10090224 CITY OF CUPERTIN O BUILDING PERMIT
BUILDING ADDRESS: 10354 COLBY AVE CONTRACTOR: PERMIT NO: 10090224
DETERIvfft4l!D/r
OWNER'S NAME: MCCHESNEY DOUGLAS G DA E ISSUED:09/23/2010
'NER'S PHONE: 4082534928 �l �",J , PHONE NO:
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
RE-ROOF TEAR OFF SHINGLES-LANDMARK 40 YRS CLASS
� � A,EXISTING PLYWOOD. 28 SQUARES.
License Class Lic.# J!
Contractor k--k,:5„�j 7,V11 Date
I hereby affirm that I am licensed under the provis ons 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.
Sq.Ft Floor Area: Valuation:$8000
I hereby affirm under penalty of perjury one of the following two declarations:
1. 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 APN Number:31629038.00 Occupancy Type:
performance of the work for which this permit is issued.
2. 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 Ahis,
permit is issued. 4PERMIT EXPIRES IF WORK IS NOT STARTED
APPLICANT CERTIFICATION WITHIN 180 DAYS OF PERMIT ISSUANCE OR
I certify that I have read this application and state that the above information is 180 DAYS FROM LAST CALLED INSPECTION.
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 ,,�-- Date: 7 • ��
upon the above mentioned property for inspection purposes. (We)agree to save Issued h �r
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additi nally,the applicant understands and will comply with RE-ROOFS:
all non-point source regi &i s per the Cupertino Municipal Code,Section 9.18. All roofs shall be inspected prior to any roofing material being installed.If a roof is
{ti
Date ��1 ' installed without first obtaining an inspectin,I agree to remove all new materials for
Signature_ %" �� inspection.
�
/i,Date: � �"� ,
OWNER-BUILDER DECLARATION Signature of Applicant:
I hereby affirm that I am exempt from the Contractor's License Law for one of
ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
the following two reasons:
1. 1,as owner of the property,or my employees with wages as their sole HAZARDOUS MATERIALS DISCLOSURE
compensation,will do the work,and the structure is not intended or offered for
sale(Sec.7044,Business&Professions Code) I have read the hazardous materials requirements under Chapter 6.95 of the
2. I,as owner of the property,am exclusively contracting with licensed contractors to California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
construct the project(Sec.7044,Business&Professions Code). compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Safety Code,Section 25532(a)should I store or handle hazardous material.
Additionally,should I use equipment or devices which emit hazardous air
1 hereby affirm under penalty of
ti perjury one of the following three declarations: contaminants as defined by the Bay Area Air Quality Management District I will
1. 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 maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Health&Safety Code,Sections 25505,25533,and 25534.
performance of the work for which this permit is issued. '
2. I have and will maintain Worker's Compensation Insurance,as provided for by Owner or autho�rz ant:
Section 3700 of the Labor Code,for the performance of the work for which this �ri7` 1' Date:
permit is issued.
s. I certify that in the performance of the work for which this permit is issued,I shall CONSTRUCTION LENDING AGENCY
not employ any person in any manner so as to become subject to the Worker's I hereby affirm that there is a construction lending agency for the performance of work's
Compensation laws of California. If,after making this certificate of exemption,I for which this permit is issued(Sec.3097,Civ C.)
become subject to the Worker's Compensation provisions of the Labor Code,I Lender's Name
must forthwith comply with such provisions or this permit shall be deemed
revoked. Lender's Address
APPLICANT CERTIFICATION ARCHITECT'S DECLARATION
I certify that I have read this application and state that the above information is I understand my plans shall be used as public records.
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 Licensed Professional
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
and expenses which may accrue against said City in consequence of the
L ing of this permit.Additionally,the applicant understands and will comply with
all non-point source regulations per the Cupertino Municipal Code,Section 9.18.
Signature Date
CITY OF CUPERTINO
4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: suew
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 31629038. 00
DATE ISSUED. . . . . . . : 09/23/2010
RECEIPT #. . . . . . • • • : BS000011544
REFERENCE ID # . . . : 10090224
SITE ADDRESS . . . . . : 10354 COLBY AVE
SUBDIVISION . . . . . . .
CITY CUFERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : MCCHESNEY DOUGLAS G
ADDRESS
CITY/STATE/ZIP . . . : CUFERTINO CA, 95014-2401
RECEIVED FROM . . . . : KHUHH CONG TRAN
CONTRACTOR TBI, - TO BE DETERMINED LIC # 00096
COMPANY TBE, - TO BE DETERMINED
ADDRESS
CITY/STATE/ZIP . . . :
TELEPHONE . . . . . . . .
