10080196 CITY OF CUPERTINO BUILDING PERMIT
WILDING ADDRESS: 10197 COLBY AVE CONTRACTOR:BAY 101 ROOFING PERMIT NO: 10080196
)WNER'S NAME: PETER ANZELLOTTI PO BOX 1125 DATE ISSUED:08/26/2010
YER'S PHONE: 4082528254 ALVISO,CA 95002 PHONE NO:(408)957-0531
] LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r— ELECT r PLUMB r
.icense Class <--,3 L,i�c.#,tel /r� l/ MECH r RESIDENTIAL I— COMMERCIAL
/� r
;ontractor &A /" 6) 1�tt Date _'A
hereby affirm that I am licensed under the provisions of Chapter 9 JOB DE.iCRIPTION:RE-ROOF TEAR OFF TWO LAYERS COMP PUT ON OSB
commencing with Section 7000)of Division 3 of the Business&Professions BOARD
7/16 PUT 1>N 30 LB FELT&40YR SHINGLES COMP 33SQ
'ode and that my license is in full force and effect. CLASS A
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
lection 3700 of the Labor Code,for the performance of the work for which this
Sq.Ft FI(or Area: Valuation:$11730
)ermit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is APN Nun fiber:31628042.00 Occupancy Type:
;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
indemnify and keep harmless the City of Cupertino against liabilities,judgments, PERMIT EXPIRES IF WORK IS NOT STARTED
;osts,and expenses which may accrue against said City in consequence of the
granting of this permit. Ad ition y,the licant understands and will comply WITHIN AYS OF PERMIT ISSUANCE OR
with all non-point sou a la' ns per Cupertino Municipal Code,Section 180 DAY M LAST CALLED INSPECTION.
M8. ,(
Date J r C� Date:
Signature v "_ Issued by:
L, 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;hall 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,vithout first obtaining an' spec- n, ee to remove all new materials for
will do the work,and the structure is not intended or offered for sale(Sec.7044, inspectioi i.
Business&Professions Code) Qj r1�j–I 0
I,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: 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 r(ad the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain Worker's Compensation Insurance,as provided for by Californ a Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
Section 3700 of the Labor Code,for the performance of the work for which this compliai ice with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Safety C ode,Section.25532(a)should I store or handle hazardous material.
permit is issued. Additior ally,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 contamiitants 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 maintaii compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Compensation laws of California. If,after making this certificate of exemption,I Health 4:Safe Code,Sections 25505,25533,and 25534.
become subject to the Worker's Compensation provisions of the Labor Code,I must
Owner c r an t riz a �
forthwith comply with such provisions or this permit shall be deemed revoked. Date:
r
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 i this permit is issued(Sec.3097,Civ C.)
upon the above mentioned property for inspection purposes.(We)agree to save Lender';Name
'unify and keep harmless the City of Cupertino against liabilities,judgments,
,and expenses which may accrue against said City in consequence of the Lender';Address
granting 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 undersi and my plans shall be used as public records.
Signature Date
License 1 Professional
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 31628042 .00
DATE ISSUED. . . . . . . : 08/26/2010
RECEIPT #. . . . . . . . . BS000011304
REFERENCE ID # . . . : 10080196
SITE ADDRESS . . . . . : 10197 COLBY AVE
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : PETER ANZELLOTTI
ADDRESS 10197 CCLBY AVE
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : BAY 101 ROOFING INC
CONTRACTOR JOSE RAYIREZ LIC # 30420
COMPANY BAY 101 ROOFING
ADDRESS PO BOX 925
CITY/STATE/ZIP . . . : ALVISO, CA 95002
TELEPHONE . . . . . . . . : (408) 957-0531
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ------- --- ---------- ---------- ----------
1BCBSC VALUATION 11, 730 . 00 3 . 00 0. 00 1. 00 0 .00
1BSEISMICR VALUATION 11, 730. 00 3 .20 0 .00 1.20 0. 00
1REROOFRES SQ FEET 33 . 00 425 . 00 0 .00 429. 00 0 .00
------- --- ---------- ---------- ----------
TOTAL PERMIT 433 .20 0 .00 431.20 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- ---- ----------------
CREDIT CARD 431.20 VISI.
---------------
TOTAL RECEIPT 431 .20
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- - ------- ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
CITY OF n
1[0 CITY OF CUPE'R
TINO �J 1
REROOF
CUPERTINO PERMIT APPLICATION
APN# Date:
Building Address:
o z—
Owner s Name: Phone #:
A/JZ Ems, u0 7-7-1
HOA: Yes ❑ No ❑ If yes, provide letter from HOA 4/0 Z
Contractor: Phone #:
Aja 9,10 lI c �
A J�IFax#:
upertino Business License #: Contractor License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof i:j Built-Up roof
Asphalt Shingles 7�Asphalt Shingles
❑ Wood Shakes :i Wood Shakes
❑ Wood Shingles :i Wood Shingles
❑ Other (Specify) :i Other (Specify)
Number of existing coverings :i Provide I.C.C.E.S. Report#
To be Removed :j Provide Mfgr. Installation Specs.
