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11030036
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22326 REGNART RD CONTRACTOR:DAN SULLIVAN PERMIT NO: 11030036 CONSTRUCTION OWNER'S NAME: ELLEN LEE 115 BAYMOUNT ST DATE ISSUED:03/08/2011 ER'S PHONE: 8312067100 SANTA CRUZ,CA 95062-3459 PHONE NO:(831)206-7100 ❑ LICENSED CONTRACTOR'S DECLARATION I BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class E-7_ Lic.# Q MECH F RESIDENTIAL F COMMERCIAL F Contractor A/ `'Lk �1'elx/ Date U I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:RE-ROOF 82 SQUARES: REMOVE EXISTING TILE ROOF INSTALL NEW LANDMARK ASPHALT SHINGLE REPLACE (commencing with Section 7000)of Division 3 of the Business&Professions GUTTERS&DOWNSPOUT 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:$32000 permit is issued. APPLICANT CERTIFICATION APN Number:36639007.00 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 re lations per the Cupertino Municipal Code,Section 9.18. �- 3 1� Issued by: Dat / f Signature Date e�"� 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 an inspect n,I agree to remove all new materials for I,as owner of the property,or my employees with wages as their sole compensation, inspection. 1 will do the work,and the structure is not intended or offered for sale(Sec.7044, Signature of Applicant: Date: Business&Professions Code) `l 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 at ho-I 1 a h 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 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 it unify 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 gru,uing 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 l� REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE-CUPERTINO,CA 95014-3255 LM (408)777-3228•FAX(408)777-3333•building aCDcuoertino.org CUPERTINO PROJECT ADDRESS ZZ 2 Z/ E. wo APN# 'n G 00-71 b OWNER NAME jPHONE E-MAIL STREETADDRESS 3z G �E4 � CITY, STATE,ZIP FAX iCi u APPLICANT NAME � T Al u LLi �o.✓ tiv vrllioc eHONE � MAIL / 401 90 . l�io�yy� STREET ADDRESS CITY,SfATE, ZIP F 1 i /L>w2 s�GL /" ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CK CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME �^ LICEl J F�, LICE YPE BUS.LIC.# COMPANY NAME E-MAIL) FAX STREET ADDRESS CITY,STATE,ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC.# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF BLDG: RESIDENTIAL ❑COMMERCIAL ROOF AREA: <7-Ps/7( VALUATION: �1,�O EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES OTHER(SPECIFY) REMOVE/REPLACE YES IF NO, PLYWOOD ❑ ''/i' ❑ PLYWD ❑ OSB PITCH: v� ROOF ❑ NO I #LAYERS: THICKNESS: 115/8" TYPE: ❑ CDX '12 CLASS: A PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT# DESCRIPTION OF WORK: --�—� S c-T lfPAJ G!� �� 1 //a 7ZowJ' du By my signature below,I certify to each of the followi g: 1 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 co ect. 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 const ction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: 3'-7--Zoic SUPPLEMENT ORMAT N REQUIRED OFFICE USE ONLY _If building is associated with a Home Owner's Association,provide letter P ECK TYPE ROUTING SLIP Of approval from HOA. ()VER-THE-COUNTER BUILI)ING PLAN REVIEW Provide Planning approval to verify if there any restrictions. ❑ EXPRESS ©`PLANNING PLAN REVIEW Provide copy of Manufacturer's Installation Specifications. ❑ STANDARD ❑ FIRE DEPT Provide signed copy of Cupertino's Tear-Off Policy. ❑ OTHER: ReroofApp_2011.doc revised 03/02/11 CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot: APN 36639007 . 00 DATE ISSUED. . . . . . . : 03/08/2011 RECEIPT #. . . . . . . . . BS000012855 REFERENCE ID # . . . : 11030036 SITE ADDRESS . . . . . : 22326 REGNART RD SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER ELLEN LEE ADDRESS . 22326 REGNART RD CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : DAN SULLIVAN CONTRACTOR . . . . . . . : DAN SULLIVAN LIC # 32278 COMPANY . . . . . . . . . . : DAN SULLIVAN CONSTRUCTION ADDRESS . 115 BAYMOUNT ST CITY/STATE/ZIP . . . : SANTA CRUZ, CA 95062-3459 TELEPHONE . . . . . . . . : (831) 206-7100 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 32, 000 . 00 2 . 00 0 . 00 2 . 00 0 . 00 1BSEISMICR VALUATION 32, 000 . 00 3 .20 0 . 00 3 .20 0 . 00 1REROOFRES SQ FEET 82 . 00 1066 . 00 0 . 00 1066 . 00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 1071 .20 0 . 00 1071 .20 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 1, 071.20 visa --------------- TOTAL RECEIPT 1, 071 . 20 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: 22326 Regnart Rd. DATE: 03/08/2011 REVIEWED BY: jsg APN: BP#: "VALUATION: 1$32,000 '°PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof PRIMARY SFD or Du lex PENTAMATION 1SFDWLR00F USE: p PERMIT TYPE: WORK Remove existinq tile roofing. Install new Landmark TL asphalt shingles. Replace gutters and SCOPE downspouts FEE ID ROOF AREA s.f. 1 REROOFFRES 8,200 T7 I T I T Li 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 1:�f. '-1.-10) FEE QTY/FEE MISC ITEMS Permit Fee: $1,066.00 Work Without Permit? 0 Yes E) No $0.00 Stron Motion Fee: 1BSEISMICR $3.20 Select an Administrative Item Bldg S, 'tds Commission Fee: IBCBSC $2.00 SUBTOTALS: $1,071.20 $0.00 TOTAL FE $1,071.20 Revis . 1 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% PERMIT# J �' OWNER'S NAME: �GU49A/ ��" . PHONE# GENERAL CONTRACTOR: ,�/ BUSINESS LICENSE # ADDRESS: //S' a al T- S? CITY/ZIPCODE: v 54 1 Z- *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCV INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCON ORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. RACT r SI-q/ / 1 am not using any subcontractors: ature 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 a ,�[. i /iT v0A;,d (� Septic Tank Sheet Metal Sheet Rock Tile Owner 11tontractor§knature Date