10080178 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21830 TERRACE DR CONTRACTOR:BRIDGEMAN/MANCHA PERMIT NO: 10080178
ROOFII dG
NER'S NAME: IRINA SINZIG 13621 f ERNCREST CT DATE ISSUED:08/24/2010
OWNER'S PHONE: 4082559916 SARA?OGA,CA 95070 PHONE NO:(408)866-8170
❑ LICENSED CONTRACTOR'S DECLARATION BUILIZING PERMIT INFO: BLDG r ELECT r PLUMB
License Class — Lie.#
tP� MECH RESIDENTIAL r COMMERCIAL
Contractor � Date 10 E
I hereby a t I am 1 sed under the provisions of Chapter 9 JOB I L 40
ESCRIPTION:RE-ROOF-REMOVE 40 YR DIMENSIONAL COMP&
(commencing with Section 7000)of Division 3 of the Business&Professions
YR DIN
Code and that my license is in full force and effect. YR DIN ENSIONAL OVER 30LB FELT CLASS A 43SQ
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]loor Area: Valuation:$12500
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is APN Number:35625003.00 Occupancy Type:
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
indemnify and keep harmless the City of Cupertino against liabilities,judgments, PERMIT EXPIRES IF WORK IS NOT STARTED
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR
with all non-point source regulations per the Cupertino Municipal Code,Section 180 i0 DAYS FROM LAST CALLED INSPECTION.
9.18.
r <307d–lo
(�
mature Date +C-7 Issued by: �— Date:.
❑ 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 shall be inspected prior to any roofing material being installed.If a roof is
I,as owner of the property,or my employees with wages as their sole compensation, installe 3 without first obtaining an inspection,I agree to remove all new materials for
will do the work,and the structure is not intended or offered for sale(Sec.7044, inspect ion.
Business&Professions Code) c
I,as owner of the property,am exclusively contracting with licensed contractors to Signah re of Applicant: Date:
vv
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
I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,as provided for by Califo•nia Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
compl-ante 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
I certify that in the performance of the work for which this permit is issued,I shall contar iinants 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 maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Compensation laws of California. If,after making this certificate of exemption,I Heald &Safety Code,Sections 25505,25533,and 25534.
become subject to the Worker's Compensation provisions of the Labor Code,I must
forthwith comply with such provisions or this permit shall be deemed revoked. Owner ora tl ed ag nt:
Date: _�
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 beret y 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 wb ich this permit is issued(Sec.3097,Civ C.)
the above mentioned property for inspection purposes.(We)agree to save Lender's Name
_mify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the Lendc is 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 understand my plans shall be used as public records.
Signature Date�
Licen:ed Professional
CITY OF CUPERTINO
3 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lct:
APN . . . . . . . . : 35625003 .00
DATE ISSUED. . . . . . . : 08/24/2010
RECEIPT #. . . . . . . . . : BS000011275
REFERENCE ID # . . . : 10080178
SITE ADDRESS . . . . . : 21830 TERRACE DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : IRINA SINZIG
ADDRESS . . . . . . . . . . : 21830 TERRACE DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : BRIDGENAN/MANCHA RO
CONTRACTOR . . . . . . . : JEFF BRIDGEMAN LIC # 29138
COMPANY . . . . . . . . . . : BRIDGENAN/MANCHA ROOFING
ADDRESS . . . . . . . . . . : 13621 FERNCREST CT
CITY/STATE/ZIP . . . : SARATOGA, CA 95070
TELEPHONE . . . . . . . . : (408) 866-8170
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 12, 500. 00 1. 00 0. 00 1. 00 0 .00
1BSEISMICR VALUATION 12, 500. 00 1.30 0. 00 1.30 0 .00
1REROOFRES SQ FEET 43 . 00 559. 00 0. 00 559. 00 0 .00
---------- ---------- ---------- ----------
TOTAL PERMIT 561.30 0. 00 561.30 0.00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
CITY OF CUP ERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: DATE: REVIEWED BY:
APN: BP#: "VALUATION: $12,500
FPERMIT TYPE: Minor=Bui=ldingermit =PLANCK TYPE: Re-roof
PRIMARY '101I�tl PENTAMATION 1SFDWLROOF
USE: SFD or Duplex ))E�t�x .li ,-� PERMIT TYPE:
WORK
SCOPE
FEE ID ROOF AREA.
s.f.
1REROOFFRES 4,300
tf ?'-rtltlt f'c� Elattril'. F rt,rt T 'ir. 7:1cr Powlit Vcc
Ir:�7Cit/;c 'Ph!frd7 h'rc1" Od r`/_�i`ec. I�tp
P2�j
Ph,.6 bov. /." 1 Icc.Ir7s�. Pc"'
NOTE: These fees are based on the preliminary in ormation available and are on! an estimate. Contact the Dept for addn'l info.
FEE ITEMS(Fee Resolution 09-051 Eff. 74,10) FEE QTY/FEE MISC ITEMS
Pliol Che4 1"Ev.
