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10070074 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19721 MERRITT DR CONTRACTOR:CONRAD ROOFING PERMIT NO: 10070074 SERVICE `IWNER'S NAME: JOHN ISHII 332 PHELAN AVE DATE ISSUED:07/09/2010 OWNER'S PHONE: 4087681351 SAN JOSE,CA 95112 PHONE NO:(408)294-7615 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIAL❑ License Class6w3 ( 3 Lic.# 21 C1. 2— RE-ROOF TEAR OFF 30 YR COMP INSTALL NEW 30ILB 4 r( O Contractor Date FELT / 50YR CLASS A 30 SQUARES I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business&Professions 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. Sq.Ft Floor Area: Valuation:$800 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 APN Number:31635008.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relatirg WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED IN7r- with ION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the 1-;tO j/ granting of this permit. Additionally,the applicant understands and will comply Issued by: '/L� Date: l all non-point source regulations per the Cupertino Municipal Code,Section 9.18. / _ -7_ RE-ROOFS: Cignature Gf�f— Date All roofs shall be inspected prior to any roofing material being installed.If a roof is _ installed without first obtaining an inspection,I agree to remove all new materials for inspection. ❑ OWNER-BUILDER DECLARATION -79-1 O Signature of Applicant: Date: // (( I hereby affirm that I am exempt from the Contractor's License Law for one if the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I,as owner of the property,or my employees with wages as their sole compensatic n, will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors tc HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sec ' ns 5505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date: 9—/C) permit is issued. I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I mL st I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 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 -)n the above mentioned property for inspection purposes.(We)agree to save amnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date CITY OF CITY OF CUPERTINO REROOF CUPERTINO PERMIT APPLICATION W APN# �) LP 35 . Date: / 0 Building Address: 19 � 21 m cx c Owner's Name: 7::T_5it;� Phone #: HOA: Yes ❑ No If Yes, provide letter from HOA Contractor: ,,`� a �r`S ,cvr� Phone #: ' ,A ? S Fax#: Cupertino Business License #: �-LZc� Contractor License #: Z� L�" Z Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof p( Asphalt Shingles A Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other (Specify) ❑ Other(Specify) Number of existing coverings f ❑ Provide I.C.C.E.S. Report # To be Removed ❑ Provide Mfgr. Installation Specs. Job Description: -�� ' - 3� �.c. C-Z�p s�.) ,�� 1-r c7 +�. c- C-0 1—p L �q 5 5 b�20 - Residential Commercial ❑ Green Building: Please complete relevant por':ion of the Cornfrmed with-Planning Dept. if Green Building Checklist & attach it to the aF plication or if there are any restrictions: ❑ applicable, include in plan set & the sheet index. Valuation: 4 I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy: Signature Revised 02/05/09 REROOF TEAR-OFF POLICY COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION ALBERT SALVADOR,P.E.,C.B.O.,BUILDING OFFICIAL 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228 FAX(408)777-3333•tuildingca`Dcupertino.orq PROJECT ADDRESS PHONE / E-MAIL OWNER NAME ••T7)_ �7" i {� OJ CITY, ST,.TE,ZIP / 7FAX 7 STREET ADDRESS 1-7 �t�l s, �..� ✓h..� 1 LICENSE NUMBE 2 LICENSE TYPE BUS.LIG# CONTRACTOR NAME �O�`� d_-_ yam '�'`�_Z_ ��39 1� -l E-MAIL FAX 1 ,741 - COMPANY NAME /" t^�K � 2w L 3 (�O CITY,STi.TE,ZIP (•7 / C �� PHONE ^ (� ['` STREET ADDRESS 33Z— J', C-► v I UNDERSTAND AND A3REE TO THE FOLLOWING: 1. The re-roof project shall comply with all applicaile 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)-/77-3228 between 7:30-3:30 (Mon-Fri). 3. Tear-off roof inspection is required. Please cE 11 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 availab e 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 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 obtain(d 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 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 n i ing 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: I am the property owner or authorized agent to act on the property owner's behalf. I stand a d a i ee to comply with the re-roof policy=drab O Signature of Applicant/Agent: J Date: ReroofPo1icy_2010.doc revised 05/17/10 CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 31635008 . 00 DATE ISSUED. . . . . . . : 0-1/09/2010 RECEIPT #. . . . . . . . . : BE000010832 REFERENCE ID # . . . : 1C070074 SITE ADDRESS . . . . . : 1S721 MERRITT DR SUBDIVISION . . . . . . CITY CT PERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . . JC-HN ISHII ADDRESS . . . . . . . . . . : 1S721 MERRITT DR CITY/STATE/ZIP . . . : CtPERTINO CA, CA 95014-2406 RECEIVED FROM . . . . : CCNRAD ROOFING CONTRACTOR . . . . . . . : KE,ITH CARNAHAN LIC # 22297 COMPANY . . . . . . . . . . : CC,NRAD ROOFING SERVICE ADDRESS . . . . . . . . . . : 3:2 PHELAN AVE CITY/STATE/ZIP . . . : SIN JOSE, CA 95112 TELEPHONE . . . . . . . . : (408) 294-7615 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- - --------- ---------- ---------- ---------- 1BCBSC VALUATION 800 .00 1 . 00 0 . 00 1. 00 0 . 00 1BSEISMICR VALUATION 800 . 00 0 . 50 0 . 00 0 .50 0 . 00 1REROOFRES SQ FEET 30 . 00 390 . 00 0 . 00 390 . 00 0 . 00 - --------- ---------- ---------- ---------- TOTAL PERMIT 391.50 0 . 00 391. 50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 391 . 50 13041 --------------- TOTAL RECEIPT 391 . 50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 604 ROOF IN-PROGRESS 605 FINAL REROOF Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 CUPERTINO Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: Zl /�e�c<:t't R PERMIT# -74) OWNER'S NAME: 'oj,.� 74T- ' PHONE# 77(0- 1 3S-1 GENERAL CONTRACTOR: Go,n<orA vS C k, BUSINESS LICENSE# 2-1-2-9 7 ADDRESS: 33-2- )9k l ►1 14V'-'- CITY/ZIPCODE: s--7 C" 9sl 1 Z *Our municipal code requires all businesses working it 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 SUBCONTt,ACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. - ! _ ( O I am not using any subcontractors: Si;nature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINE SS 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