10090024 CITY OF CUPERTIT40 BUILDING PERMIT
BUILDING ADDRESS: 21015 CLASSIC CT CONTRACTOR:EL CAMINO ROOFING PERMIT NO: 10090024
CO INC
NER'S NAME: BRIAN WADA 1650 S 7TH ST DATE ISSUED:09/03/2010
OWNER'S PHONE: 4084460967 SAN JOSE,CA 95112 PHONE NO:(408)292-7644
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIAL
License Class C Y Lic.# YL V -? I-2 RE-ROOF 2700 SQ FT CLASS A REMOVE 1 ROOF INSTALL
(�� �` 11 1/2 CDX 30ILB FELT
Contractor CI v-'r�� ���Aate l�� �I I�)
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:$10000
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:36218052.00 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 180 DAYS 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 FROM 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 Issued b Date:
granting of this permit. Additionally,the applicant understands and will comply y:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
� RE-ROOFS:
nature Date r�_� 1 U 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.
11OWNER-BUILDERDECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one(f y `
Signature of Applicant: Date:
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. 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 25505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this /` 3' o
Owner or authorized age nt•/ Dater
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 CONSTRUCTION LENDING AGENCY
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 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
,n the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION
.emnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,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
4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec: Twp: Rng: Sub: Blk.: Lot:
APN 36218052 . 00
DATE ISSUED. . . . . . . : 09/ 03/2010
RECEIPT #. . . . . . . . . BS( 00011382
REFERENCE ID # . . . : 10(90024
SITE ADDRESS 21015 CLASSIC CT
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER BR-.-.AN WADA
ADDRESS 21015 CLASSIC CT
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-5028
RECEIVED FROM EL CAMINO ROOFING
CONTRACTOR CASTILLO, MARK LIC # 21455
COMPANY EL CAMINO ROOFING CO INC
ADDRESS 1630 S 7TH ST
CITY/STATE/ZIP . . . : SAN JOSE, CA 95112
TELEPHONE (4 )8) 292-7644
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- - --------- ---------- ---------
1BCBSC VALUATION 10, 000 .00 1. 00 0 .00 1 . 00 0. 00
1BSEISMICR VALUATION 10, 000 . 00 1. 00 0 . 00 1. 00 0. 00
1BUSLIC FLAT RATE 1 .00 114 . 00 0 .00 114 . 00 0.00
1REROOFRES SQ FEET 27 . 00 351. 00 0 .00 351 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 467. 00 0 .00 467 . 00 0 .00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 467 . 00 13512
---------------
TOTAL RECEIPT 467. 00
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
Telephone: 408-777-3228
C U P E RT I N O Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: o15 C PERMIT#
OWNER'S NAME: PHONE#
GENERAL CONTRACTOR: (r iP — � BUSINESS LICENSE#
ADDRESS: j.� S �''� CITY/ZIPCODE: Z�
*Our municipal code requires all businesses working in th 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. ' T —��G
I am not using any subcontractors:
Si;;nature Date
Please check applicable subcontractors and compl ate 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
Sr✓ptic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPART VIENT•BUILDING DIVISION
ALBERT SALVADOR, P.E.,C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE-CUPERTINO, DA 95014-3255
CUPERTINO
(408)777-3228• FAX(408)777-3333•b aildinga(kupertino.org
A7PN
PROJECT ADDRESS `• - r
OWN
ERNAME !
r \ PHON'! E-MAIL /
t
STREET ADDRESS CITY, STA FE,ZIP FAX
CONTRACTOR NA I -�\C' LI E SEN MBEF LICfAjSE TY C BUS.LIC.#
'1 J Jl,
COMPANY NAME r E-MAIL FAX
STREET ADDRESSrCITY,STA-E,ZIP �` -� P E ZG' -
- t ` a _l
I UNDERSTAND AND AGREE TO THE FOLLOWING:
1. The re-roof project shall comply with all applicat le 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)7'7-3228 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 ar d 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 inspee:tion is required.
5. In-Progress roof inspection is required. Call f)r 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 dow i to the sheathing so a proper inspection can be
performed.
7. A final inspection and approval shall be obtainec 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 per f got 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 i e-inspection fee shall be paid before another
inspection can be scheduled.
By my signing below, I certify each of the following i� true: I am the property owner or authorized agent to act
on the property owner's beh I understand an6, gre to comply with the re-roof policy stated above.
Signature of Applicant/Agent: Date:
ReroofPo1icy_2010.doc revised 05/17/10
CITY OF
CITY OF CXPERTINO
REIZOOF
CUPERTINO PERMIT A:PPLICATION QDa�
n
APN# %3 x 2 S="-?.,(5 v Date: I T
Building Address:
Owner's Name: A Phone #:
HOA: Yes ❑ No If yes, provide lets er from HOA
Contractor: Phone #: a Z t-C Q
Fax#: Z Z,
Cupertino Business License #: Contractor License #:
1-( 2-
Type
2Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ ,Built-Up roof
❑ s halt Shingles w'Asphalt Shingles
P g
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:
Residential Commercial El
Green wilding: Please complete relevant por,.-ion of the Confirmed 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: 1 <-*)rC) <=� &
I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
Signature
Revised 02/05/09