FEE ID UNIT QUANTITY 1fMOUNT PD-TO-DT THIS REC NEW BAL
---------- -------------
---------- -- -------- --------
1BCBSC VALUATION 8, 000 .00 1. 00 0 .00 1. 00 0 .00
1BSEISMICR VALUATION 8, 000 .00 0 .80 0 .00 0 .80 0. 00
1BUSLIC FLAT RATE 1.00 114 . 00 0 . 00 114 .00 0. 00
1REROOFRES SQ FEET 28 .00 364 . 00 0 .00 364 . 00 ------0_00
- --------- -------
TOTAL PERMIT 479. 80 0 . 00 479 .80 0.00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------
CREDIT CARD 479. 80 VISA
---------------
TOTAL RECEIPT 479 . 80
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- -
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
CITY OF C-UPERTINO
FEE ESTIMATOR BUILDING DIVISION
ADDRESS: �(e DATE: REVIEWED BY:
APN: C ,�� BP#: G� G:�?�2 �- *VALUATION: 1$8,000
R*PERMITTYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY 71r ii'
FPE-NTSFDWLROOF
USE: SFD or DuplexERMIT TYPE:
WORK
SCOPE
FEE ID ROOF AREA
s.f.
1REROOFFRES 2,300
C)Fl,rf'
NOTE: These fees are based on the preliminary in ormation available and are only an estimate. Contact the De t or addn'1 info,
FEE ITEMS (Pee Resolution 09-051 Et 7,"b"1O FEE QTY/FEE MISC ITEMS
/hIn ChecA
sZ11)17f. PC f'c e
PlzrIr hl,1, 1c c17.i1:Ic�c 1'fE117 lte�a.
Permit Fee: $364.00
S1pp/. Ir1'sp
f'17zr1.11.i;llcclr.%I:It c: C nir Fcc•:
1'/11rIttl.i_1lt�c•lr.%I'?ci� 1'��rtllit I-�t°��:
C"(I77.1irli aoi7 7"n
Work Without Permit? 0 Yes E) No $0.00
1'1444.117i17<l'F C CE -
I'l-o `E'I1)t3i"Itt31<'pllUltialt
Strong Motion Fee: 1BSEISMICR 10.80 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC g 1.00
SUBTOTALS: $3E 5.80 $0.00 TOTAL FEE: $365.80
Revised: 9/22/2010
r
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPAR- MENT•BUILDING DIVISION
ALBERT SALVADOR,P.E., C.B.O., BUI-DING OFFICIAL
10300 TORRE AVENUE•CUPERTINO. CA 95014-3255
CUPERTINO
(408)777-3228 FAX(408)777-3333•building aC�.cupertino.org
_7FPROJECTS ~ /� C ] VAPN 4
- /'� n j�' /I PHOT , t 17 Z e E-MAIL
STREET ADDRESS // / C CITY, ST.+TE,ZIP �'l FAX
�/
CONTRACTOR NAME { %jrL _`/J� '.�- LICENSE NUMBE R 7C/Z� LIC/E'N'SE TYPE ] BUS.LIC.N
COMPANY NAMc � ,1�C['4 ^'.�.�YZ h6/ �- '/Y E-MAIL �'y����Z.`` tFI L�`���i, C���'j7 FAX
STREET ADDRESS
�/ CITY,ST/.TE,ZIP Clef-Z.` r-/�/ PHONE l( �� Z
I UNDERSTAND AND A�IREE 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 follow ing items will be verified:
a. Flat roofs shall have a minimum of 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 inspectic n.
c. Proper spark arrestor installation.
8. NOTE: If you call for a tear-off or plywood na ling 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 follow g i,,,true: I am the property owner or authorized agent to act
on the property owner's behalf. I and rstan an7Vre: to comply with the re-roof policy stated above.
Signature of Applicant/Agent: Date:
ReroofPolicy_201 0.doc revised 05/17/10
Cl-" OF
CITY OF ('_XPERTEN 0
REROOF
CUPERTINO PERMIT APPLICATION
APN Date: �1 j��j,7✓
Building Address: c,
C
Owner's Name: Phone 9:
HOA: Yes ❑ No If es, provide letter from HOA
Contractor: 1" Phone #:
�Y_ Fax#:
Cupertino Business License #: Contractor License #:
Type of Roof Covering:
Existing: Proposed:
u Built-Up Roof o Built-Up roof
3( Asphalt Shingles Y Asphalt Shingles A
u Wood Shakes u Wood Shakes
• Wood Shingles u Wood Shingles
• Other (Specify) u Other (Specify)
Number of existing coverings o Provide I.C.C.E.S. Report#
c3 To be Removed li a Provide Mfgr. Installation Specs.
r r
41
Job Description:
Residential Commercial
l
Green Building: Please complete relevant portion of the Con-firmed uCith-Planning Dept. if
Green Building Checklist & attach it to the application or if there are any restrictions: EI
applicable, include in plan set & the sheet index.
Valuation:
I Have Read, Und7st--Ind and Will Comply with Cupertino's Tear-Off Policy:
Signature
Revised 02/05/09