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13030130 (2) CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10965 DRYDENAVE CONTRACTOR:NEIGHBORS ROOFING PERMIT NO:13030130 AND GUTTERS OWNER'S NAME: MARCIA SCRIVANO 200 FORD RD STE 236 DATE ISSUED:03/25/2013 OWNER'S PHONE: 4082097202 SAN JOSE,CA 95138 PHONE NO:(408)472-3869 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIALS License Class G 3. Lic.#. 6 v O�s" TEAR OFF(E)WOOD SHINGLES,INSTALL CERTAINTY LIFE-TIME CLASS A COMP , Contractor i✓'.e(�,yj o-rS Yb®tt�y�*,Date •�,.-,Z S'�'r/2 3 2- rJ Q I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business&Professions 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. Sq.Ft Floor Area: Valuation:$15000 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 APN Number:35614020.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city:and county,ordinances and state laws relating WITIHN 180 D T ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the'above mentioned-property for inspection purposes. (We)agree to save 180 DA O CALLED INSPECTION. indemnify and keep harmless the Cityof Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the-applicant understands and will coin ssued Date: Z / with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature Date ?--�Z �--l� All roofs shall be inspected prior to any roofing material being installed.If a roof is installed without first obtaining an inspection,I agree to remove all new materials for inspection. ❑ OWNER-BUILDER-DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I,,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec,.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 2255505,,,25.533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this LLf�y'�" \ permit is issued. Owner or authorized agent: Date: 2 I certify that in the performance of the work,for which this permit is issued,I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address I certify that I have read this application and state that the above information is correct.I agree to comply with all city and Bounty 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this.permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date 4 - MP REROOF PERMIT APPLICATION � COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION O 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 O� CUpERTITiO (408)777-3228•FAX(408)777-3333•building(ftupertino.org \� rPROJFCT.ADDRESS APN# $l/ I `) O2010 v bVNAME PHONE E-MAIL 2a 2DZADDRESSCITY,STATE,ZIP FAXCT NAME PHONE E-MAI ADDRESS CITY,STATE,ZIP FAX IJ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT MIrONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME LICENSE NUMBER�O LICE TYPE BUS.LIC.# COMPANYNAME C'iI S E-MAIL J F 8�l 4'2f�72 f STREET ADDRESS _ CITY,STATE,ZIP ��— �/ PHONE a�, (/17 ;31.5 16"© :(� I1 Z T�c7D ARCHITECT/ENGINEERNAME LICENSENUMBER BUS.LIC.# COMPANY NAME _ E-MAIL FAX STREET ADDRESS - CITY,STATE,ZIP PHONE USE OF SFD or DupleX : ❑ Multi-Family . ROOF AREA: VALUATION: - STRUCTURE:. .Lq Commercial EXISTING ROOF.TYPE: .:❑BUILT-UP ROOF: G!k1SSPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY) REMOVE/REPLACE ®YES IF NO, PLYWOOD ❑ '/:" ❑ PLYWD ❑OSB PITCH: ROOF ❑NO #LAYERS: THICKNESS: ❑ 5/8" TYPE: ❑CDX '12 CLASS: L1 ICC-ES REPORT# ' PROPOSED ROOF TYPE: ❑BUILT-UP ROOF 91 ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER DESCRIPTION OF WORK: / f [nri. e f Lcle .. one_ �-�- 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 build* cons tion. I uthorize re sentatives of Cupertino to enter the above-dentified property for inspection purposes., Signature of Applicant/Agent: Date: �� SUPPLEMENTAL INFORMATION REQUIRED If building is associated with a Home Owners Association,provide letter of approval from HOA. r Provide Planning approval to verify if there any restrictions. _Provide copy of Manufacturer's Installation Specifications. Provide signed copy of Cupertino's Tear-Off Policy. #4, ReroofApp_2011.doc revised 03/16/11 REROOF TEAR-OFF POLICY COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 T.ORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228•FAX(408)777-3333•buildingCa�cupertino.org PROJECT ADDRESS .. APN# OWNER NAMEPH E-MAIL V Li STREET ADDRESS 110 66 S, D Y 1 nD Y__ Y/ S ATE,ZI )-IC-,) � 0` FAX CONTRA OR AME !J LICE SE(-CNjTMJ BER LICElg YPE BUS.LIC.