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11030060CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 11872 SHASTA SPRING CT CONTRACTOR: CASTILLO'S ROOFING PERMIT NO: 11030060 OWNER'S NAME: MARGARET WONG 1703 CATHAY DR DATE ISSUED: 03/11/2011 OWNER'S PHONE: 4082187874 SAN JOSE, CA 95122 PHONE NO: (408)251-3565 L LICENSED CONTRACTOR'S DECLARATION (— PLUMB License Class ,� Lic. # 'V,30 !J c� �v BUILDING PERMIT INFO: BLDG ELECT � j _._ � r� `ll' // MECH RESIDENTIAL COMMERCIAL Contra Date C I hereby affirm th I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: RE -ROOF TEAR OFF INSTALL #30LB FELT, APPLY GAF (commencing wit Section 7000) of Division 3 of the Business & Professions GRAND CANYON. EXISTING PLYWOOD REMAINS -CLASS A Code and that my license is in full force and effect. 18SQ 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 Sq. Ft Floor Area: Valuation: $9250 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APN Number: 36655022.00 Occupancy Type: APPLICANT CERTIFICATION 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, Section 9.18. JJ ` I Date V Issued byx Date:—1 Signature r 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 inspection, 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) Signature of A plicanf: 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: 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 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(x) 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 Own r o uthorized agent: forthwith comply with such provisions or this permit shall be deemed revoked. If Date: CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION 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 costs, and expenses which may accrue against said City in consequence of the ig of this permit. Additionally, the applicant understands and will comply ARCHITECT'S DECLARATION ., All non -point source regulations per the Cupertino Municipal Code, Section 9.18. 1 understand my plans shall be used as public records. Signature Date Licensed Professional 3 ITEMS OF 3 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 36655022.00 DATE ISSUED.......: 03/11/2011 RECEIPT #.........: BS000012886 REFERENCE ID # ...: 11030060 SITE ADDRESS .....: 11872 SHASTA SPRING CT SUBDIVISION ...... CITY CUPERTINO IMPACT AREA ...... OWNER ............: MARGARET WONG ADDRESS 11872 SHASTA SPRING CT CITY/STATE/ZIP ...: CUPERTINO, CA 95014 OPERATOR: patg COPY # : 1 RECEIVED FROM ....: CASTILLO'S ROOFING CONTRACTOR .......: JOSE CASTILLO LIC # 25850 COMPANY ..........: CASTILLO'S ROOFING ADDRESS 1703 CATHAY DR CITY/STATE/ZIP ...: SAN JOSE, CA 95122 TELEPHONE ........: (408)251-3565 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC ---------- NEW BAL ---------- ----------------------- 1BCBSC VALUATION ---------- 9,250.00 ---------- 1.00 ---------- 0.00 1.00 0.00 1BSEISMICR VALUATION 9,250.00 0.93 0.00 0.93 0.00 1REROOFRES SQ FEET 18.00 234.00 0.00 ---------- 234.00 ---------- 0.00 ---------- TOTAL PERMIT ---------- 235.93 0.00 235.93 0.00 METHOD OF PAYMENT ----------------- CHECK TOTAL RECEIPT : AMOUNT --------------- 235.93 --------------- 235.93 VOICE ID DESCRIPTION -------- ---------------------------- 309 EXTERIOR LATH 601 ROOF TEAR OFF REFERENCE NUMBER -------------------- #16965 VOICE ID DESCRIPTION -------- ---------------------------- 311 SCRATCH COAT 602 ROOF PLYWOOD NAIL 604 ROOF IN -PROGRESS 605 FINAL REROOF CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION FEE ID ROOF AREA s.f. 1 REROOFFRES 1,800 wvjC: j hese tees are aasea on the nretiminary tnrormation avattante ana are only an estimate. contact the vent ror aaan't into. FEE ITEMS (fee Resolution 09-051 1?ff.' '/ .%10) FEE QTY/FEE MISC ITEMS Permit Fee: $234.00 Work Without Permit? 0 Yes E) No $0.00 Strom Motion Fee: IBSEISMICR $0.93 Select an Administrative Item Bld€' Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $235.93 $0.00 TOTAL FEE: $235.93 Revised: 01/15/2011 ADDRESS: 11872 shasta springs ct. DATE: 03/11/2011 REVIEWED BY: bobs. APN: BP#: 'VALUATION: 1$9,250 -� *PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re -roof PRIMARY SFD or Duplex USE: PENTAMATION 1 SFDWLROOF PERMIT TYPE: WORK tear off exisiting plywood remains add 301b felt apply of grand canyon. SCOPE FEE ID ROOF AREA s.f. 1 REROOFFRES 1,800 wvjC: j hese tees are aasea on the nretiminary tnrormation avattante ana are only an estimate. contact the vent ror aaan't into. FEE ITEMS (fee Resolution 09-051 1?ff.' '/ .%10) FEE QTY/FEE MISC ITEMS Permit Fee: $234.00 Work Without Permit? 0 Yes E) No $0.00 Strom Motion Fee: IBSEISMICR $0.93 Select an Administrative Item Bld€' Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $235.93 $0.00 TOTAL FEE: $235.93 Revised: 01/15/2011 CUPERTINO r/o I CS L� REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • build in4(a-Dcupertino.ora PROJECT ADDRESS ,shac,4n \nc, e4l APN # / 0 OWNER NAME P E';j�IT E-MAIL STREET ADDRESS ITY, STAT ,ZIP /y' 95c) 11 FAX APPLICANT NAMFQ A + ((0S V PHI - �j �.�. E-MAIL STREET ADDRESS , ` COY, STATE, Z .a n A t I -L FAX 11 OWNER ❑ OWNER -BUILDER 13 OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑` ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME('A S LICENSE iR QcSy LICENSE BUS. LIC. # COMPANY NAME .C'� E-MAIL FAX STREET ADDRESS n� ` l ` ^ CITY, STATE, ZIP0?1 l �� (! PHONE j -35 / ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC. # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE IUSE OF BLDG: )RESIDENTIAL ❑ COMMERCIAL ROOF AREA: � 8 Is � VALUATION: 'o c/ Q 5D 0 0 jv) EXISTING ROOF TYPE: 13L7 BUILT-UP ROOF ❑ ASPHALT SHINGLES WOOD SHAKES ❑ WOOD SHINGLES 11OTHER (SPECIFY) REMOVE /REPLACE 121 YES IF NO, PLYWOOD I13./. ' ❑ PLYWD El PITCH: ROOF ❑ NO # LAYERS: THICKNESS: 1:15/8" TYPE: ElCDX .:12 CLASS: A PROPOSED ROOF TYPE: ❑ BUILT-UP ROOF ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER ICC -ES REPORT # DESCRIPTION OF WORK: -rr A _412olu (DPff� 0kV(1VY 6 Cl A �JCW Tom. C-� � � ` Q�� c�J C ReroofApp_2011.doc revised 03/02/11 CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: �]� S r1�/'j PERMIT # OWNER'S NAME: 1' �, ;'1 ci J PHONE # - Sr GENERAL CONTRACTOR:12 (,� rn � BUSINESS LICENSE # ADDRESS: O �LZ� CITY/ZIPCODE: *Our municipal code requires all busidesses working in the city to have a City of c:upertinm business ncense. 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: Owner % Contractor Signature Date 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