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10090049 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7572 BOLLINGER RD CONTRACTOR:FFF ROOFING SPECIALIST PERMIT NO: 10090049 OVPNER'S NAME: STEVE REN 657 GAUNDABERT LN DATE ISSUED:09/08/2010 NER'S PHONE: 4082539380 SAN JOSE,CA 95136 PHONE NO:(408)365-0553 ❑ LICENSED CONTRACTOR'S DECLARATION r r— r C BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class C 3 Lie.# d* �3S© 3 MECH r RESIDENTIAL [_ COMMERCIAL ContractorGr�aC+• c Date es Z (G I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: RE-ROOF TEAR OFF EXISTING WOOD SHAKE ROOF (commencing with Section 7000)of Division 3 of the Business&Professions INSTALL ONE LAYER#30LBS FELT UNDERLAYMENT&LIGHTWEIGHT Code and that my license is in full force and effect. EAGLE CONCRETE TILE CLASS A 29SQ 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:$16000 APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is APN Number:35922047.00 Occupancy Type: correct.I agree to comply with all city and county ordinances and state laws relatin; 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 DAYS OF PERMIT ISSUANCE OR with all non-po' urce regulations per the Cupertino Municipal Code,Section 180 DA OM LAST CALLED INSPECTION. 9.18. Signature Date4�_0 Issued by: Date: Li OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one(f RE-ROOFS: the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is I,as owner of the property,or my employees with wages as their sole compensatioi u, installed without first obtai ' 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 roe am exclusive) contracting with licensed contractors to Signature of Applic t: / Date: property,m', Y g 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 California Health&Safety Code,Sections 25505,25533,and 25534. 1 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. 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 mu;t forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: !v Dater APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that 1 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 relatir g 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 -►nify 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 granting of this permit.Additionally,the applicant understands and will comply with all non rce regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION 9.18. I understand my plans shall be used as public records. Signature--poin, Date "Q/d Licensed Professional CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: Blk : Lot: APN 35922047 .00 DATE ISSUED. . . . . . . : 09/08/2010 RECEIPT #. . . . . . . . . BSC00011407 REFERENCE ID # 10( 90049 SITE ADDRESS . . . . . : 75"2 BOLLINGER RD SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER STEVE REN ADDRESS . 7572 BOLLINGER RD CITY/STATE/ZIP CU?ERTINO, CA 95014 RECEIVED FROM . . . . : FR.%NKROOFING CAMOLINGA L LIC # 28519 CONTRACTOR . . . . . . . COMPANY FFF ROOFING SPECIALIST ADDRESS 657 GAUNDABERT LN CITY/STATE/ZIP SAV JOSE, CA 95136 TELEPHONE . . . . . . . . : (408) 365-0553 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC --NEW-BAL- ---------- ____ ---------- ----- 1BCBSC VALUATION 16, 000 . 00 1 .00 0 .00 1. 00 0 .00 1BSEISMICR VALUATION 16, 000. 00 1 .60 0 .00 1. 60 0 .00 1REROOFRES SQ FEET 29. 00 377 . 00 ---- 377. 00 ------0_00 - --------- ---------- ---------- TOTAL PERMIT : 379.60 0.00 379 .60 0 .00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- -- --------------- ---- CREDIT CARD 379 .60 VISA --------------- TOTAL RECEIPT 379.60 VOICE ID DESCRIPTION VOICE ID -------DESCRIPTION ----- _ - ------ - ----------- - -- ---------- ___ 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 ELI] Telephone: 408-777-3228 CUPERTINO Fax: 408-777-3333 CONTRACTOR/ �;UBCONTRACTOR LIST JOB ADDRESS: PERMIT# OWNER'S NAME: ,,► PHONE# L p�- 3(K 6-S L GENERAL CONTRACTOR: BUSINESS LICENSE # ADDRESS: 1-r/ 'e 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 OCC, NC's' INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SU CONTRACTORS H VE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: ;signature Date Please check applicable subcon ractors and complete the following information: 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 Z'/0 Owner/Contractor Signature Date v REROOF TEAR-OFF POLICY COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BU LDING OFFICIAL 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228•FAX(408)777-3333• building a(�cupertino.orq FOWNERNAME S b ,, 7APN 11 � '/ PHO JE E-MAIL r STREET ADDRESS CITY, Sl ATE,ZI� FAX 6411 CONTRACTOR NAME #LICE :R LICENSE TYPE BUS.LIC.# COMPANY NAME FAX sine STREET ADDRESS NJ NTE,ZIPPHONE 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 min mum of one day before the requested inspection date. Please schedule inspections online or call (408);77-3228 between 7:30-3:30 (Mon-Fri). 3. Tear-off roof inspection is required. Please cell 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 whicl- 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 foi 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 nE iling 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, Iacerfif)eaLchofhe follo ing istrue: I am the property owner or authorized agent to act on the property owner' stand agree to comply with the re-roof policy stated above. Signature of Applicant/Age Date: a RerooJPolicy_20 10.doc revised 05/17/10 CITY OF CITY OF C'UPERTINO REI:OOF CUPERTINO PERMIT APPLICATION APN# �� r Date: Building Address.: 2 O F er's Name: Phone #: L-Lo� 253 -q3 d `DA e_�j C HOA: Yes ❑ No �f yes, provide letter from HOA Phone #: "o%o� -316 S s o`k Contractor: T_T Otos c `�S� Fax#: ti�or6 6s a5 Fax Cupertino Business License #: Contractor License #: g 50C;�3 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) W + T''C Number of existing coverings ❑ Provide I.C.C.E.S. eport# ❑ To be Removed ❑ Provide Mfgr. Installation Specs. Job Description: �,c o a a t-0 r e, Residential ommercial ❑ Green Building: Please complete relevant porl:ion of the Con.frmed with Planning Dept. if Green Building Checklist & attach it to the ap plication or if there are any restrictions: ❑ applicable, include in plan set & the sheet index. Valuation: ) 0-t-(L I Have R. Understand and Will Comply with Cupertino's Tear-Off Policy: 5Wa-lure Revised 02/05/09