10120017 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20971 PEPPER TREE LN CONTRACTOR:DADDARIO ROOFING PERMIT NO: 10120017
OWNER'S NAME: ALBERT&ROSE YIAN 1734 WILLA WAY DATE ISSUED: 12/03/2010
OWNER'S PHONE: 4089314612 SANTA CRUZ,CA 95062 PHONE NO:(831)476-9109
L LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class-� C 3 q Lic.# �3c 7`'5 R MECH RESIDENTIAL I— COMMERCIAL
Contractor (Do dia-f t d Ozi,IF% Date 14 03 fV110
JOB DESCRIPTION: RE-ROOF TEAR OFF SHAKE&INSTALL OSB&40 YR
I hereby affirm that I am licensed under the provisions of Chapter 9
COMPOSITION CLASS A 24SQ
(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 Sq.Ft Floor Area: Valuation:$11290
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
APN Number:35912017.00 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 PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes. (We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION.
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. Issued�liy: �� Date�'2._7-
Signature_,',�_ D5 y� Date
OWNER-BUILDER DECLARATION RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed.If a roof is
I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for
the following two reasons: inspection.
1,as owner of the property,or my employees with wages as their sole compensation, J�
will do the work,and the structure is not intended or offered for sale(Sec.7044, Signature of Applicant GGA 7 Date: ��X33 r �'alo
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to
ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the
Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material.
Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
1 certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534.
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 Owner or author' a agent:
become subject to the Worker's Compensation provisions of the Labor Code,I must Date'/�"
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's
I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.)
correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
co-}s,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION
ng of this permit.Additionally,the applicant understands and will comply
r:_ _all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records.
9.18.
Licensed Professional
Signature Date
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 20971 pepper tree In. DATE: 12/03/2010 REVIEWED BY: bobs.
APN: BP#: ."VALUATION: 1$11,290-�
xPERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
-----[PRIMARY >; PENTAMATION 1 SFDWLROOF
USE: SFD or Duplex 1 ,�f p PERMIT TYPE:
WORK sfd re-roof class a remove existing shake install comp. shingles
SCOPE
FEE ID ROOF AREA
s.f.
1 REROOFFRES 2,400
%,,,,,
I 0 i';llip i
NOTE. These fees are based on the preliminary information available and are onily an estimate. Contact the De t or addn'1 info,
FEE ITEMS(Fee Resolution 09-051 Ef. 7,11I0) FEE QTY/FEE MISC ITEMS
Pkrer ,tE't:h
Permit Fee: $312.00
1➢l fiFtl j', �'t ' F. �:fs � k.7 lr c.,.
z
Work Without Permit? 0 Yes E) No $0.00
F
Strong Motion Fee: IBSEISMICR $1.13 Select an Administrative Item
Bld>;Stds Commission Fee: 1BCBSC $1.00 1 i
SUBTOTALS: $314.13 $0.00 TOTAL FEE: $314.13
Revised: 11/08/2010
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN 35912017 .00
DATE ISSUED. . . . . . . : 12/03/2010
RECEIPT #. . . . . . . . . BS000012135
REFERENCE ID # . . . : 10120017
SITE ADDRESS . . . . . : 20971 PEPPER TREE LN
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : ALBERT & ROSE YIAN
ADDRESS . . . . . . . . . . : 20971 PEPPER TREE LN
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : DADDARIO ROOFING CO
CONTRACTOR . . . . . . . : EDGAR MONTOYA LIC # 26245
COMPANY . . . . . . . . . . : DADDARIO ROOFING
ADDRESS . . . . . . . . . . : 1734 WILLA WAY
CITY/STATE/ZIP . . . : SANTA CRUZ, CA 95062
TELEPHONE . . . . . . . . : (831) 476-9109
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 11, 290 . 00 1 . 00 0 . 00 1. 00 0 .00
1BSEISMICR VALUATION 11, 290 . 00 1 .13 0 .00 1.13 0 .00
1REROOFRES SQ FEET 24 . 00 312 .00 0. 00 312 . 00 0 .00
---------- ---------- ---------- ----------
TOTAL PERMIT 314 .13 0. 00 314 .13 0 .00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 314 .13 #5249
---------------
TOTAL RECEIPT 314 .13
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
INPUT RLsources EnergyAD
.In oor Ir Quabty an mis es
1.Use Low/No-VOC Paint 1 IAQ/Health pts y=yes 0
2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes 0
3.Use Low/No VOC Adhesives 3 IAQ/Health pts y=yes 0
4.Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes 0
5.Use Engineered Sheet Goods with no added Urea
Formaldehyde 61AQ/Health pts y=yes 0
0
6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes
7.Seal all Exposed Partioleboard or MDF 4 IAQ/Health. pts y=yes 0
S.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes 0
9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y--yes D
10.Install Whole House Vacuum System 3 IAQ/Health pts y=yes 0
1 1 1
N.Flooring
1.Select FSC Certified Wood Flooring 8 Resource pts y=yes 0
2.Use Rapidly Renewable Flooring Materials 4 Resource pts y=yes 0
3.Use Recycled Content Ceramic Tiles 4 Resource pts y--yes 0
4.Install Natural Linoleum in Place of Vinyl 5 IAQ/Health pts y=yes 0
5.Use Exposed Concrete as Finished Floor 4 Resource pts y=yes 0
6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes 0
1 1 1
Total Points Available: 1401 130r---5771
Total Points Project Received:i 0 0 r 0
�2- c3 - �olv
G: alprog i 6*,n.,�-modelers/greenp6intsfina]2.12.04protected.xis
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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 Qcupertino.org
PROJECT ADDRESS APN#
to,7'71 ✓
OWNER NAME / PHONE -7 E-MAIL
I d s 'ak 31- b!c
STREET ADDRESS CITY, STATE,ZIP ,57/ FAX
CONTRACTOR NAMELICENSE NUMBER LICENSE TYPE BUS.LIC.#
�J n� nciV.1 C
13 3�
COMPANY NAME E-MAIL FAX
(< <l L 1 1
STREET ADDRESS CITY,STATE.ZI PHONE
; e 7!5e 10
a
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 1/4"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 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.
Signature of Applicant/Agent: Date:
ReroofPolicy_2010.doc revised 05/17/10
CITY OF !0
CITY OF CUPERTINO
REROOF
CUPERTINO PERMIT APPLICATION
O Irl
APN# Date.
zc,97/ Q 12 atz r G I2 03 /0
Building A dies :,
Al koA c IJ eo5-e O
Owner's Name: Phone #:
HOA: Yes No If yes, provide letter from HOA `'la8 "13 -- G
Contractor: Phone 9: �t �7�_ q1 o cf
a r;C ^� Fax#: 63 / X76- 215 -3
Cupertino Business License #: Contractor License #: 413o739
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)
Number of existing coverings ❑ Provide I.C.C.E.S. Report#
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description:
TO
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: AV 0 U
it, 29c-
I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
Signatur
Revised 02/05/09