11020074 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10775 LA RODA DR CONTRACTOR:7BD--T&B- PERMIT NO: 11020074
BETERMWED
OWNER'S NAME: JAN&MARY EDBROOKE ( ) DATE ISSUED:02/18/2011
VNER'S PHONE: 4087250438 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
License Class Li,.# ipp7�Q1 r RE-ROOF 21 SQ,REMOVE SHAKE,INSTALL OSB&30YR
Contractor W L 9 c Date
COMP �Cl+k55 t r
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:$6500
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:36934036.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT i ' IF WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating W HIN 180 DAYS ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enterupon the above mentioned property for inspection purposes. (We)agree to save 180D ROM LAS�PERMIT
CALLED INSPECTION.
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 Issue by: Dater I
with all non-point source regulations per Cupertino Municipal Code,Section
9.18.
�f' � / RE-RO FS:
Signature Date /�` All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed without first obtaining an inspection,I agre remove all new materials for
inspection.
OWNER-BUILDER DECLARATION
Signature of Applicant: Date: O
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
1,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 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. I 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(a)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 emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,255533,awn 34.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: xS� 1/W Date:
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,1 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
upon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION
lemnify and keep harmless the City of Cupertino against liabilities,judgments,
:s,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
bfanting 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
CITY OF CUPERTINO
4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . . 36934036 . 00
DATE ISSUED. . . . . . . : 02/18/2011
RECEIPT #. . . . . . . . . : BS000012739
REFERENCE ID # . . . : 11020074
SITE ADDRESS . . . . . : 10775 LA RODA DR
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : JAN & MARY EDBROOKE
ADDRESS . 10775 LA RODA DR
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4443
RECEIVED FROM . . . . : STEVE WILLIAMS
CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096
COMPANY . . . . . . . . . . : TBD - TO BE DETERMINED
ADDRESS . . . . . . . . . .
CITY/STATE/ZIP . . . : ,
TELEPHONE . . . . . . . .
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 6, 500 . 00 1. 00 0 . 00 1 . 00 0. 00
1BSEISMICR VALUATION 6, 500 . 00 0. 65 0 . 00 0 . 65 0 . 00
1BUSLIC FLAT RATE 1 . 00 115. 00 0 . 00 115 . 00 0. 00
1REROOFRES SQ FEET 21 . 00 273 . 00 0 . 00 273 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 389. 65 0 . 00 389 . 65 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 389 . 65 VISA
---------------
TOTAL RECEIPT 389 . 65
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
Is 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 775— it APN#
OWNER NAME PHONEtl 6 _7Z5---c(/
']Z��(/.2 c� E-MAIL
61
STREET ADDRESS CITY, STATE,ZIP 6 J FAX
LIE I
CONTRACTOR NAME f ` j/ LICENSE NUMBER f_OTS Q/ LICENSE TYPE ^-q q BUS.LIC.#
COMPANY NAME t, /) /� E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP ,LL PHONE4Z> C/6(Id
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I UNDERSTAND AND AGREE TO THE FOLLOWING:
1. The re-roof project shall comply with all applicable provisions of the 2010 California Codes.
2. An inspection request shall be scheduled the day before the inspection date. Please call (408)777-
3228 from 7:30 - 3:30pm (Mon-Thurs) or 7:30 - 2:30pm (Friday) to schedule the next day inspection.
On the day of the inspection, a building inspector will be available within one hour for either a Tear-Off
Inspection or Nailing Inspection if you call again on that day between the hours specified.
3. The following inspections are required:
a. Tear-Off Inspection is required. Any and all dry-rotted wood shall be replaced prior to this
inspection. Unless new plywood roof sheathing is proposed throughout, all the nails/fasteners
shall be either completely knocked-down or removed prior to this inspection.
b. If plywood is installed, a plywood Nailing Inspection is required.
c. Progress Inspection is required when approximately 50% of roof covering is installed.
4. New roof coverings shall not be applied without first obtaining all inspection 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.
5. A final inspection and approval shall be obtained from the building inspector when the re-roofing is
completed. To receive a final sign-off, the following items will be verified:
a. Flat roofs shall have a minimum of I/4" per foot of slope and 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.
6. 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. I also understand that
smoke detectors and carbon monoxide detectors are reqpirFd to be installed in accordance with Sections R314 and R315 of
the 2010 California Residential C
Signature of Applicant/Agent: Date: 0 Z l
ReroofPolicy_2011.doc revised 02/16/11
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: U 775- .eon }- PERMIT# //01Z 60 711OX
OWNER'S NAME: 'i:-V'6 < PHONE# 1110 - -7 ZS_ d �'
GENERAL CONTRACTOR: BUSINESS LICENSE#
ADDRESS: q26E3 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 AL SUBCONT C ORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE. _ ell/l
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following informations
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
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 10775 la rods DATE: 02/18/2011 REVIEWED BY: bobs.
APN: BP#: "`VALUATION: 1$6,500
*PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD or Duplex PENTAMATION
USE: PERMIT TYPE: 1 SFDWLROO;
WORK
SCOPE
FEE ID ROOF AREA
s.f.
1 REROOFFRES 2,100
T_
t,(:11, M"n-,Ch"
i.'r;
F-1 L_
Li I
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 Resolution 09-051 E�E 7,-1"10) FEE QTY/FEE MISC ITEMS
Plata (heel ""(v:
slfpr,'l. PC 1'_c>c
F 'A
I t1Z117tf7.:�1 `t't7. 7:�C't 1'101 { (;ESE 1i.
Permit Fee: $273.00
P/11 ad) I f I7.:F,ict. Ullir 1,'0:%
F'ltrrnh.,'a 1e�t°1t.-T'lec Permit /-,cc:
C"ottso-11 'lion Tn
Work Without Permit? 0 Yes E) No $0.00
Troic'11)o tftl'rtt 1101tf)ii
Strong?Motion Fee: IBSEISMICR $0.65 Select an Administrative Item
Bldg;Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $274.65 $0.00 TOTAL FEE:T $274.65
Revised: 01/15/2011
CITY OF
Mf" 111611M
CITY OF CUPERTINO
REROOF
CUPERTIN0 PERMIT APPLICATION
APN# Date:
If residential, is house an Eichler? Yes ❑ No n If yes, needs planning approval.
Building Address:
0 7 ,;7-5—' Z_,T /2-c JPO--- C�P—
Owner's Name:f)02-L, Phone #:
HOA: Yes ❑ No If es, provide letter from HOA 616� - ?2--5 — O V 9 8
Contractor: c,F'r,� Phone #: _5-/c __ Z —y,(
Z
Fax #:
Cupertino Business License #: Contractor License #-
6873� /
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ;z:' Asphalt Shingles
r� 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:
?QWu-
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:
Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy: