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11010003I CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 21120 GRENOLA DR 1 CONTRACTOR: ABOVE ALL ROOFING 1 PERMIT NO: 11010003 OWNER'S NAME: LINDA PEREZ 1700 NORTHRUP ST 1 DATE ISSUED: 01/03/2011 OVINER'S PHONE: 4082572512 Ci LICENSED CONTRACTOR'S DECL9ARA+'TIION License Class 3 Lic. # Contractor Date ! 3z1f 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. 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. Ie-e� 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 indemnify and keep harmless the City of 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 comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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 construct the project (Sec.7044, Business & Professions Code). 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 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. 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 become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, cr and expenses which may accrue against said City in consequence of the i sg of this permit. Additionally, the applicant understands and will comply wh.i all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date. SAN JOSE, CA 95126 PHONE NO: (408)2924188 BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r MECH r RESIDENTIAL r COMMERCIAL r JOB DESCRIPTION: RE -ROOF TEAR OFF EXISTING TAR & GRAVEL ROOFING.INSTALL A 4 -PLY GRAVEL SURFACED ROOF,32 SQ CLASS A Sq. Ft Floor Area: I Valuation: $13217 APN Number: 32628062.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: ----7 . Date! ` ff `/,0 RE -ROOFS: 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. Signaturp of pplicant:�'''�"�'.- Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Owner r auth� j CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional 3 ITEMS OF 3 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 32628062.00 DATE ISSUED.......: 01/03/2011 RECEIPT #.........: BS000012364 REFERENCE ID # ...: 11010003 SITE ADDRESS .....: 21120 GRENOLA DR SUBDIVISION ...... CITY CUPERTINO IMPACT AREA ...... OWNER LINDA PEREZ ADDRESS 21120 GRENOLA DR CITY/STATE/ZIP ...: CUPERTINO, CA 95014 OPERATOR: patg COPY # : 1 RECEIVED FROM ....: ABOVE ALL ROOFING S CONTRACTOR .......: KEN SULESKY LIC # 23092 COMPANY ..........: ABOVE ALL ROOFING ADDRESS ........... 700 NORTHRUP ST CITY/STATE/ZIP ...: SAN JOSE, CA 95126 TELEPHONE (408)292-4188 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC ---------- NEW BAL ---------- ----------------------- 1BCBSC VALUATION ---------- 13,217.00 ---------- 1.00 ---------- 0.00 1.00 0.00 1BSEISMICR VALUATION 13,217.00 1.32 0.00 1.32 0.00 1REROOFRES SQ FEET 32.00 416.00 0.00 416.00 ---------- 0.00 ---------- TOTAL PERMIT ---------- 418.32 ---------- 0.00 418.32 0.00 METHOD OF PAYMENT ----------------- CHECK TOTAL RECEIPT : AMOUNT --------------- 418.32 --------------- 418.32 VOICE ID DESCRIPTION -------- ---------------------------- 309 EXTERIOR LATH 601 ROOF TEAR OFF REFERENCE NUMBER -------------------- #19690 VOICE ID DESCRIPTION -------- ---------------------------- 311 SCRATCH COAT 602 ROOF PLYWOOD NAIL 604 ROOF IN -PROGRESS 605 FINAL REROOF CITY OF CUPERTINO FEE ESTIMATOR -BUILDING DIVISION imlADDRESS: 21120 grenola dr. DATE: 01/03/2011 REVIEWED BY: bobs. . —L— APN: BP#: *VALUATION: 1$13,217 *PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re -roof PRIMARYSFD or Du lex USE: P T(>Lz i. i°'L(10Iti ihf t. PENTAMATION 1 SFDWLROOF PERMIT TYPE: WORK tear off existing t roofing. Install 4 -ply, class A 32 squares. SCOPE FEE ID ROOF AREA s.f. 1REROOFFRES 3,200 NnTJ Thncv frac nrn hncod not tho nroliminary infarmatinn availahle and are only an estimate. Contact the Dept for addh 7 info. FEE ITEMS (Fee Resohition 09-051 Eff 711:'101 lcch, Pfart ('Nirx'k I'ititrt'�. 1'�`,rr Chcci, Pict" 110 1 (`Cr>'c%c . —L— fyt"Irmit %'cc, 1', it'[.', P"i-Mil 1`'i': (),dwr Af c'h. h-isp. C111r,r• Ph,nih h-I'V,Lj Urh,'T 1;10c_ MV), _ ,1c (h, M'w. 1"v: /''.tr;rtth_ h oh. F("., lsiec. Irtsjv FCC', NnTJ Thncv frac nrn hncod not tho nroliminary infarmatinn availahle and are only an estimate. Contact the Dept for addh 7 info. FEE ITEMS (Fee Resohition 09-051 Eff 711:'101 FEE QTY/FEE MISC ITEMS Plan Check S2pp/. PC' 1'ec P/tltnh.i plc ('ft.il le'c Plant (:'lieck: Permit Fee: $416.00 Suppl Insp I'ee t%nit Tlurtrh.:`:'l�lc clt.i/�`l��(' P��1-ntit T ec,: Cvnnstruction Tax Icoustical Revictti' Work Without Permit? 0 Yes No $0.00 1'lunntntr t' c es: � Ir"(1Pe'I [)(!L`llrl'tf'iZtatlt?!"! /°k'eS: Strong Motion Fee: IBSEISMICR $1.32 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $418.32 $0.00 TOTAL FEE: ; $418.32 Revised: 12/07/2010 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: 2112- Q Gee ,& PERMIT # O OWNER'S NAME: ,[ pvt -i PHONE jD 2 2 GENERAL CONTRACTOR: BUSINESS LICENSE # ADDRESS: ?,eV /f Ac CITY/ZIPCODE: _S;., *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 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 , CITY OF CITY OF CUPERTINO REROOF C U P E RT I N O PERMIT APPLICATION itJI _,� 3 APN # � Date: 3 / If residential, is house an Eichler? Yes ❑ No $0 If yes, needs planning approval. Building Address: 2 2. 0l rr ^ lTr� O � r Owner's Name. L A w PAe4,L Phone #:L%k 2 5-7. 25-12- 51ZHOA: HOA:Yes ❑ No If yes, provide letter from HOA Contractor: A'�u2 Sv1,A-ijl"A.J 114- Phone #: L�10 Fax #: �10j) 2 9 2 - 13 Cupertino Business License #: Contractor License #: Type of Roof Covering: Existing: Proposed: w"Built-Up Roof u"' Built -Up roof ❑ Asphalt Shingles ❑ Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles G" ❑ Wood Shingles T � G` Other (Specify) rK Other (Specify) Number of existing coverings o Provide I.C.C.E.S. Report # ❑ To be Removed ❑ Provide Mfgr. Installation Specs. Job Description: Ttov o 4 -e,*Js P T /`v,� �� , Tlu 419 o• L/- Ply 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: �f /3, 21.7 I Have Read, Understand and Will Comply with Cupertino's Tear -Off Policy: