11020080 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10450 LANSDALE AVE CONTRACTOR:HALLROAN AND PERMIT NO: 11020080
POWERS CONSTRUCTION
OWNER'S NAME: SHANNON O'BRYANT 6366 COMMERCE BLVD STE 175 DATE ISSUED:02/22/2011
,IER'S PHONE: 4088593638 ROHNERT PARK,CA 94925 PHONE NO:(415)846-1053
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIALE]
License Class Lic.# Z RE-ROOF 29 SQ CLASS A TEAR OFF EXISTING WOOD
SHAKES INSTALL 1/2 PLY OVER SHEATHING INSTALL
Contractor l7ii!ftit/ � Date 22 ( ASPHALT SHAKES
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:36912002.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITHIN I A S OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS LAST 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
Date:
granting of this permit. Additionally,the applicant understands and will comply Issued by:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
r // RE-ROOFS:
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 agree to remove all new materials for
inspection.
u OWNER-BUILDER DECLARATION Z /
Signature of Applic Date:
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
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 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. 1 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,Sect' 25505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this l
Owner or authorized agent:
permit is issued. ate:
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 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
mnify and keep harmless the City of Cupertino against liabilities,judgments,
,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting 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
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36912002 . 00
DATE ISSUED. . . . . . . : 02/22/2011
RECEIPT # . . . . . . . . . : BS000012751
REFERENCE ID # . . . : 11020080
SITE ADDRESS . . . . . : 10450 LANSDALE AVE
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : SHANNON O'BRYANT
ADDRESS . 10450 LANSDALE AVE
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : HALLROAN & POWERS
CONTRACTOR . . . . . . . : MICHAEL HALLROAN LIC # 32282
COMPANY . . . . . . . . . . : HALLROAN AND POWERS CONSTRUCTI
ADDRESS . . . . . . . . . . : 6366 COMMERCE BLVD STE 175
CITY/STATE/ZIP . . . : ROHNERT PARK, CA 94925
TELEPHONE . . . . . . . . : (415) 846-1053
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
1REROOFRES SQ FEET 29 . 00 377. 00 0 . 00 377 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 378 . 65 0 . 00 378 . 65 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 378 . 65 visa
---------------
TOTAL RECEIPT 378 . 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
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: 1 �� s. 1 e`' PERMIT# (�
OWNER'S NAME: PHONE# c(l J- �"
GENERAL CONTRACTOR: d,e, BUSINESS LICENSE# 4AVdSV 32,2k Z-
ADDRESS: (' CITY/ZIPCODEJ1 P. (�
*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:
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
-0—z
0 -z
Owner Contractor Signature ID to
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 10450 lansdale ave. DATE: 02/22/2011 REVIEWED BY: gs
APN: I BP#: *VALUATION: 1$6,500
xPERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD or Duplex PENTAMATION 1 SFDWLROOF
USE: P PERMIT TYPE:
WORK
SCOPE
FEE ID ROOF AREA
s.f.
1REROOFFRES 2,900
-7
T-1
FIT,
:t�! 1 ,.f7�l1 f''C'E,; ��1,t t. ��t x 1���•{�: i;i�.C'. �c,r7�tl�` '�::
1"Nmh, b.),/,
NOTE. Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addn'1 info.
FEE ITEMS (Fee Resolution 09-051 Eff.' 7i1i10) FEE QTY/FEE MISC ITEMS
1'1.111 Chcc it 1"(1,",.
S1 pp/. 1'C:'1,`c e
Phfill h, 1 lc::f`iwl Clwc k:
Permit Fee: $377.00
.Stf111>l. 11rs , 1"C",
P111tltlh I'le(h. .djC 7I}7?L
t'ltalrtfl.i:l�lc c1r.-'Iilc�c l'ti'1'ttrrt 11'<°ch
C on.ti'wllc!ion 1 t7:1" F-1
.1c°olisti",ol
Work Without Permit? 0 Yes E) No $0.00
,1-a vel 0oc'roll"wl'alioll Fccx
Strong Motion Fee: IBSEISMICR $0.65 Select an Administrative Item
Bldp Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $378.65 $0.001TOTAL FEE: 1 $378.65
Revised: 01/15/2011
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 okugertino.org
PROJECT ADDRESS j %C~v / `d.`S/f %Q /�� APN# 3 — / ^ 2-
OWNER
OWNER NAME _ /J�' PHONEt��G'Z � �/ �L E-MAIL
STREET ADDRESS J D L( Vj�,,�t l,��n CITY, STATE,ZIP�.A✓ _ w FAX
CONT CTO %M� (U�` ,Z,.�l /Grs LIC Sf�NU,I,Y16Fx,{t� LICENSE TYPE BUS.LIC.#
COMPANY. ��VL`J�D C / E-MAIL j FAX
ST E D E�Ur�M O I> vor J (( [ CITY,STATE, /Q PHONE ((� f^/{/ ( J
qt
I UNDERSTAND AND AGREE TO THE FOLLO_WIZNG: l
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 behal I understand and agree to comply with the re-roof policy state abov .
Signature of Applicant/Agent: Date: 2
ReroofPolicy_2010.doc revised 05/17/10
CrrY OF
CITY OF CUPERTINO
REROOF
CUPERTINO PERMIT APPLICATION v
!/0.2 ob U
APN .Z Date: Z
If residential, is house an Eichler? Yes ❑ No K
If yes, needs planning app oval.
Building Address:
Owner's Name: �C /„ cl 6 ,-B AA(t_ Phone #:
HOA: Yes No If yes, rovide letter from HOA
Contractor: / , Phone #: � 5. � ���r3
W*1/,.Arj 2- Fax#:
Cupertino Business License #: Contractor License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles U(- 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: _/-,-,�'Z e S � �(
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:
I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy: