11050077 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10666 ROSEWOOD RD CONTRACTOR:GORMAN ROOFING PERMIT NO: 11050077
SERVICES,INC
OWNER'S NAME: ESSEX PROPERTY TRUST 2229 E UNIVERSITY DR DATE ISSUED:05/23/2011
ER'S PHONE: 6508151622 PHOENIX,AZ 85034 PHONE NO:(602)262-2423
❑ LICENSED CONTRACTOR'S DECLARATION
,� '-1!� (,/ BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class C ic.# t
`� a ') MECH RESIDENTIAL COMMERCIAL F
Contractor f P,01% 0 01 1� t Date
I hereby affirm that I am licensed unde the provisions of Chapter 9 JOB DESCRIPTION:APT A-D- RE-ROOF OVERLAY EXISTING ROOF WITH
(commencing with Section 7000)of Division 3 of the Business&Professions POLYURETHANE FOAM CLASS A 27SQFT
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:$9450
permit is issued.
APPLICANT CERTIFICATION APN Number:31643005.10666 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,Se tion
9.18.
Signature Date
3 (' Issued by: Date:
L 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 i pection,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) Signatureif Appl cant: 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. I 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 Owner orAy rized agent: !/
forthwith comply with such provisions or this permit shall be deemed revoked. 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 wrk'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
e mify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
and expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
with 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 51 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 31643005 .10666
DATE ISSUED. . . . . . . : 05/23/2011
RECEIPT #. . . . . . . . . : BS000013531
REFERENCE ID # . . . : 11050077
SITE ADDRESS . . . . . : 10666 ROSEWOOD RD
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . . :
OWNER . . . . . . . . . . . . : ESSEX PROPERTY TRUST
ADDRESS . . . . . . . . . . : 925 EAST MEADOW DR
CITY/STATE/ZIP . . . : PALO ALTO, CA 94303
RECEIVED FROM . . . . : GORMAN ROOFING
CONTRACTOR . . . . . . . : DANIEL J GORMAN LIC # 32440
COMPANY . . . . . . . . . . : GORMAN ROOFING SERVICES, INC
ADDRESS . . . . . . . . . . : 2229 E UNIVERSITY DR
CITY/STATE/ZIP . . . : PHOENIX, AZ 85034
TELEPHONE . . . . . . . . : (602) 262-2423
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 9,450 .00 1. 00 0. 00 1. 00 0. 00
1BSEISMICR VALUATION 9,450 . 00 0. 95 0. 00 0. 95 0. 00
1REROOFRES SQ FEET 27 . 00 351. 00 0. 00 351. 00 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 352 . 95 0 . 00 352 . 95 0. 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
309 EXTERIOR LATH 311 SCRATCH COAT
600 PRE-INSPECTION 601 ROOF TEAR OFF
602 ROOF PLYWOOD NAIL 603 ROOF BATTENS
604 ROOF IN-PROGRESS 605 FINAL REROOF
REROOF PERMIT APPLICATION
ELI COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228 •FAX(408)777-3333•buildingacupertino.ora
CUPEFtTlNQ
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PROJECT ADDRESS APN#
OWNER NAIvtE PHONE / V ,_-) j w ', ' E-MAIL
STREET ADDRESSCITY,STATE,ZIP FAX
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APPLICANT N /► PHONE E-MAIL
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❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT 1�NTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME n LICENSE NUMBER LICENSE o TYPQE BUS.LIC.#
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COMPANY NAME E-MAIL FAX
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ARCHITECTIENGWEER NAME LICENSE NUMBERf ``J BUS.LIC.�r9 ��^^ U
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑ SFD or Duplexulti-Family ROOF AREA: VALUATION: 0
,TRUCTVRE: [ICo,.?mmmeercial ®0 ��r O
EXISTING ROOF TYPE: LBUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY)
REMOVE/REPLACE �❑, %n"YES IF NO, PLYWOOD ❑ _ PLYWD ❑ OSB PITCH ROOF
U'No #LAYERS: THICKNESS: ❑ 5/8" TYPE: ❑ CDX ,/ 12 CLASS: A
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF C1 ASPHALT SHINGLES ❑WOOD SHAKES 13 WOOD SHINGLES od'16THER T'A� ICC-ES REPORT#
DESCRIPTION OF WORK: j
1 �o d,
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 o comply with all applicable local
ordinances and state laws relating to bui on tru tion. I authorize representatives of Cupertino to enter the above- entified property
for inspection purposes.
Signature of Applicant/Agent: Date: 01
SUPPLEMENTAL ORMATION REQUIRED -
-If building is associated with a Home Owner's Association,provide letter -'prArrc> cxE_. _ _UiTrtG rssP
of approval from HOA. Q oux TBS colJLwx Q N.7REVD
. per -
-Provide Planning approval to verify if there any restrictions. - - >
-EXPR$SS. UP P�A1r(NINGPLhNRE IEW
—Provide copy of Manufacturer's Installation Specifications.
STANDARD— .EIRtr13E PT
Aq 3
Provide signed copy of Cu ertino's Tear-OfPolicy.
-z {
= _
ReroofApp 2011.doc revised 03/02/11
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
F13ADDRESS: rosewood/maplewood ,5j,Ue ,,,, DATE: 05/11/2011 REVIEWED BY: bob s.
APN: BP#: %VALUATION: 1$9,450
"PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY Multi-Family Dwelling Buildina is PENTAMATION 1 R2ROOF
USE: 3 Stories 0 Yes (E) No PERMIT TYPE:
wORK overlay existing roof with polyurethane foam.
SCOPE
FEE ID ROOF AREA
s.f.
1REROOFMRES 2,700
T-T I T
Li
Lj
NOTE: Theseees are based on the preliminary information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 09-051 F.f 1.-"10) FEE QTY/FEE MISC ITEMS
SPermit Fee: $351.00
Work Without Permit? 0 Yes E) No $0.00
Strong Motion Fee: IBSEISMICR $0.95 Select an Administrative Item
Bldg Stds Coinmission Fee: IBCBSC $1.00
SUBTOTALS: $352.95 $0.00 TOTAL FEE: $352.95
Revised: 04/29/2011