# �-' �j C CE-MAILOMP jNY NAME /� C STREET ADDRESS CI�,Y,STATE,ZIP PHONE ��.� I UNDERSTAND AND AGREE TO THE FOLLOWING: 1. The re-roof project shall comply with all applicable provisions of the 2010 California Codes. 2. An inspection request can be scheduled up to one business day before the requested inspection date. Please call (408) 777-3228 from 7:30-3:30pm(Mon-Thurs)or 7:30-2:30pm(Friday)to schedule inspection. For Tear-Off and Nailing Inspections,you must also call on the day of the inspection only. after that phase of the work is completed. The building inspector will be available within one hour. Final Inspections will be given a two hour window. 3. Tear-Off Inspection is required. Any and all dry-rotted wood shall be replaced prior to this inspection. Unless new plywood roof sheathing is proposed throughout, all the nails/fasteners shall be either completely knocked-down or removed prior to this inspection. 4. If plywood is installed, a plywood Nailing Inspection is required. 5. Roofing.shall not be applied without first obtaining all prior inspection and written approvals from the building inspector.. Any roofing which is applied without first obtaining an approved inspection will require the removal of all new material down to the sheathing so a proper inspection can be performed. 6. A Final Inspection and approval shall be obtained from the building inspector when the re-roofing is completed. To receive a final sign-off,the following items will be verified: a. Flat roofs shall have a minimum of'/4"per foot of slope and demonstrate there is no ponding. b. Listings from approved testing agencies for all pre-manufactured products used shall be available on-site to review at the time of the inspection. c. Proper spark arrestor installation,vents painted, gutter/downspouts installed, debris removed. 7. 1 NOTE: If you call'for a tear-off or plywood nailing inspection and the work is not complete,you will be charged a re-inspection fee. The re-inspection fee shall be paid before another inspection can be scheduled. By my signing below,Lcertify each of the following is true: I am the property owner or authorized agent to act on the property owner's behalf. I understand and agree to comply with the re-roof policy stated above. I also understand that smoke detectors and carbon monoxide detectors are required to be installed in accordance with Sections R314 and R315 of the 2010 California Residential Code. Signature of Applicant/Agent: Date: ReroofPo1icy_2012.doc revised 10/7/12 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 10965 DRYDEN 1106• DATE: 03/25/2013 REVIEWED BY: MELISSA APN: 35614020 BP#: 'VALUATION: 1$15,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY SFD or Duplex PENTAMATION 1 SFDWLROO USE: pPERMIT TYPE: WORK TEAR OFF E WOOD SHINGLES INSTALL CERTAINTY LIFE—TIME CLASS A COMP SCOPE Llech.flan CheckPlumb,Plan Check Elec.Plan Check 1tec:h.Permit Fee: Plumb.Permit f ee: Elec•.Permit ree: LOnc�r Heck Insp. Li Other Plumb Insp. OtherElee.Insp. A4 .1 Insp.Fee: Plumb. hish.Fee: Elee.Insp,.Fee: NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District etc.). These ees are based on the relimin in ormation available and are onl an estimate. Contact the Det or addn't info. FEE ITEMS(Fee Resolution 11-053 E . 711112) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 3,200 s.f. Re-roof Suppl.PC Fee: Q Reg. ® OT 0.0 hrs $0.00 $480.00 1REROOFRES PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp.Feer Reg. Q OT0 0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: Adinlnistrative Fee: Work Without Permit? 0 Yes 0 No $0.00 Advanced Planning Fee:. $0.00 . Select a Non-Residential G Building or Structure h°avel Dactiinentation'Fees: Strong Motion Fee: IBSEISMICR $1.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 $2.50 $480.00 a $482.50 \A , Revised: 01/01/2013