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10120068 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 839 CANDLEWOOD DR CONTRACTOR:TELLY ROBBINS PERMIT NO: 10120068 CONSTRUCTION OWNER'S NAME: DAVID&MADELINE ROTOLO 659 BARTO ST DATE ISSUED: 12/13/2010 OWNER'S PHONE: 4082186174 SANTA CLARA,CA 95051 PHONE NO:(408)480-1948 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ / RE-ROOF-REMOVAL OF COMPOSITION&REPAIR AS ell NECESSARY SHEATHING.INSTALL NEW RAFTER.REMOVE& License Class Lic.# REPLACE GUTTER-CLASS A,23 SQUARES. Contractor Date I hereby affirm ha 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: Sq.Ft Floor Area: Valuation:$6000 1. 1 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. APN Number:36918025.00 Occupancy Type: 2. I have and will maintain Worker's Compensation Insurance,as provided fol-419 Section 3700 of the Labor Code,for the performance of the work t permit is issued. PEi RMIT EXPIRES IF WORK IS NOT STARTED APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is WITHIN 180 DAYS OF PERMIT ISSUANCE OR correct.I agree to comply with all city and county ordinances and state laws relating 180 DAYS FROM LAST CALLED INSPECTION. to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save ate: � l� j. indemnify and keep harmless the City of Cupertino against liabilities,judgments, Issued by:�? costs,and expenses which ay accrue against said City in consequence of the granting of this permit. d tionally,the applicant understands and ill co ply with all non-points re la r the Cupertino Municipal Code, ectio .18. RE-ROOFS: ------- //0 All roofs shall be inspected prior to any roofing material being installed.If a roof is Signature Dat r installed without first obtaining an inspection,I agree to remove all new materials for inspection. ❑ O R-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER the following two reasons: i. 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 HAZARDOUS MATERIALS DISCLOSURE sale(Sec.7044,Business&Professions Code) 2. 1,as owner of the property,am exclusively contracting with licensed contractors to I have read the hazardous materials requirements under Chapter 6.95 of the construct the project(Sec.7044,Business&Professions Code). 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. I hereby affirm under penalty of perjury one of the following three declarations: Additionally,should I use equipment or devices which emit hazardous air 1. I have and will maintain a Certificate of Consent to self-insure for Worker's Compensation,as provided for b Section 3700 of the Labor Code,for the contaminants as defined by the Bay Area Air Quality Management District I will P P Y maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the performance of the work for which this permit is issued. Health&Saf ode Sections 25505,25533,and 25534. 2. 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 OwnerOwner d nt; /4-1) permit is issued. Date: 3. 1 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 CONSTRUCTION LENDING AGENCY Compensation laws of California. If,after making this certificate of exemption,I I hereby affirm that there is a construction lending agency for the performance of work's become subject to the Worker's Compensation provisions of the Labor Code,I for which this permit is issued(Sec.3097,Civ C.) must forthwith comply with such provisions or this permit shall be deemed Lender's Name revoked. Lender's Address APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is ARCHITECT'S DECLARATION correct.I agree to comply with all city and county ordinances and state laws relating I understand my plans shall be used as public records. to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save Licensed Professional 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 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 839 candlewood /DATE: 12/13/2010 REVIEWED BY: bobs. APN:36-9� BP#: 'VALUATION: $6,000 9;�PERMITTYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof PRIMARY -71"i'77 It) PENTAMATION 1SFDWLROOF USE: SFD or Duplex i ,f�, , _j,' I PERMIT TYPE: WORK SCOPE FEE ID ROOF AREA s.f. 1REROOFFRES 2,300 P r, ., i. A""i I.'c." NOTE: Thesefees are based on the preliminary in ormation available and are only an estimate. Contact the De t or addn7 info. FEE ITEMS(Fee Resolution 09-051 Elf. '1;10) FEE QTY/FEE MISC ITEMS PIor1 ("I"c'k 1 1" Permit Fee: $299.00 `�?I�JjJ1/t. �1?tiara f•t t, Work Without Permit? 0 Yes E) No $0.00 Strong Motion Fee: IBSEISMICR $0.60 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $300.601 $0.00 TOTAL FEE: 1 $300.60 Revised: 12/07/2010 CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: suew COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36918025.00 DATE ISSUED. . . . . . . : 12/13/2010 RECEIPT #. . . . . . . . . : BS000012213 REFERENCE ID # . . . : 10120068 SITE ADDRESS . . . . . : 839 CANDLEWOOD DR SUBDIVISION . . . . . . : CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : DAVID & MADELINE ROTOLO ADDRESS . . . . . . . . . . : 839 CANDLEWOOD DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : TELLY ROBBINS CONTRACTOR . . . . . . . : TELLY ROBBINS LIC # 24204 COMPANY . . . . . . . . . . : TELLY ROBBINS CONSTRUCTION ADDRESS . . . . . . . . . . : 659 BARTO ST CITY/STATE/ZIP . . . : SANTA CLARA, CA 95051 TELEPHONE . . . . . . . . : (408)480-1948 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 6, 000.00 1. 00 0 .00 1 .00 0. 00 1BSEISMICR VALUATION 6, 000 . 00 0. 60 0 .00 0 .60 0. 00 1REROOFRES SQ FEET 23 .00 299.00 0 .00 299.00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 300.60 0 .00 300 .60 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 300. 60 VISA --------------- TOTAL RECEIPT 300 . 60 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 REROOF TEAR-OFF POLICY COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333•building(a.cupertino.org PROJECT ADDRESS f _p,�f/- APN# Ej �� " E-MAIL OWNERNAME STREE .STATE,ZI .__.. FAX C T OT l/E LICE j LIC YPE BUS. FAX COMPA STREET DJi ,STAT IP PHO 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 following is true: I am the property owner or authoriz d agent to act on the property owner's be u ers d agree to comply with the re-roof policy tated ove. Signature of Applicant/Agent: Date: ReroofPolicy_2010.doc revised 05/17/10 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: BUSINESS LICENSE# 572 � ADDRESS: ? 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 SUBC RACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. f _ I am not using any subcontractors: —7 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/ ntractor S gnature Date CITY OF • CITY OF CUPERTINO REROOF CUPERTINO PERMIT APPLICATION Q APN# 363 C S Date: o Building"q Owner's Name: .z�qv,'4 I/WeZ,;✓� ,�'p �/c� Phone #: HOA: Yes El No If yes, provide letter from HOA i65 ^ Contractor: Phone #: eK68- �� t/5w lEz_(Cr Fax#: Cupertino Elusiness License #: � Contractor Lic gxise #: Type of)Poof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof -41 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: ,( /oc3 -� `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, in Jude in plan set & the sheet index. Valuation: 6/6760 I Himd derstand and Will Comply with Cupertino's Tear-Off Policy: Signature Revised 02/05/09