10080222 CITY OF CUPERTINO BUILDING PERMIT
WILDING ADDRESS: 11129 CLARKSTON AVE CONTRACTOR:CUPERTINO ROOF,INC PERMIT NO: 10080222
)WNER'S NAME: BILL WILSON 1052 KEI LY DR DATE ISSUED:08/30/2010
NER'S PHONE: 4083093956 SAN JOSE,CA 95129 PHONE NO:(408)973-9427
LICENSED CONTRACTOR'S DECLARATION r r— r
(:V,5
__ l / BUILDTYG PERMIT INFO: BLDG ELECT PLUMB
3 l
.icense Class �-
'1 Lic.# �S '7 3
MECH r- r-r- COMMERCIAL�
:ontractor C L'�' � ) c/ C� Date r 3y—Z`� v
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hereby affirm that I am licensed unde a provisions of Chapter 9 JOB DE 3CRIPTION: RE-ROOF TEAR OFF SHAKE INSTALL 50YR SHINGLES
commencing with Section 7000)of Division 3 of the Business&Professions CLASS
,ode and that my license is in full force and effect. A 38SQ
hereby affirm under penalty of perjury one of the following two declarations:
have and will maintain a certificate of consent to self-insure for Worker's
,ompensation,as provided for by Section 3700 of the Labor Code,for the
)erformance of the work for which this permit is issued.
have and will maintain Worker's Compensation Insurance,as provided for by
>ection 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area: Valuation:$13000
wrmit is issued.
APPLICANT CERTIFICATION APN Number:35620056.00 Occupancy Type:
certify that I have read this application and state that the above information is
:orrect.I agree to comply with all city and county ordinances and state laws relating
o building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save PEI:MIT EXPIRES IF WORK IS NOT STARTED
ndemnify and keep harmless the City of Cupertino against liabilities,judgments,
*sts,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
,ranting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all - int source regulations per the Cupertino Municipal Code,Section
1.18.
o Issued b� Date: 4f 2c—to
>ignature Date
OWNER-BUILDER DECLARATION
RE-ROOFS:
[hereby affirm that I am exempt from the Contractor's License Law for one of All roofs:hall be inspected prior to any roofing material being installed.If a roof is
he following two reasons: installed without fi ng an inspection,I agree to remove all new materials for
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,
3usiness&Professions Code) Signature 3f Applicant: Date:
as owner of the property,am exclusively contracting with licensed contractors to
;onstmct 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
leclarations: HAZARDOUS MATERIALS DISCLOSURE
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 res.d the hazardous materials requirements under Chapter 6.95 of the
)erformance of the work for which this permit is issued. Californi;u Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
have and will maintain Worker's Compensation Insurance,as provided for by complian.e with the Cupertino Municipal Code,Chapter 9.12 and the Health&
3ection 3700 of the Labor Code,for the performance of the work for which this Safety Ca de,Section 25532(a)should I store or handle hazardous material.
Additions.11y,should I use equipment or devices which emit hazardous air
)ernit is issued. contamin ants 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
iot 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
)ecome subject to the Worker's Compensation provisions of the Labor Code,I must Owner uthor' d agent: S ZO 1 V
Forthwith comply with such provisions or this permit shall be deemed revoked. Date:
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
f certify that I have read this application and state that the above information is I hereby a ffirm that there is a construction lending agency for the performance of work's
,orrect.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.)
:o building construction,and hereby authorize representatives of this city to enter Lender's Name
ipon the above mentioned property for inspection purposes.(We)agree to save
-'-mnify 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
pwiting 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
I.18. I understa ad my plans shall be used as public records.
signature Date Licensed Professional
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 35620056 .00
DATE ISSUED. . . . . . . : 08/30/20L0
RECEIPT #. . . . . . . . . BS000011335
REFERENCE ID # . . . : 10080222
SITE ADDRESS . . . . . : 11129 CLARKSTON AVE
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : BILL WIL3ON
ADDRESS . . . . . . . . . . : 11129 CLARKSTON AVE
CITY/STATE/ZIP . . . : CUPERTIND, CA 95014
RECEIVED FROM . . . . : DAVE SMITH
CONTRACTOR . . . . . . . : DAVE SMITH LIC # 25701
COMPANY CUPERTIND ROOF, INC
ADDRESS 1052 KELLY DR
CITY/STATE/ZIP . . . : SAN JOSE, CA 95129
TELEPHONE (408) 973-9427
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 13, 000 . 00 1 .00 0. 00 1 .00 0. 00
1BSEISMICR VALUATION 13, 000 . 00 1 .30 0 .00 1.30 0 .00
1REROOFRES SQ FEET 38. 00 494 .00 0 .00 494 . 00 0 .00
---------- ---------- ---------- ----------
TOTAL PERMIT 496 .30 0. 00 496.30 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 496 .30 MC
---------------
TOTAL RECEIPT 496 .30
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
CITY OF
CITY OF CUPI:RTINO
REROO E' --
CUPERTINO PERMIT APPLICATION
APN# .- Date:
Building Address:
Owner's Name: Phone #:
HOA: Yes ❑ No ❑ If yes, provide letter froni HOA
Contractor: Phone #: <1
Fax#:
Cupertino Business License #: Contractor License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof c-i Built-Up roof
❑ Asphalt Shingles i Asphalt Shingles
Wood Shakes u Wood Shakes
❑ Wood Shingles ci Wood Shingles
❑ Other (Specify) Li Other (Specify)
Number of existing coverings Ej Provide I.C.C.E.S. Report#
❑ To be Removed a Provide Mfgr. Installation Specs.
