10070115 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 6365 BOLLINGER RD CONTRACTOR: e Itl� irk"t rly; PERMIT NO: 10070115
OWNER'S NAME: ANGIE JARAMILLO rt �A_C,, DATE ISSUED:07/19/2010
NER'S PHONE: 4083746218 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic.#
MECH (_ RESIDENTIAL r— COMMERCIAL
Contractor &Ieoy- z_,t Date 7 7/
I—leo
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB]DESCRIPTION:6365-6367 DUPLEX-RE-ROOF CLASS A 34SQ,TEAR OFF
(commencing with Section 7000)of Division 3 of the Business&Professions OLD ROOF&INSTALL 30YR COMPOSITION
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations: J
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:,Ioor Area: Valuation:$12252
permit is issued.
APPLICANT CERTIFICATION APN Number:36919004.00 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 1f;0 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
Signature '
�� Issued hy-' Dates ��/ lU
Date
LJ OWNER-BUILDER DECLARATION
RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of All roo is shall be inspected prior to any roofing material being installed.If a roof is
the following two reasons: installeI 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, inspect on.
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code) Signatr re of Applica Date:
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: HAZARDOUS MATERIALS DISCLOSURE
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 I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. Califoi nia Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance 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.
Additionally,should I use equipment or devices which emit hazardous air
permit is issued. contaminants 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
not 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
become subject to the Worker's Compensation provisions of the Labor Code,I must 1X9,
or autho ' agent:
forthwith comply with such provisions or this permit shall be deemed revoked. Date:1a
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is I hereb i 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 for whish this permit is issued(Sec.3097,Civ C.)
to building construction,and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned property for inspection purposes.(We)agree to save
mify 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
granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
with all non-point source regu tions per the Cupertino Municipal Code,Section
9.18. Q I under stand my plans shall be used as public records.
Signatur — Date 7�� ( ^'�� Licens A Professional
CITY OF CUPFRTINO
RECEIPT NUMBER: BS000010894
RECEIVED BY: PATRICIAG PAYOR: RONALD F NEMMER
TODAY'S DATE: 07/19/10 REGISTER DATE: 07/19/10
TIME: 08 : 51
3
1BCBSC 10070115 $1 .00
1REROOFRES 10070115 $442 . 00
BUSINESS LICENSE TAX NEW- NEMMEER ROOFING $114 . 00
----------------
TOTAL DUE: $557 . 00
CREDIT CARD: $557 .00 REF NUM: MC
TENDERED CHANGE
;557 . 00 $ . 00
CITY OF CUPERTINO
2 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lost:
APN . . . . . . . . : 36919004 . 00
DATE ISSUED. . . . . . . : 07/19/::010
RECEIPT #. . . . . . . . . : BS0000:.0894
REFERENCE ID # . . . : 100701:_5
SITE ADDRESS . . . . . : 6365 BOLLINGER RD
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . . CUPERT"NO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : ANGIE JARAMILLO
ADDRESS . . . . . . . . . . : 6365 BOLLINGER RD
CITY/STATE/ZIP . . . : CUPERT= NO, CA 95014
RECEIVED FROM . . . . : RONALD F NEMMER
CONTRACTOR . . . . . . . : TBD — "0 BE DETERMINED LIC # 00096
COMPANY . . . . . . . . . . : TBD — "0 BE DETERMINED
ADDRESS . . . . . . . . . .
CITY/STATE/ZIP . . . : ,
TELEPHONE . . . . . . . .
FEE ID UNIT QUANTITY AMOUNT PD—TO—DT THIS REC NEW BAL
---------- ------------- ---------- ----------- ---------- ---------- ----------
1BCBSC VALUATION 12, 252 . 00 1 .00 0 .00 1. 00 0 . 00
1REROOFRES SQ FEET 34 . 00 4«2 .00 0 .00 442. 00 0 . 00
----- ---- ---------- ---------- ----------
TOTAL PERMIT 443 .00 0.00 443 . 00 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 CUPERTINO
FEE ESTIMATOR- BU][LDING DIVISION
ADDRESS: DATE: REVIEWED BY:
APN: BP#: "VALUATION: 1$12,252
PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD or Duplex TROOO
AL [ 3 400 S.f. APPLICATION 1R3SFDADD/REM
USE: F AREA: TYPE:
xw
as
O
3 �
FEE ID
1 REROOFFRE:S
FT-1 T-1 I
NOTE. Thesefees are based on the preliminain ormation availab'e and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS ( ee Resolution 0.9-051 Eff: ?7/09) FEE :?TY/FEE MISC ITEMS
Permit Fee: $442.00
_T
Work Without Permit? Q Yes (E) No $0.00
Strong Motion Fee: 1BSEISMICR $1.23 Select an Administrative Item
Bld�,, Sids Commission Fee: 1BCBSC $1.00
SUBTOTALS: $444.23 $0.00 TOTAL FEE: $444.23
Revised: 6/30/2010
CITY OF /
CITY OF CUPERTINO
ELI] REROOF
CUPERTINO PERMIT APPLICATION
APN# A Date:
Building Address: .
65 - &36 2 &1l
Owner's Name: Phone #:(el0�
Ta"L ^
HOA: Yes ❑ No If es, provide letter from HOA ? Y
Contractor: Phone #: S510 3 b
Fax#:
Cupertino Business License #: Contractor License #:
Type of Roof C overing:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
14,Asphalt Shingles �d- Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other (Specify) ❑ Other (Specify)
Number of existing coverings 3 Y ❑ Provide I.C.C.E.S. Report#
To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description: Z� /Q�5 4
ResidentialFF Commercial
Green Building: Please complete relevant portion of the Cop rmed.ith_Planning Dept. if
Green Building Checklist & attach it to the applicalaon 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:
ignature
Revised 02/05/09
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
ALBERT SALVADOR, P.E.,C.B.O., BUILDING OFFICIAL
CUPERTINO 10300 TORRE AVENUE•CUPERTINO, CA 95)14-3255
(408)777-3228•FAX(408)777-3333•buildin 'd-)cupertino.orq
PROJEC SAD_"e5,/ �O I �r APN#
OWNER N E(0 �p TC�^ N` //-,, PHO E7 L `I F E-MAIL
210 rk
STREET ADDRESS Vl CITY, STATE,ZIP V FAX
CONTRACTOj� ME .� LICENSE NUMBER LICEN E TYPE BUS.LIC.#
/� CP_y'X t Od✓ 6 L
COMPANY NAej C�1 t J� E-MAIL 6 FAX
STREEDI2E C�� aLC /�//� /�� CITY,STATE, PHONE `�
SS I UNDERSTAND AND AGREE 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)777-32:!8 between 7:30-3:30 (Mon-Fri).
3. Tear-off roof inspection is required. Please call for t:ar-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 — 10:3Cam and 1:00—3:30pm (Mon—Thurs);
7:30 — 10:3Cam 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 o)taining 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 items 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-insp:ction 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 be f. I unders d agree to comply with the re-roof policystated
'—! ostate/d/a'bove..
Signature of Applicant/Agent- _ Date: < r`
ReroofPolicy_2010.doc revised 05/17/10