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11030110 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20610 RODRIGUES AVE CONTRACTOR:R E ROOFING& PERMIT NO: 11030110 CONSTRUCTION INC OWNER'S NAME: LULU LAI 15230 CLYDELLE AVE DATE ISSUED:03/25/2011 C FR'S PHONE: 4082559819 SAN JOSE,CA 95032 PHONE NO:(408)626-9320 ❑ LICENSED CONTRACTOR'S DECLARATIONt r– � BUILDING PERMIT INFO: BLDG ELECT PLUMB License Clas ' Lic.# t �� 19 1 51 MECH� RESIDENTIAL� COMMERCIAL� Contact Date 16 ereby affirm licensed under the provisions of Chapter 9 JOB DESCRIPTION:RE-ROOF REMOVE EXISTING 1 LAYER OF WOOD SHAKE (commencing with Section 7000)of Division 3 of the Business&Professions & Code and that my license is in full force and effect. INSTALL NEW 1/2"CDX PLYWOOD,30LB FELT&LIFETIME COMP,CLASS A 34SQ 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 permit is issued. Sq.Ft Floor Area: Valuation:$17000 APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is APN Number:35911018.00 Occupancy Type: 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 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 wit on-point source regulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION. 18. _ s � �.Signatur Date Issued by:- T Date 2�� L 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: Alm shall be inspected prior to any roofing material being installed.If a roof is 1,as owner of the property,or my employees with wages as their sole compensation, installed thoi t first obtaining an ins ection,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, y' Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to ►gnat `of A p t. Date: 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 "OR BETTER declarations: 1 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 1 have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain Section 3700 of the Labor Code,for the performance of the work for which this compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& 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 er s "Health& nce with the Cupertino Municipal Code,Chapter 9.12 and the Compensation laws of California. If,after making this certificate exemption,I ode,Sections 25505,25533,and 25534. become subject to the Worker's Compensation provisions of the L�bor Code,I mustforthwith comply with such provisions or this permit shall be deemed revoked. ze j APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY 1 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 indemnify and keep harmless the City of Cupertino against liabilities,judgments, c nd expenses which may accrue against said City in consequence of the Lender's Address gr,, "_.ig 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. 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 . . . . . . . . : 35911018. 00 DATE ISSUED. . . . . . . : 03/25/2011 RECEIPT #. . . . . . . . . : BS000012985 REFERENCE ID # 11030110 SITE ADDRESS . . . . . : 20610 RODRIGUES AVE SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . . LULU LAI ADDRESS . . . . . . . . . . : 20610 RODRIGUES AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : R E ROOFING & CONST CONTRACTOR . . . . . . . : PROCTOR, PAUL LIC # 20615 COMPANY . . . . . . . . . . : R E ROOFING & CONSTRUCTION INC ADDRESS . . . . . . . . . . : 15230 CLYDELLE AVE CITY/STATE/ZIP . . . : SAN JOSE, CA 95032 TELEPHONE . . . . . . . . : (408) 626-9320 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 17, 000 .00 1. 00 0. 00 1.00 0. 00 1BSEISMICR VALUATION 17, 000 . 00 1.70 0. 00 1 .70 0. 00 1REROOFRES SQ FEET 34 . 00 442 . 00 0.00 442 .00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 444 .70 0 . 00 444 .70 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 444 . 70 #3293 --------------- TOTAL RECEIPT 444 .70 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 o �iia REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINC3 (408)777-3228• FAX(408)777-3333• building(@cupertino.org PROJECT ADDRESS /? 6 D �� jL�1'' 1/i),'1c'`( APN# OWNER NAME 1 ,` ! L j PHONE U!lx_ (� _ 9 C E-MAIL �STREET ADDRESS CITY, STATE,ZIP �jo FAX APPLICANT NAME- U I PHONE E-MAIL �' �j0(1�IN'/ Sy(o�O� O'i'oc4"n' 4 LIC�i �� STREET ADDRESS�t'�/)��Iv ��j ryI � J +, .1 `l c CITY,STATE, ZIP � ,/ �;�� FAX ❑OWNER ❑ OWNER-BUILDER `❑ OWNERAGENT VV CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT t CONTRACTOR NAME ` LICE NUMBER _7 LICENsf 1�2BUS.LIC. '?j Ac� 4061 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 D r Duplex p Multi-Family ROOF AREA: '✓J[� VALUATION: J IN STRUCTURE / ❑ Commercial �� EXISTING ROOF TYPE:,/ ❑BUILT-UP ROOF ❑ASPHALT SHINGLES WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY) REMOVE REPLACE 1C�YES IF NO, PLYWOOD '/:" ❑ PL) ❑ OSB PITCH: ROOF /❑ NO #LAYERS: THICKNESS: ///❑"' 5/6" TYPE: CDX :12 CLASS: `� PROPOSED ROOF TYPE: ❑BUILT-UP ROOF XASPHALTSHINGLFS ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT# DESCRIPTION OF WORK' r 1 Y*-1 i LAN �� r >✓ � ,,�� 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 correcL._ihave read the c ptlo of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws rehdting to di construction._I a or reo%wnta of Cupertino to enter the above-ide ified pr erty for inspection purposes. Signature of Applicant/Agent: - `� � �—` Date: SUPPLEMENTAL INFORMATION REQUIRED `OFFICE irsE olvLr ' _If building is associated with a Home Owner's Association,provide letter 'P CHECK TYP "RournvG s> of approval from HOA. 'Ld' QVER THE COUNTER BUILDING PLAN REVIEW Provide Planning approval to verify if there any restrictions. ❑T 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_201 Ldoc revised 03/02/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 20610 rodrigues ave. DATE: 03/25/2011 REVIEWED BY: bobs. APN: BP#: 'VALUATION: 1$17,000 PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof 7- PENTAMATION 1 SFDWLROOF USE: PERMIT TYPE: PRIMARY SFD or Duplex WORK re lace wood shake with new comp shingles. Class A SCOPE FEE ID ROOF AREA s.f. 1 REROOFFRES 3,400 77 , Li NOTE. Thesefees are based on the prelitninary 12formation 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 Permit Fee: $442.00 Work Without Permit? 0 Yes E) No $0.00 Strong Motion Fee: 1BSEISMICR $1.70 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $444.70 $0.00 TOTAL FEE: $444.70 Revised: 01/15/2011 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: U U UD I PERMIT# OWNER'S NAME: PHONE# Lf v i Z GENERAL CONTRACTOR: ' % t"d BUSINESS LICENSE# 20 ADDRESS: CITY/ZIPCODE: 12 *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINA . R FINA OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRAgTOR AND AL SUBCONTRAC AVE OBTAINED A CITY F CUPERTINO BUSINESS LICENSE. [ am not usingan subc tractors: ` arty 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 Owner/Contractor Signature Date