Job Description: -7-,F Q ` Q ,/�t jj � S
PD 011-1 c° FXE6%
Residential IK
- Commercial
Green Building: Please complete relevant portion of the 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.
Valuatio
I Have Read, Understand and Will C pl with ertino's Tear-Off Policy:
Signature
Revised 02/05/09
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: DATE REVIEWED BY:
APN:
BP#: 'VALUATION: $11,730
*PERMIT TYPE: Minor Building Permit PLAN CHECK:TYPE: Re-roof
PRIMARY 7'1)7:91. ___7j
PENTAMATION 1SFDWLR00F
USE: SFD or Duplex ,-Z.00/R,11N."I. PERMIT TYPE:
WORK
SCOPE
FEE ID ROOF AREA
s.f.
1REROOFFRES 3,300
i k
PL,nth. Plan (hr<1, EIe,'. r'hrn Che'rlc
IYrn :I I c,: Plurral? P::'r;nit l;'c
lJther Plural,ircc Utlrcr E'1't'c_ Irrsp.
Onc,-r:19r G� Ltry�- 1'
.11,•x1, Ljlrr,t�. h:'<' 1'hrnrh. juxp. Pc..
NOTE: These fees are based on the preliminary information available and are on1v an estimate. Contact the De t or addn'l info.
FFEEEMS fleeResolution 09-051 Eff. 7/1.%/0) FEE QTY/FEEMISC ITEMS
i'c C'
Phnr:L.%�1�c'It. I�lc°c PlanCheck.
Permit Fee: $429.00
Supp/. In p Fee
f'lunth./;11et'h.r'F_Ic'c; ('nit Fee:
Plnnrh.i,1'/C ch.'Z;le'c 1'c l'frtiP Fcc
C-'c711s1±rx tiol7 7''0
Work Without Permit? 7IBSEISMICR
E) No $0.00
1'Irlrtltift<� )Wirt';:
irctverll)t>c•rrnac�rrtc.rlinrt TerE's':
Strom Motion Fee: $1.17 Select an Administrative Item
BldLy Stds Commission Fee IBCBSC $1.00
$431.17 $0.00 QTEr $431.17
_._. .
Revised: 8/17/2010
M.lndODr Mir Quality and Finishes
I.Use iOwlfilo-vf)CPairit 1 1AQMealth pts y--yes p
2,Use Low VOC,Water-Based Wood Finishes 2 IAQ Haab pts y--yes p
3.Use LoAft VOC Adhesives 3 IAQ'Health pts y--yes p
4.Use Salvaged Materials for Interior Finishes 3 Re`ouroe pts Y--yes p
5.Use Engineered Sheet Goods with no added Urea
Formaldehyde 6IAQ'Health pts y=yes p
6.Use Exterior Grade Plywood for Interior Uses 1 IAQ'Health pts y--yes p
4 fAQ'Health is v--vas
B.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes p
9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y=yes p
10.Install Whole House Vacuum System 3 fAChiealth pts y_yes p
1 1 1
N.Flooring M M
1.Select FSC Certified Wood Rooring B Reso irce pts y=yes Lj 2.Ilse l apid�ri3e±�etirahle flooring Ailafwli s 4 Reso irce pts y-yes 3.Use Recycled Content Ceramic Tiles 4 Reso irce pts y=yes 4.Install Natural Linoleum in Place of Vinyl 5 IAQAiealth pts y=yes p
5.Use Exposed Concrete as Finished Floor 4 Reso irce pts y_yes 6.Install Recycled Content Carpet with Low VOCs 4 Reso uce pts y=yes 1
Total Points Avai ab e: 140 1301 57
Total Points Pro'ect Received: 0 0
c�—
G:daWproWgreenbulldingc uidelineshemodelerslgreenpointsnanal2 04prote d.zls
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
CUPERTINO Fax: 408-777-3333
CONTRACTOR/ SUB)CONTRACTOR LIST
JOB ADDRESS: 0 PERMIT#
OWNER'S NAME: PHONE# S� 2- Z
GENERAL CONTRACTOR: y BUSINESS LICENSE #
ADDRESS: d CITY/ZIPCODE, ' O �d
*Our municipal code requires all businesses working in t ie city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUP`� 11�PECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUB C S HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
/Signature Date
Please check applicable subcontractors and complete the following information:
s/ 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
Owner/Contractor Signature Date