r*,ed a �y7Li�L ��
forthwith comply with such provisions or this permit shall be deemed revoked. A;;1, Date:
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
rg of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
w«,i 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
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36929042 . 00
DATE ISSUED. . . . . . . : 06/28/2011
RECEIPT #. . . . . . . . . BS000013904
REFERENCE ID # . . . : 11060214
SITE ADDRESS . . . . . : 10421 LAS ONDAS WAY
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER SALLY ALLEN
ADDRESS 10421 LAS ONDAS WAY
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : M C ROOFING
CONTRACTOR . . . . . . . : MIGUEL CASTILLO LIC # 24741
COMPANY . . . . . . . . . . : M C ROOFING
ADDRESS 14800 MCVAY AVE
CITY/STATE/ZIP . . . : SAN JOSE, CA 95127
TELEPHONE . . . . . . . . : (408) 729-3436
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 10, 300 .00 1. 00 0. 00 1.00 0. 00
1BSEISMICR VALUATION 10,300 .00 1. 03 0 . 00 1. 03 0 .00
1REROOFRES SQ FEET 24 . 00 312 . 00 0. 00 312 .00 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 314 . 03 0 . 00 314 . 03 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 314 . 03 #5663
---------------
TOTAL RECEIPT 314 . 03
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
StADDRESS: 10421 las ondas way DATE: 06/28/2011 REVIEWED BY:
PN: BP#: "VALUATION: $10,300
`°PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD or Duplex PENTAMATION 1SFDWLR00F
USE: P PERMIT TYPE:
WORK tear off wood shake replace with comp shingles.
SCOPE
FEE ID ROOF AREA
s.f.
1 REROOFFRES 2,400
Li
NOTE: These ees are based on the preliminary information available and are only an estimate. Contact the De t or addn'1 in o.
FEE ITEMS (Fee Resolution 09-051 I�;ff. 7-'1.-"10) FEE QTY/FEE MISC ITEMS
Permit Fee: $312.00
Work Without Permit? 0 Yes E) No $0.00
Strong Motion Fee: IBSEISMICR $1.03 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00
SUBTOTALS: $314.03 $0.00 TOTAL FEE: $314.03
Revised: 04/29/2011
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(a)cugertino.orQ
PROJECT ADDRESS APN#
OWNER NAME \ \^ PHONE- _ ' E-MAIL
STREET ADDRESS CITY, STATE,ZIP FAX
CONTRACTOR NAME LICENSE MBR LICENSE TYP BUS.LIC.#
G
COMPANY NAME A A j E-MAIL FAX
313 -7
STREET ADDRESS Iv� CITY,STATE,ZIP PF1
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 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.
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. Progress
and 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. Progress Inspection is required when approximately 50% of roof covering is installed.
7. 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 1/" 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.
8. 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 require44o be installed in accordance with Sections R314 and R315 of
the 2010 California Residential Co
Signature of Applicant/Agent: Q Date:
ReroofPolicv_2011.doc revised 02/16/11
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/ SUBCONTRACTOR LIST '
JOB ADDRESS: L W PERMIT# 007
OWNER'S NAME: kj PHONE#
GENERAL CONTRACTOR: BUSINESS iICENSE#
ADDRESS: 0,4 CITY/ZIPCODE: 19`1
*Our municipal code requires all businesses working in the city to have a City of Cupertino siness 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:
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 j
Septic Tank
Sheet Metal
Sheet Rock
Tile
caner/Contractor Signature Date
REROOF PERMIT APPLICATION
Lo COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO, CA 95014-3255
(408)777-3228• FAX(408)777-3333 • building(c5cupertino.ong
CUPERTINO
PROJECT ADDRESS L q
OWNER NAME t ` �� PHONE 1531-
E-MAIL
\ 31
STREET ADDRESS � CITY, STATE,ZIP �7 a FAX
APPLICANT NAME _ PHONE E-MAIL
rJ�
STREET ADDRESSL �f,e CITY,STATE, -IDS C'd FAX C
❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR N ` L/L LICENSE NUMB LICENSE TYPE BUS.LIC.#
I � r'
COMPANY NAMEA E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
r'
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC.#
COMPANY NAME E-MAIL 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 ❑ASPHALT SHINGLES P5OOD SHAKES ElWOOD SHINGLES ❑OTHER(SPECIFY)
REMOVE/REPLACE M,YES IF NO, PLYWOOD ❑ %w, 7 PLYWD OSB PITCH: ROOF
❑ NO 14LAYERS- THICKNESS: ❑ 5/8" 6rTYPE: ElCDX 12 CLASS:
PROPOSED ROOF TYPE: ❑Bun T-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT#
DESCRIPTION OF WORK:,_ �
rSh 4 K C-S I ? 0
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 relatingto buil co ction. I oriz e n 'v s of Cupertino to enter the above-ide tified p erty for inspection purposes.
Signature of Applicant/Agent: IF Date: � �
SUPPLEMENTAL INF TION REQUIRED
.,
_If building is associated with a Home Owner's Association,provide letter OU_MG'sL'IP �
of approval from HOA. L��A' cQz�tvy�R ❑ B""II c pL,�zv itvt�w
Provide Planningapproval to verify If there an restrictions.
PP fY Y ] :�xPxEss ❑ PLANNING PLAN REVIEW
—Provide copy of Manufacturer's Installation Specifications. ❑ .�TAN�I�
ETI
� �
Provide signed copy of Cupertino's Tear-Off Policy. 0 -;oTBEx
ReroofApp_2011.doc revised 03/02/11