11010075 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 11406 LINDY PL CONTRACTOR:R E ROOFING& PERMIT NO: 11010075
CONSTRUCTION INC
OWNER'S NAME: BERNEDETTE&KELLY HIRANO 15230 CLYDELLE AVE DATE ISSUED:01/13/2011
`ER'S PHONE: 4085647301 SAN JOSE,CA 95032 PHONE NO:(408)626-9320
❑ LICENSED CONTRACTOR'S DECLARATION F-
BUILDING PERMIT INFO: BLDG ELECT PLUMB
Gik Lic.# 2-�
MECH RESIDENTIAL r COMMERCIAL r
Date
t licensed under the provisions of Chapter 9 JOB DESCRIPTION:RE-ROOF REMOVE EXISTING 1 LAYER OF TILE,INSTALL
(commencing with Section 7000)of Division 3 of the Business&Professions NEW 1/2"CDX,30#FELT&EAGLELITE LIGHT WEIGHT
Code and that my license is in full force and effect. TILE CLASS A 36SQ
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 Sq.Ft Floor Area: Valuation:$25000
permit is issued.
APPLICANT CERTIFICATION APN Number:35624011.00 Occupancy Type:
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 18 AYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,the applicant understands and will comply 180 DAY M LAST CALLED INSPECTION.
non-wo*sou egulations per the Cupertino Municip Code,Section
f! 9.18.
Issued by: � / Date:
Signature L"'-_ Date
r, OWNER-BUILDER DECLARATION
RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of Al--mf5 shall be inspected prior to any roofing material being installed.If a roof is
the following two reasons: installed wr ut f_itst taining an inspection,I agree to remove all new materials for
I,as owner of the property,or my employees with wages as their sole compensate inspection. ' L
will do the work,and the structure is not intended or offered for sale(See.7044, ature t 2 ( t I
Business&Professions Code) SignAp 'cant: Date: l
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: HAZARDOUS MATERIALS DISCLOSURE
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 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. 1 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(a)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 A shaYl intain 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 W6rker'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 ° e° `-72 I
forthwith comply with such provisions or this permit shall be deemed revoked. 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
i^-1!mnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
,and expenses which may accrue against said City in consequence of the
6—sting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
with 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
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35624011 . 00
DATE ISSUED. . . . . . . : 01/13/2011
RECEIPT #. . . . . . . . . : BS000012468
REFERENCE ID # . . . : 11010075
SITE ADDRESS . . . . . : 11406 LINDY PL
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : BERNEDETTE & KELLY HIRANO
ADDRESS . . . . . . . . . . : 11406 LINDY PL
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4814
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 25, 000 . 00 1 . 00 0 .00 1 . 00 0 . 00
1BSEISMICR VALUATION 25, 000 . 00 2 .50 0 .00 2 .50 0 . 00
1REROOFRES SQ FEET 36 . 00 468 . 00 0.00 468 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 471 .50 0 .00 471.50 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 471 .50 #3107
---------------
TOTAL RECEIPT 471 .50
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
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 11406 lindy PI. DATE: 01/13/2011 REVIEWED BY: gs
APN: BP#: *VALUATION: 1$25,000
R�PERMITTYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD or Duplex lex I( 7.`tL PENTAMATION 1SFDWLR00F
USE: 1`10011 1if t. PERMIT TYPE:
WORK
SCOPE
FEE ID ROOF AREA
s.f.
1 REROOFFRES 3,600
tllcclr. Plan C"beck F
P onh. Plot!Chcr; : eMyan(`l.cr
":1. Pct-mil P'C". 1ctmil
.. 1,','V,,
C)'hc r'.l1cr,'17. f� s.1>_ Oti;c'r P r�r,�Tl 7 '�>_ ElM,"i'1>lo, Ingp, Li
Plumb, Ii y, Fe"', 1""10 limp, j,"C
NOTE: Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resohition 09-051 Eff. 7/Ii10) FEE QTY/FEE MISC ITEMS
Plan Check Fec:
,.41!11/)!. P(l,FCC
Plrlrrtll.-"1Ie<11.;`1;lec Pla11 t:.7lec:k:
Permit Fee: $468.00
Supp/. hop Fee F
P111r�1f7.::tlec�T1. "1 l�'c Z.�r1it t�"�r�':
f'lunlh.;'1�1 rcjt.;'1'lt�' Perini! Fee:
C �trzsti uc°lion 1 CLV
Work Without Permit? 0 Yes No $0.00
Planni nor 1,'c 0S:
7'1-ovel 1)ac'ttinc nttatfr�n 1'c'e'.ti':
Strong Motion Fee: IBSEISMICR $2.50 Select an Administrative Item
Bldjz Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $471.50 $0.00 TOTAL FEE $471.50
Revised: 12/07/2010
Building Department
City Of Cupertino
Lai 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: (p 1 L PERMIT# / ( �
OWNER'S NAME: t RA140 PHONE# —b L(r, - T-'720
GENERAL CONTRACTOR: BUSINESS LICENSE# v l
ADDRESS: Cj2 CITY/ZIPCODE: U SIE q5A 2
*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 CONTRACTO ND A SU TRACT S HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE. A f
I am not using any subcont ctors:
-Signature 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
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•building(d)cupertino.orq
PROJECT ADDRESS 1 I_ L-1` �n'J J APN#
�j
OWNER NAME M'� H ` jq4- �3o ( E-MAIL
STREET ADDRESS CITY, STATE,ZIPbt t,uc-111
40
FAX
CONTRACTOR NAM L 1 N /.. LICENSE NUMBER 2,-7�i LIC SE f E BUS.LIC# '�f o 5 1 f
COMPANY NAME E-MAIL Y-�1(c)o ; 1+ l ' a0 I.� FAX �^� 1�
IM
STREET ADDRESS /n jV ��J ^ ,l A/c'' CITY,ST��E6ZJP_ C�i, ( Jo
-I/l PHONEiG / -,•M Z '\
L I UNDERSTAND AND AGREE 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 signirig"below, I cert, each othe following is true: I am the property owner or authorized agent to act
on the prop� nrty owner's be uhe
and agree to comply with the re-roof policy stated above.
Signature of Ap�licant/Agent: ' (�—'' Date: 7
—.-�' ReroofPolicy_2010.doc revised 05/17/10
CITY OF
` U
CITY OF CUPERTINO
REROOF
CUPERTINO PERMIT APPLICATION
APN# Date:
If residential, is house an Eichler? Yes ❑ No ❑ If yes, needs planning approval.
Building Address: L 1
Owner's Name: - Phone #:
HOA: Yes ❑ No If yes, provide letter from HOA `AL1 ' ! i" 0
Contractor: Phone #:
CGS hm.n"i , �c. 1
�1 Fax#: q� -- 2,(0 (�
Cupertino Business License #: 2-oI�� Contractor License #:
7
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
Other (Specify) )� Other (Specify)
❑ Provide I.C.C.E.S. Report# I
Number of existing coverings � p
To be Removed ❑ Provide Mfgr. Installation Specs.
5� S�
Job Description:�p ��'�(l�'f �.�`'IG1f j1 L�, t 1� �fi��'L 1.. i�l kCtiJ
VQ e �-► i 'r� 1.
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:
Z.S000
I Have Read, derstand and '11 Comfly.with upertino's Tear-Off Policy:
r