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11060154 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10386 SAN FERNANDO AVE. CONTRACTOR:BRIDGEMAN/MANCHA PERMIT NO: 11060154 ROOFING OWNER'S NAME: LINDA ROY 13621 FERNCREST CT DATE ISSUED:06/17/2011 C ' R'S PHONE: 4082520886 SARATOGA,CA 95070 PHONE NO:(408)866-8170 ❑ /LICENSED CONTRACTOR'S DEC�L—ARATION BUILDING PERMIT INFO: BLDG� ELECT PLUMB 215 License Class C_J-` Lic.# �n 4, � MECH RESIDENTIAL COMMERCIAL Contractor Date(D`17-11 I am li n d under the provisions of Chapter 9 JOB DESCRIPTION:RE-ROOF TEAR OFF COMP SHINGLE&CAP SHEET, I hereby a (commencing with Section 7000)of Division 3 of the Business&Professions REPLACE WITH TORCH DOWN&COMP SHINGLES CLASS A 20SQFT 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:$7400 permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above informatio is APN Number:35712022.00 Occupancy Type: correct.I agree to comply with all city and county ordinances and state laws ting 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, PERMIT EXPIRES IF WORK IS NOT STARTED costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non-point source regulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION. 9.18. / f Signature Lam— Date —� Issued by: ��---- -- Date:(f— t C� OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS: the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is I,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I agree to remove all new materials for will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection. Business&Professions Code) ` �_f 7_f 1 1,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: Date: I construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE 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 read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain [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. permit is issued. Additionally,should I use equipment or devices which emit hazardous air I certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District I will not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Compensation laws of California. If,after making this certificate of exemption,I 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. Owner!r r or' d agent: t 1 11 Date APPLICANT CERTIFICATION ou 11CONSTRUCTION LENDING AGENCY 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 I hereby affirm that there is a construction lending agency for the performance of work's to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.) upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name i- •nify and keep harmless the City of Cupertino against liabilities,judgments, :md expenses which may accrue against said City in consequence of the Lender's Address gra.aing of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION 9.18. 1 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 . . . . . . . . : 35712022 . 00 DATE ISSUED. . . . . . . : 06/17/2011 RECEIPT #. . . . . . . . . BS000013810 REFERENCE ID # . . . : 11060154 SITE ADDRESS . . . . . : 10386 SAN FERNANDO AVE. SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . : OWNER . . . . . . . . . . . . . LINDA ROY ADDRESS 10386 SAN FERNANDO AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : BRIDGEMAN/MANCHA RO CONTRACTOR . . . . . . . : JEFF BRIDGEMAN LIC # 29138 COMPANY BRIDGEMAN/MANCHA ROOFING ADDRESS 13621 FERNCREST CT CITY/STATE/ZIP . . . : SARATOGA, CA 95070 TELEPHONE . . . . . . . . : (408) 866-8170 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 7,400 .00 1. 00 0. 00 1. 00 0. 00 1BSEISMICR VALUATION 7,400 . 00 0 .74 0. 00 0 .74 0. 00 1REROOFRES SQ FEET 20 . 00 260. 00 0 . 00 260 . 00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 261. 74 0. 00 261 .74 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 261. 74 #1435 --------------- TOTAL RECEIPT 261.74 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 ADDRESS: 10386 san fernando ave. DATE: 06/17/2011 REVIEWED BY: bobs. APN: BP#: VALUATION: 1$7,400 R'PERMITTYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof PRIMARY SFD or Du lex PENTAMATION 1SFDWLR00F USE: P PERMIT TYPE: WORK tear off comp shingle and cap sheet replace with torch down and comp shingles. SCOPE FEE ID ROOF AREA s.f. 1 REROOFFRES 2,000 L__J NOTE. Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addn 7 info. FEE ITEMS (Fee Resolution 09-051 lJf 7/1.,`10) FEE QTY/FEE MISC ITEMS Permit Fee: $260.00 Work Without Permit? 0 Yes G No $0.00 Strong Motion Fee: IBSEISMICR $0.74 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS; $261.74 $0.00 TOTAL FEE: $261.74 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/ SUBCONTRACTOR LIST JOB ADDRESS: 10336 Sa-s\ (,rxcksJ z oc, PERMIT# OWNER'S NAME: L:Acs- Inu PHONE# GENERAL CONTRACTOR: '� 'Aethrr^ BUSINESS LICENSE# ADDRESS: �;� G , CITY/ZIPCODE: � 5010 *Our municipal code requires all businesses workiW in the city to have a City of Cupertino usiness 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: 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 c Septic Tank Sheet Metal Sheet Rock Tile W' _� -) r —1 N (i P� Owner ontractor Signature Date REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333•building(a1cupertino.mg PROTECT ADDRESSto 3- �� J�. T7PN# \__�% � I � OWNER NAME �O PHONES �'1 E-MAIL STREET ADDRESSCrfY, STATE,ZIP 'n w APPLICANT NAME r PHONE E- e i d (s 3 v31� � Qc�c aswtv� hamar r STREET ADDRESS 13 i - sr�c� (�' CITY,STATE,ZIP��L� x /t F 12 OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT R CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME:. LICEN ER�� LIC BUS.LIC.# COMPANY NAME ` E-MAIL FAX STREET ADDRESS �CO7 CPHONE 13G_ Zha 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 t4 -7 Ll W1. EXISTING ROOF TYPE: ❑BUILT-UP ROOF ®ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES C OTHER(SPECIFY) } REMOVE/REPLACE 10-YES IF NO, PLYWOOD ❑ '/:" ❑ PLYWD ❑ OSB PITCH: ROOF �3 ❑ NO I #LAYERS: THICKNESS: ❑ 5/8" TYPE: ❑ CDX -H—:12 CLASS: nA PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ®ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ®OTHER 1 ICC-ES REPORT# DESCRIPTION OF WORK: i C111-0 c1L-V+ I N A L4 O uc ot eo q,- 3d I b, 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 building on tru 'on.6 thorize.representatives of Cupertino tc enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: 63 ��)r SUPPLEMENT TION WUIRED _Ifbuilding is associated with a Home Owner's Association,provide letter �' I ` �� RotlTtNcsLZP of approval from HOA. pvER I&COUNTER x DING PTfAN RDV V Provide Planning approval to verify if there any restrictions. Ei�RssMe U ❑ BI ANrInvG PLArIREVIEw "M � Pro ide copy of Manufacturer's Installation Specifications. �] ✓ Provide signed copy of Cupertino's Tear-Off Policy. ❑ oT ReroofApp_2011.d6c revised 03/02/11