10110027 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 1139 ELMSFORD DR CONTRACTOR:WOODS ROOFING PERMIT NO: 10110027
OWNER'S NAME: tRIC LEE 17700 SERENE DR DATE ISSUED: 11/04/2010
'ER'S PHONE: 4089739799 MORGAN HILL,CA 95037 PHONE NO:(831)637-5576
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG F ELECT F PLUMB r
License Class G �7 Z Li,# '� 2.,5'13 /
MECH r— RESIDENTIAL r— COMMERCIAL r
Contractor , I+t�c' Date 11 4 /to
I hereby affirm that I am licensed under he provisions of Chapter 9 JOB DESCRIPTION:RE-ROOF TEAR-OFF EXISTING SHAKE RESHEET W/OSB
(commencing with Section 7000)of Division 3 of the Business&Professions 2 30#FELT,SOYR DIMENSIONAL COMP CLASS A
Code and that my license is in full force and effect. 29STALL SQ
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:$11600
permit is issued.
APPLICANT CERTIFICATION APN Number:36208015.00 Occupancy Type:
I certify that I have read this application and state that the above information
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 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source tions per the Cupertino Municipal Code,Section
9.18.
l Issued by- Date:(`-�- l d
Signature ate
L, OWNER-BUILDER DECLARATION
RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is
the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
I,as owner of the property,or my employees with wages as their sole compensation, inspection.
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code) Signature of Applicant: Date:
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. I 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,I shall maintain 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 Worker'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 Owner or orize agent:
forthwith comply with such provisions or this permit shall be deemed revoked.
STRUCTION LENDING AGENCY
APPLICANT CERTIFICATION ffi
I certify that I have read this application and state that the above information is I hereby aat 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
-mify 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
gra,.-.ing 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. I understand my plans shall be used as public records.
Signature Date Licensed Professional
loL � vv �-I
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 1139 elmsford dr. DATE: 11/04/2010 REVIEWED BY:
APN: BP#: *VALUATION: 1$11,600
*PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARYSFD or Duplex PENTAMATION 1SFDWLR00F
USE: P ��r th l�� �� : PERMIT TYPE:
WORK
SCOPE
FEE ID ROOF AREA
s.f.
1 REROOFFRES 2,900
LiC)th i 1Frr,"lr. Ir,'s�=> t1,1 t>,, I•i°_�> �1�,';Er '<<c'_1r,sl'"
NOTE. Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addh7 info,
FEE ITEMS (free Resolution 09-051 Ef 7%7.%10) FEE QTY/FEE MISC ITEMS
r5upp/. I,('
P1tr,rr�'7.i:�lc�c It.'IIct"f'lrrrr C.7�e<;I�:
Permit Fee: $377.00
Srtpp/, 111sl) 11v
Pl11111h."11cch "IIIc=c ( f7It FCC.'
/�'/trrrtla./��fc�clt.:`l_le c 1'tra",�rtrr 1='c>ce:
Work Without Permit? 0 Yes 0 No $0.00
Ii-urel Dtx�rrrrrCr�rfcrtir�,2 1�`Crc�.�°: �
Strong Motion Fee: IBSEISMICR $1.16 Select an Administrative Item
Bldg;Stds Commission Fee: 1BCBSC $1.00
SUBTOTALS: $379.16 $0.00 TOTAL FEE: $379.16
Revised: 10/17/2010
CITY OF CUPERTINO
3 ITEMS OF 10 PERMIT RECEIPT OPERATOR: patg
COPY ## 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36208015 .00
DATE ISSUED. . . . . . . : 11/04/2010
RECEIPT #. . . . . . . . . : BS000011919
REFERENCE ID # . . . : 10110027
SITE ADDRESS . . . . . : 1139 ELMSFORD DR
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . . ERIC LEE
ADDRESS . . . . . . . . . . : 1139 ELMSFORD DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : JEFF RAINEY
CONTRACTOR . . . . . . . : WOOD, LAWRENCE E LIC # 20810
COMPANY . . . . . . . . . . : WOODS ROOFING
ADDRESS . . . . . . . . . . : 17700 SERENE DR
CITY/STATE/ZIP . . . : MORGAN HILL, CA 95037
TELEPHONE . . . . . . . . : (831) 637-5576
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 11, 600 . 00 1. 00 0 .00 1. 00 0 . 00
1BSEISMICR VALUATION 11, 600 . 00 1.16 0. 00 1. 16 0 .00
1REROOFRES SQ FEET 29. 00 377 .00 0. 00 377. 00 0 .00
---------- ---------- ---------- ----------
TOTAL PERMIT 379 .16 0 .00 379.16 0 . 00
VOICE IDDESCRIPTION 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
CUPERTINO 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228• FAX(408)777-3333•building0kupertino.org
PROJECT ADDRESS � �� Q /� JA � � �(� APN#
OWNER NAME _I PHO lj E G 7q 0 E-MAIL
'
STREET ADDRESS (� CITY, STATE,ZIP FAX
CONTRACTOR NAME / y Q>(, LICENSEE NUMBER LICENSEE TYPE BUS.LIC.#
1
COMPANY NAME C , ` ) E-MAIL FAN0 -77 2-0
STREET ADDRESS T� 7 ,� i f- /V CITv T TF 71P PH NE , ,.
77U`V ji✓'RL tit i iz. CMZ(_,4,j H I c'(_ 0 ��C u�
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 I/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.
.y 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. nderstand and agree to comply with the re-roof policy stated above.
Signature of Applicant/Agent: Date: ( I a
ReroofPolicy_2010.doc revised 05/17/10
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: 408-777-3228
CU PERTI NO Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: I 0�' Cl ec'y l 5 FZJZ—p /Z PERMIT#
OWNER'S NAME: e�-(tl G PHONE # -'U • 7
GENERAL CONTRACTOR: C9z)V/5 BUSINESS LICENSE#
ADDRESS: t 20 "Z CAJE7 CITY/ZIPCODE: M c-'- i
*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 SU CONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
ignatu Date
Please check applicable subcontractors and comp a 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
to
F O n Contr or Signature Date
4
INPUT Resources Energy IAQIHealth
M.Indoor Air Cluality and Finishes
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 Particleboard or MDF 4 IAQ/Health pts y=yes 0
8.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 0
10.Install Whole House Vacuum System 3 IAQ/Health pts y=yes 11io
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
I 1 1
Total Points Available: 1401 130 57
Total Points Project Received: 01 01 0
( I f g I I c)
G:data/progs/greenbuildingguidelines/remodelers/green pointsfinal2.12.04protected.xls
CI Y OF
CITY OF CUPERTINO
its REROOF
CUPERTINO PERMIT APPLICATION
APN# 3 ('0eg
�� Date: ,1
C/ y N)
Building Address:
1 I'5CLvM 5 F�Az-,7 ,Z-
Owner's Name: L Lr E Phone #:
HOA: Yes1 o g - cf 13 - 7 7
❑ No 0 If es provide letter from HOA `
77
Contractor: Phone #:
WOOD'S ROOFING 408-605-5115
Fax #: 408-267-9999
Cupertino Business License #: Contractor License #:
325131
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
P Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) k Other(Specify) SyK, 66NO
Number of existing coverings O'yC ❑ Provide I.C.C.E.S. Report#
To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description: °f e--/02 _6 t Cj S'T,A)�1 S(�,� � 2-t�-S�t�- � tjl OSS
2`1 S<j ✓�� G���s/1_
Residentialx❑ 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: A 111 r
I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
Signature
Revised 02/05/09