,Slitp/l PC Fee
Ph11)71'.,"�V( h_T'Icc Phf11 ChccA:
Permit Fee: $559.00
.S1!111,1. Ilop
Ph1171h. 1c'�h. l fc'c t)lir l"c :
Ph11P1h14cch. h 1t< Parrs! Veal
(�.�t�iTSlt'1K'ItefF7 �tl.?"
1t;t1t15°Ii'Li el:lit 1'IC'11�1'E'c:
Work Without Permit? 0 Yes 0 No $0.00
Pltir'71JIJ7 '" 1'cc':5:
TV,n E'l I)o('ttaltc 110!io11 Fcrc,>=
Strong Motion Fee: IBSEISMICR $1.25 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00
SUBTOTALS: $561.25 $0.00 ' TOTAL FEE: $561.25
Revised: 8/17/2010
CITY OF CU)PERTINO ^�
REROOF
CUPEkT1NO PERMIT APPLICATION
APN # Date:
Building Address:
Owner's Name: S Z��� Phone #:
HOA: Yes ❑ No S If yes, provide letter fi-om HOA H d$ 255-offl
Contractor: Phone #: Lidg1�366-S30
azt,
Fax #: 40-3 q.) -$1$
Cupertino Business License #: Contractor License #:
Type of Roof Covering:
Existing: P roposed:
❑ Built-Up Roof ❑ Built-Up roof
a Asphalt Shingles s Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other (Specify) ❑ Other (Specify)
Number of existing coverings J- ❑ Provide I.C.C.E.S. Report#
® To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description: � � y 0 LrA.
TS
Residentialy Commercial ❑
Green Building: Please complete relevant portion c,f 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:,of 5-00)
I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
Signatqjr
Revised 02/05/09
M.Indoor Air Quality and Finishes
1- `�. .... _ 1 1AQiHealth pts y=yes 0
2.Use Low VOC,Water-Based Wood Finishes. 2 IAQi Health pts y=-yes 0
- 31AQ,Health pts y=yes D
4.Use Salvaged Materials for Interior Finishes 3 Res)urce pts y=yes 0
5.Use Engineered Sheet Goods with no added Urea
Formaldehyde 6IAQiHealth pts y=yes 0
6.Use Exterior Grade Plywood.for Interior Uses 1 IAQ/H"th pts yeses 0
�z 4IMI Health. pts y=yes 0
8.Use FSC Certified Materials for Iriterior Finish 4 Res)urce pts y=yes D
9.Use Fnger-Jointed or Recycled-Content Trim 1 Res)urce pts y=yes 0
10.Install Whole House Vacuum System 3 IAQ Health pts yeses 0
1 i 1
N.Flooring
1.Select FSC Certified Wood Flooring B Reso trce pts y=yes 0
,iiseftape�aeli-7oorin9 4Resotrce pts y=yes 0
3.Use Recycled Content Ceramic Tiles 4 Reso irce pts y=yes 0
4.Install Natural Linoleum in Place of Vnyl 5 IAQA iaalth pts y=yes 0
5.Use Exposed Concrete as Finished Floor 4 Resource pts y=yes 0
6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes D
1 1 1
Total Points Available: MI. 1301 57
Total Points Project Deceived: C>� 1 01 0 0
G:data/prog9/greenbu11dng1 Niderines/ramodelers/gn enpointsfina1212D4protectedxls
REROOF TEAR-OFF POLIO"
COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING.OFFICIAL
CUPERTINO 10300 TORRE AVENUE-CUPERTINO, CA 9 5014-3255
(408)777-3228-FAX(408)777-3333-buildin 1(a)cupertino.ong
PROJECT ADDRESS APN#
OWNER NAME PHONY 0,8 b _9(1 I E-MAIL
STREET ADDRESS 15a� I
CITY, STATE,ZIP A - ,i FAX
Y1
CONTRACTOR NAME LICENSE NUMBE$,�,� LICENS TYt( BUS.LIC.#
COMPANY NAME E-MAIL SCt, �) `1\ /�Q//
n FAX�V W 4a9-$i$3
STREET ADDRESS 7�pZ1 CITY,ST E,ZIP �61 PHONEtlo%J� � 0
aA� I
I UNDERSTAND AND AGREE. TO THE FOLLOWING:
1. The re-roof project shall comply with all applicable previsions 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 i ear-off inspection after the roof is torn off and all
the nails/fasteners have been removed. Any and all iry-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 — 10:3(lam 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 n-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 o staining all inspections and written approvals
from the building inspector. Any roofing which is app ied without first obtaining an approved inspection
will require the removal of all new material down to th,- 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 ite ns 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-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 re-inspection fee shall be paid before another
inspection can be scheduled.
By my signing below, I certify each of the following is true: 1 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: 1�4
Date:
ReroofPolicy_201 0.doc revised 05/17/10