11010117 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10825 W ESTATES DR CONTRACTOR:ARMSTRONG PERMIT NO: 11010117
INSTALLATION
OWNER'S NAME: ROBINSON RUSSELL H AND NORMA C 4575 SAN PABLO AVE DATE ISSUED:01/21/2011
AVNER'S PHONE: 4082532529 EMERYVILLE,CA 94608 PHONE NO:(510)777-1234
LL.ICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
License Class /� C 3 Lic.# �'�S�1/ RE-ROOF 6 SQUARES, TEAR OFF EXISTING FLAT ROOF
/ AND REPLACE WITH CLASS A
Contractor •1K Date t e / I
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:$7000
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:36923036.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION o
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 WITHIN 180 DAYS OF PERMIT 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 DAYS FROM LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said Ci in consequence of the
granting of this permit. Additionally,the applicant u derstands and will comply Issued by:, Date:
with all non-point sourc gulations pert e Cupe Municipal Code,Section
9.18.
l RE-ROOFS:
Signatur Date ! 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)
1,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. 1 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(x)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 end hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Are Air Quality Manageme t District I
performance of the work for which this permit is issued. will maintain compliance with the Cuper' Mu cipal Cod ,Cha r 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sect' 255 ,2553 ,and 255
Section 3700 of the Labor Code,for the performance of the work for which this
Owner or authorized agen te:�
permit is issued.
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 county ordinances and state laws relating
to building construction,and hereby authorize representatives of this city to enter
noon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION
'emnify and keep harmless the City of Cupertino against liabilities,judgments,
sts,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
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
ALBERT SALVADOR, P.E.,C.B.O., BUILDING OFFICIAL
CUPERTINO 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228•FAX(408)777-3333•buildingcacugertino.orc
PROJECT ADDRESS U _ /^5 1 1 e L Jam^ APN#
OWNER NAME n D A r% �� PV;E _ r J E-MAIL
STREET ADDRESS Iv 7 "� ) CI ,`STATE ZI LQ FAX
CONTRACTOR NAME r /ro �KC / •�, LICENSEZN. MBERLICENSE TYPE /� BUS.LIC#
COMPANY NAME /r�f71 I/ E-MAIL •i7 FAXL/Jr
R �ADDRESS
O'�a► �O�O�6 V ` GSTSTATE,� Y�,�� C i �U PHO��O'777,
I�
I UNDERSTAND AND REE TO THE FOLLOWING:
1. The re-roof project shall comply with all applicable provisions of the 2007 California Building Code.
2. You must schedule all needed inspections a minimum of one day before the requested inspection date.
Please schedule inspections online or call (408)777-3228 between 7:30-3:30 (Mon-Fri).
3. Tear-off roof inspection is required. Please call for tear-off inspection after the roof is torn off and all
the nails/fasteners have been removed. Any and all dry-rotted wood shall be replaced prior to this
inspection. A building inspector will be available within one hour.
There are special hours for this service: 7:30 — 10:30am and 1:00—3:30pm (Mon—Thurs);
7:30 — 10:30am and 1:00—2:30pm (Friday).
4. If plywood is installed, a plywood nailing inspection is required.
5. In-Progress roof inspection is required. Call for an in-progress roof inspection to verify building is
weather tight after installation of approximately 25% of the roofing material.
6. New roof coverings shall not be applied without first obtaining all inspections 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.
7. A final inspection and approval shall be obtained from the building inspector when the re-roofing is
complete. 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 must 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.
8. 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 of$126.00. The re-inspection fee shall be paid before another
inspection can be scheduled.
By my signing below, I certify each of e following is true: I am,#e property owner or authorized agent to act
on the property owner's beha . u stand an r t mpl ith the re-roof policy sta b/ov
Signature of Applicant/Agent: Date:
ReroofPolicy_2010.doc revised 05/17/10
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36923036 . 00
DATE ISSUED. . . . . . . : 01/21/2011
RECEIPT #. . . . . . . . . : BS000012538
REFERENCE ID # . . . : 11010117
SITE ADDRESS . . . . . : 10825 W ESTATES DR
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : ROBINSON RUSSELL H AND NORMA C
ADDRESS . . . . . . . . . .
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4537
RECEIVED FROM . . . . : ARMSTRONG INSTALLAT
CONTRACTOR . . . . . . . : MITCH FINE LIC # 22581
COMPANY . . . . . . . . . . : ARMSTRONG INSTALLATION
ADDRESS . . . . . . . . . . : 4575 SAN PABLO AVE
CITY/STATE/ZIP . . . : EMERYVILLE, CA 94608
TELEPHONE . . . . . . . . : (510) 777-1234
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 7, 000 .00 1. 00 0 . 00 1. 00 0.00
1BSEISMICR VALUATION 7, 000 .00 0 .70 0 .00 0 . 70 0 . 00
1REROOFRES SQ FEET 6 .00 78 . 00 0 . 00 78 . 00 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT : 79. 70 0 . 00 79 . 70 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 79. 70 1955
---------------
TOTAL RECEIPT 79. 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
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: PERMIT#
OWNER'S NAME: PHONE#
GENERAL CONTRACTOR: .zs BUSINESS LICENSE#
ADDRESS:lt- y, T6 CITY/ZIPCODE:
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUB NTRACTORS H E OBTAINED A CITY O CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors: Z f
Signature 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
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 10825 west estates dr. DATE: 01/21/2011 REVIEWED BY: bobs.
APN: 23 0 b� BP#: "VALUATION: 1$7,000
R�PERMITTYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY PENTAMATION 1 SFDWLROOF
USE: SFD or Duplex PERMIT TYPE:
WORK re lace existing tar and gravel and replace with foam roofing system.
SCOPE
FEE ID ROOF AREA
s.E
1REROOFFRES 600
1f1t. i'ILm('ho k �t.ra;°', 7'?rtrt t_t�=c�l, ie 1-ata C±ec%
"hop"h. Xst m,,., Fcc., nn;"i"'c,
C�,1xr ,11er1, 1Yr�.�> F-1
tatl;er P ."raa7llrtsl> (1t;r r°la`ec:Ittsl�._L_
Li
NOTE. Thesefees are based on the preliminary in ormation available and are only an estimate. Contact the De t or addn'1 info,
FEE ITEMS (Fee Resolution 09-051 Eff. 7/1110) FEE QTY/FEE MISC ITEMS
Plan Che(.1,
sztj� rl. Pt.'/t cF_ A
f'lrrrnfJ.;'tt c lr.;l:'lec:Plan t hcuk
Permit Fee: $78.00
supp/, 1118p Fee
F'lrsrrrfr.;1I <:°lr. "I Cc3t; I'nii 1'ce
l'ltirnit.,`;k F�clt.:�l.lc°c�
Permit I'ce:
Cvonsiruction 7(r.v F71
.4couslical I&,vici I ec:
Work Without Permit? 0 Yes G No $0.00
Plcanrrrtr�7 f't'E',':
Travel 0octonctttolion FCC
S,
Motion Fee: IBSEISMICR $0.70 Select an Administrative Item
Bldg;Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $79.70 $0.00 TOTAL FEE: $79.70
Revised: 01/03/2011
CITY OF
CITY OF CUPERTINO
REROOF
CUPERTINO PERMIT APPLICATION
APN# Dater
If residential, is house an Eichler? Yes NoM If yes, needs planning approval.
Building Address: /40
Owner's Name: (Z�� e l� /<v sd yl Phone #:
HOA: Yes ❑ No If es, provide letter from HOA
Contractor: /4rpv 5, ` " "
5 �,lle"`00 Phone#:j/o - 7 7j—/�3 y
� 9 Fax#: :F/b 1'9�
Cupertino Business License #: CO ttor License #:
Type of Roof Covering:
Existing: Proposed:
-�rq Built-Up Roof A Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes 11
❑ Wood Shingles ❑ Wood Shingles vror '
❑ Other (Specify) >b Other (Specify) tto&,m
Number of existing coverings ❑ Provide I.C.C.E.S. Report#
To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description: j,.e raJ;
jaSS A '1''l �•t. 1�o-tM, 60o
A
Residential Commercial ❑
Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if
Green Building Checklist & attach it to the application or if there are any restrictions: ❑
applicable, include in plan set & the sheet index.
Valuation:
71c)v b
t Have Read, erstand and Will Co ly with Cu " rtino's ear-Off Policy: