10110066 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21884 OAKVIEW LN CONTRACTOR:PRESIDENTIAL ROOFING PERMIT NO: 10110066
OWNER'S NAME: MILLER MATTHEW R 1868 ENESCO AVE DATE ISSUED: 11/10/2010
IER'S PHONE: 4082524898 SAN JOSE,CA 95122 PHONE NO:(408)717-3493
❑ LICENSED CONTRACTOR'S DECLARATION r F
�y BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class — Lic.# G �-7 0�,
` / ,/1,0,�� MECH RESIDENTIAL COMMERCIAL
Contractor ✓ems `N �( `�" D� l gO'—/d ID
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:RE-ROOF TEAR OFF ASPHALT SHINGLES INSTALL NEW
(commencing with Section 7000)of Division 3 of the Business&Professions 30YR
ASPHALT CLASS A 27SQ
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
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$10568
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is APN Number:32619106.00 Occupancy Type:
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
indemnify and keep harmless the City of Cupertino against liabilities,judgments, PERMIT EXPIRES IF WORK IS NOT STARTED
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR
with all non-point source regulations per the Cupertino Municipal Code,Section 180 D S FROM L T CALLED INSPECTION.
9.18.
Signature Date A7 Issued by: Date:
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS:
the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
1,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I agree to remove all new materials for
will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection.
Business&Professions Code) /
I,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: C Date:
construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE
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 read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
Section 3700 of the Labor Code,for the performance of the work for which this compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Safety Code,Section 25532(a)should I store or handle hazardous material.
permit is issued. Additionally,should I use equipment or devices which emit hazardous air
I certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District I will
not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Compensation laws of California. If,after making this certificate of exemption,I Health&Safety Code,Sections 25505,25533,and 25534.
become subject to the Worker's Compensation provisions of the Labor Code,I must
forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent:
Date:
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
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 I hereby affirm that there is a construction lending agency for the performance of work's
to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.)
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name
ira-mnify and keep harmless the City of Cupertino against liabilities,judgments,
and expenses which may accrue against said City in consequence of the Lender's Address
g. ,ting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION
9.18.
I understand my plans shall be used as public records.
Signature Date
Licensed Professional
CITY OF CUPERTINO
3 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Elk: Lot:
APN . . . . . . . . : 32619106 . 00
DATE ISSUED. . . . . . . : 11/10/2010
RECEIPT #. . . . . . . . . : BS000011969
REFERENCE ID # . . . : 10110066
SITE ADDRESS . . . . . : 21884 OAKVIEW LN
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : MILLER MATTHEW R
ADDRESS . . . . . . . . . . : 21884 OAKVIEW LN
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-1146
RECEIVED FROM . . . . : PRESIDENTIAL ROOFIN
CONTRACTOR . . . . . . . : ALONSO LOPEZ LIC # 31235
COMPANY . . . . . . . . . . : PRESIDENTIAL ROOFING
ADDRESS . . . . . . . . . . : 1868 ENESCO AVE
CITY/STATE/ZIP . . . : SAN JOSE, CA 95122
TELEPHONE (408) 717-3493
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 10, 568 . 00 1 .00 0 .00 1. 00 0 . 00
1BSEISMICR VALUATION 10, 568. 00 1 .06 0 .00 1. 06 0 . 00
1REROOFRES SQ FEET 27. 00 351 .00 0. 00 351. 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 353 .06 0. 00 353 . 06 0 .00
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
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 21884 oakview In DATE: REVIEWED BY:
APN: BP#: *VALUATION: 1$10,568
*PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD or Duplex ' f PENTAMATION 1 SFDWLROOF
USE: 4.�,E.;�',` ., PERMIT TYPE:
WORK re-roof 27s
SCOPE
FEE ID ROOF AREA
s.t:
1REROOFFRES 2,700
1/oh 1'hw t h t
F1,17 P"i M"`l`E
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 Eff: 7/1/10) FEE QTY/FEE MISC ITEMS
Ilan C he c, Fc
Scrppl, PC`Fc'
F'ltrr�tl�.%"11E>£•t1./I�1c'�� F'1�,�, {,';rrcc�lc
Permit Fee: $351.00
St d pp/. 17,4:3 I'is c
P111 lh-'1lcc hl `]Jcc C-'fdl C£°
1 lu�7rl>.._11c ch -'lJcc°1,crwit Fc,",
t 0l 'L
do ollstic,"ll R,,vicw Fcc
Work Without Permit? 0 Yes G No $0.00
Planoi?th f`CCS
Strong Motion Fee: IBSEISMICR $1.06 Select an Administrative Item
Bldg;Stds Conunission Fee: IBCBSC $1.00
SUBTOTALS: $353.061 $0.00 TOTAL FEE.-T $353.06
Revised: 11/08/2010
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(cDcupertino.org
PROJECT ADDRESS t �`��. ( 1 - _ APN#
OWNER NAME y V `••/ PHONE y E-MAIL
STREET ADDRESS CITY, STATE,ZIP FAX
4.
144
CONTRACTOR NAME LICENSE NUMR LICENSE TYPE BUS.LIC#
0 WF-70
L
COMPANY NAME /Z; 1 / (� E-MAIL
STREET ADDRESS,9
Lz- 1 CITY,STA ,ZIP ^ _ PHONEE�
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/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. understand and agree to comply with the re-roof policy stated above.
Signature of Applicant/Agent: Date: y
ReroofPolicy_2010.doc revised 05/17/10
'ITY OF
CITY OF CUPERTINO
REROOF
CUPERTINO PERMIT APPLICATION
APN# Date:
Building Address: .
Z ,'� �.✓ A�
Owner's Name: f, zCJ ( � r Phone #:
HOA: Yes ❑ No ❑ If Yes, provide letter from HOA 2 S"-Z —C)'&
Contractor: Phone -+II-3 V 13
Pr c-5 cl -c..-- i g_eo r� Fax 4CP "2-�--7 'Z7-
Cupertino Business License #: Contractor License #:
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 Mfg. Installation Specs.
Job Description: .� v � r Ln a
'_3E
Residential Commercial
Green Building: Please complete relevant portion of the Corf.rmed 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:
Iq L�7�� �
Signature
Revised 02/05/09