10080187 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21849 CORTE MADERA LN CONTRACTOR: PERMIT NO: 10080187
OWNER'$ AME: PAMELA AVRIT lullDATE ISSUED:08/26/2010
SEWS PHONE: 4082576925 U PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
License Class L-3"k Lic.# !�9;k 6 9,
� MECH r RESIDENTIAL r— COMMERCIALr
Contractor �i �A Joa � V- Date g :l
I hereby affirm that I am licensed under a provisions of Chapter 9 JOB DESCRIPTION:RE-ROOF TEAR OFF SHAKE ROOF,INSTALL 1/2 INCH
(commencing with Section 7000)of Division 3 of the Business&Professions PLYWOOD 30#FELT&30YR SHINGLES CLASS A
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.
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 Sq.Ft Floor Area: Valuation:$10500
permit is issued.
APPLICANT CERTIFICATION APN Number:32645031.00 Occupancy Type:
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
upon the above mentioned property for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
�"
fS='gnatur (�V v'� S •�y•� Date �ssued by: Date: A7,t�j G
b
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of ROOFS:
X11 roofs shall be inspected prior[o anyy ro roofing material being installed.If a roof is
the following two reasons: i zstalled without first obtaining an inspection,I agree to remove all new materials for
I,as owner of the property,or my employees with wages as their sole compensation, i ispection.
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code) f ignature of Applicant:_A,& ��'g,5 n�tr�c� Date: Vis' -16
I,as owner of the property,am exclusively contracting with licensed contractors to
construct 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
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 I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by c 3mpliance 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
c rntaminants 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 in kaintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's F ealth&Safety Code,Sections 25505,25533,and 25534.
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 C wner or Guth ized agent:
forthwith comply with such provisions or this permit shall be deemed revoked. `' Date: g
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is I rereby affirm that there is a construction lending agency for the performance of work's
correct.I agree to comply with all city and county ordinances and state laws relating fc r which this permit is issued(Sec.3097,Civ C.)
to building construction,and hereby authorize representatives of this city to enter L.nder's Name
upon the above mentioned property for inspection purposes.(We)agree to save
emr.4Pi and keep harmless the City of Cupertino against liabilities,judgments, L mder's Address
and expenses which may accrue against said City in consequence of the
_.ing of this permit.Additionally,the applicant understands and will comply
lAth all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION
9.18. 11 mderstand my plans shall be used as public records.
Signature Date Licensed Professional
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 21849 Corte Madera Ln DATE: 08/26/2010 REVIEWED BY: jsg
APN: BP#: *VALUATION: 1$10,500
*PERMIT TYPE: Minor Building Permit PLAN ZHECK TYPE: Re-roof
PRIMARY 701',11- PENTAMATION 1 SFDWLROOF
USE: SFD or Duplex t7_t)ct. ,lll to . PERMIT TYPE:
WORK
SCOPE
FEE ID ROOF A REA
s.f.`
1REROOFFRES 2,900
�Ifz,dt_ Plaf, ('ht'cf, 1'Ir�rrrG. 1'lcrvt C'hecT� FT_
F7cz_ Pfau Check
1lc� h Pcrwn I Fo 'Ir id' r'<"rnit hCc. F;Itc I'trrrril F�e-
CJ/rcr Af,; ,, fovp other•Pl?"Inb Ia"P 0/hobier_My, Li
tl / hr,I, /' '<�� Phtrfrh. 1-r,�.. 1,170, My t4
NOTE: These ees are based on the prelinWinatry in ormation ava ilable and are only an estimate. Contact the Det or addn I info,
FEE ITEMS (Fee Resolution 09-051 Ef. 7/1/10) FEE QTY/FEE MISC ITEMS
P/on C'hec'k F cc.
slip7r1. PC F A
P/Ifrr7/);,, lc'c1L.''Flcu Ploa Check:
Permit Fee: $377.00
Stf1,/)/. Ilse F(A,
- F I -
Pltfrnh.;.��c'c°h. Fa'ct Ullif /,ee:
!'/tfrxt�.;'J 1eclt.iZ:l�c° Pcrillit
C f)II trWC[ion KIX
� ,
,'1,,c3tfstic:crl ht's°icw['c'(1:
Work Without Permit? 0 Yes E) No $0.(0
I'Iufflfflr,<� 1�'ecrs:
7Vo< c l Ooctol2elahttwn FC(%e
I
Strong Motion Fee: IBSEISMICR $1.(15 Select an Administrative Item
B1dgStds Commission Fee: IBCBSC $1.00
SUBTOTALS: $379.05 $0.00 TOTAL FEE:; $379.05
Revised: 8/17/2010
CITY OF CUPERTINO
REROOF
CUP111 EkTiNO PERMIT APPLICATION
APN # Date:
Building Address: ,
ao�If-
Owner's Name: Phone #:
P&Pk&LA, 004fWT
HOA: Yes ❑ No If yes, provide letter from HOA S 7 t
Contractor: Phone o o �
OA-A a ', v. Cc, Fax #:
Cupertino Business License #: Contractor License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles X Asphalt Shingles
,p(, Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other (Specify) ❑ Other (Specify)
Number of existing coverings t ❑ Provide I.C.C.E.S. Report#
3 To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description:
Residential ommercial
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.
Valuation:
I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
(0 5
&Vyx G-0\ c-;,_.
Signature
Revised 02/05/09
.Indoor Air Quality and Finishes
1 IAQ,HsaJth pts y--yes 0
2.Use Low VOC,Water-Based Wood Finishes. 2 IAQ Health pts y--yea 0
7
3IAQ Health pts y--yes 0
4.Use Salvaged Materials for Interior Finishes 3 Res)urce pts y--yes 0
5.Use Engineered Sheet Goods with no added Urea
Formaldehyde 6 IAQ Health pts y=yes 0
6.Use Exterior Grade Plywood for Interior Uses 1 IAQ Health pts y--yes D
WOOF
4 IAQ Health.pts Y--yes D
B.Use FSC Certified Materials for Interior Finish 4 Resource pts y--yes 0
9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y--yessD
10.Install Whole House Vacuum System 3 IAC Mealth pts y--yes 0
1 1 1
N.Flooring
1.Select FSC Certified Wood Flooring B Rescurce pts y=yes 0
.11sei maw4s 4 Rescurce pts y--yes 0
3.Use Recycled Content Ceramic Tiles 4 Rescurce pts y--yes 0
4.Install Natural Linoleum in Place of Vinyl 5 IM-lealth pts y=yes 0
5.Use Exposed Concrete as Finished Floor 4 Rescurce pts y--yes 0
6.Install Recycled Content Carpet with Low VOCs 4 Rescurce pts y--yesD
1 1 1
Total Points Available: 1 1401 1301 57
Total Points Project Received:1 1 01 0 0
n '
1 0.
G:data/progslgreenbulldni iguidelineshemodelerslgreenpointsfina1212D4protectedxis
CITY OF CUPERTINO
3 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN 32645031.00
DATE ISSUED. . . . . . . : 08/26/2010
RECEIPT #. . . . . . . . . : BS000011294
REFERENCE ID # . . . : 10080187
SITE ADDRESS . . . . . : 21849 CORTE MADERA LN
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : PAMELA AVRIT
ADDRESS 21849 CORTE MADERA LN
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : QUALITY ROOFING
CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096
COMPANY . . . . . . . . . . : TBD - TO BE DETERMINED
ADDRESS . . . . . . . . . .
CITY/STATE/ZIP . . . : ,
TELEPHONE . . . . . . . .
FEE ID UNIT QUANTITY AM01JNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---- ------ ---------- ---------- ----------
1BCBSC VALUATION 10, 500. 00 1 .00 0. 00 1. 00 0. 00
1BSEISMICR VALUATION 10, 500 . 00 1.10 0 .00 1.10 0.00
1REROOFRES SQ FEET 29. 00 :377.00 0. 00 377. 00 0 .00
---- ------ ---------- ---------- ----------
TOTAL PERMIT :379.10 0 .00 379. 10 0 .00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTME�T-BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
CUPERTINO 10300 TORRE AVENUE•CUPERTINO,CA E5014-3255
(408)777-3228• FAX(408)777-3333•buildir q(d.)cupertino.org
PROJECT A DP
--k 1$S Co I �
O��1 A_ J_ v 1 1 O PHONE � _� s E-MAIL
STREET ADDRESS ` CITY. STATE,ZII FAX
CONTRACTOR N ME LICENSE NUMBER LICENSE TYPE BUS.LIC.#
v� :� Zoo — �, �` X868 C - �
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STAT ZIP P NE
C G`w v \\ tom a 1C -,1 o
I UNDERSTAND AND AGRE E 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 wit lin 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% )f 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 following ioms will be verified:
a. Flat roofs shall have a minimum of 1/4"per foot o:'slope and must demonstrate there is no ponding.
b. Listings from approved testing agencies for all pr,--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 i ispection 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 following is true: I am the property owner or authorized agent to act
on the property owner's behalf. I understand and ag ee to cc mply with the re-roof policy stated above.
Signature of Applicant/Agent�� c �S }. 0'- Date: -C�-G
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: PERMIT# / 7
OWNER'S NAME: PHONE# ci i?; 6 (--6 7 y
GENERAL CONTRACTOR: a_\ a �; �.a BUSINESS LICENSE#
ADDRESS: I & It( 5 Ay, CITY/ZIPCODE:
*Our municipal code requires all businesses work6g in the city 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 SUBCONTRACT ORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors: ` '" — �' A,l \� —'— A —�6 _l�
Signatt re Date
Please check applicable subcontractors and complete the following information:
6/ 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 Sig ture Date