Job Description:
s
Residen is Commercial
Green Building: Please complete relevant portion of I he 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:
Cc
Ive Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
Sign e
Revised 02/05/09
� x
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: DATE: REVIEWED BY:
APN: BP#: VALUATION: 11si3,000
*PERMIT TYPE: Minor Building Permit PLAN CHEC K TYPE: Re-roof
PRIMARY /7 i7: . PENTAMATION 1SFDWLR00F
USE: SFD or Duplex F;(�,,!, 1 R(:,I: PERMIT TYPE:
WORK
SCOPE
FEE ID ROOF AREA
s.f.
1REROOFFRES 3,800
N� P G
Ry IW
re F+, {'�0'r
rrr I'kra Cho k Pl{atrh. Phar (-'h( A L/c°c:. Ply;,»Check
Pi, w). I hJcr 11"i ma Po,
01),wr Numb lrtcl, Ut;car �7cr_
P/1111{1). hz�/,. t c- F-F-l-,
� L lcc-Jn.vr, P,:".
NOTE: These fees are based on the prelindnary in ormation available.ind are onl an estimate. Contact the De t or addh 7 info.
FEE ITEMS(F'ee Resolution 09-051 E[f. 7,%1;70) FEE Q'rY/FEE MISC ITEMS
P/,m CheCk h ec'
.1ti.1"N' PC f'cc
f'l11n1h.'11",Ih.i1lcc Punt < llcc:k:
Permit Fee: $494.00
st.tplrl. 111sp Fcc
f'ltuTth. �11ec;t. 'Iles l;rtit f��i�c:
I'Itn}th.=:�lech.iLsLc Perntii Fc°c.
�,trs��rrtc�tiurt Kt_V
Work Without Permit? 0 Yes (E) No $0.00
l'lctrutirt,�lF�cc�c:
Travel 0octmientaliort Fees:
Strong,Motion Fee: IBSEISMICR $1.30 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
"a t
.f t t *fit a a iv,
$496.30 $0.00 °Qza $496.30
Revised: 8/17/2010
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
C U P E RT I N O 10300 TORRE AVENUE-CUPERTINO, CA 95014-3255
(408)777-3228-FAX(408)777-3333-buildin Qcupertino.orq
PROJECT ADDRESS ' ( 2 O ) WN#
OWNER NAME i � -�1 � ��� PHONE �D Q ^���) E-MAIL
STREET ADDRESS j It1 i` <, ] CITY, STATE,ZIP 7 I r 'ILV.� FAX
CONTRACTOR NAM�^� 1Q4 LICENSE NUMBEt,,,. LICENSTYPE BUS.LIC#
COMPANY NAME { )�(JZ' S 1! E-MAIL /`e'1_ `� FAX
STREET ADDRESS i (/ 1 CITY,S PHONE Q �`
I UNDERSTAND AND AGREE 'rO THE FOLLOWING:
1. The re-roof project shall comply with all applicable pro),isions of the 2007 California Building Code.
2. You must schedule all needed inspections a minimum o'one day before the requested inspection date.
Please schedule inspections online or call (408)777-3223 between 7:30-3:30 (Mon-Fri).
3. Tear-off roof inspection is required. Please call for te?r-off inspection after the roof is torn off and all
the nails/fasteners have been removed. Any and all dly-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 obi aining all inspections and written approvals
from the building inspector. Any roofing which is appli,;d 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 iterr s 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-inanufactured 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-inspe(tion 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. I understand and agree to comply with the re-roof policy stated above.
Signature of Applicant/Agent: Date:
ReroofPolicy_2010.doc revised 05/17/10
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: <f 41..-,1 'S'4qfJ PERMIT# 0v Z
OWNER'S NAME: It-o pvJ PHONE#
GENERAL CONTRACTOR: BUSINESS LICENSE#
ADDRESS: ) 0 Z �d l CITY/ZIPCODE:
*Our municipal code requires Ill businesses working in the citi to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AN LL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE. ?
I am not using any subcontractors: Yj" G Z o > D
Signature Date
Please check applicable subcontractors 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
� - Sy - 2crD
Owner/Contractor Signature Date