10060176 CITY OF CUPERTINO :BUILDING PERMIT
BUILDING ADDRESS: 19721 MERRITT DR CONTRACTOR:CONRAD ROOFING PERMIT NO: 10060176
SERVICE
I—INER'S NAME: ISHII JOHN R JR AND JANICE M 332 PHELAN AVE DATE ISSUED:06/29/2010
L. YNER'S PHONE: 4087681351 SAT JOSE,CA 95112 PHONE NO:(408)294-7615
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT F PLUMB
License Class L-3 Lic.# 21I) 1 t .5_Z'
c� MECH RESIDENTIAL F COMMERCIAL
Contractor Date / I C)
1 hereby affirm that I am licensed under the provisions of Chapter 9 JOU DESCRIPTION: RE-ROOF TEAR-OFF SHAKES,INSTALL 7/16"OSB
(commencing with Section 7000)of Division 3 of the Business&Professions RAC IANT
Code and that my license is in full force and effect. BARRIER SHEATHING,30LB FELT&50YR COMP SHINGLES
CLASS A 30SQ
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
permit is issued. Sq.1't Floor Area: Valuation:$13000
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is APT Number:31635008.00 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, ]HERMIT 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 t80 DAYS FROM LAST CALLED INSPECTION.
9.18.
c:-nature J�—"�— Date 9'
Issued b -"n.�? Date:25 �)
❑ 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 r>ofs 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, installed without first obtaining an inspection,I agree to remove all new materials for
will do the work,and the stricture is not intended or offered for sale(Sec.7044, inspc ction.
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to Sign iture 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 ha,,e read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain Worker's Compensation Insurance,as provided for by Cali'ornia 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 compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Safe y Code,Section 25532(a)should I store or handle hazardous material.
permit is issued. Add tionally,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 cont iminants 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 mail tain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Compensation laws of California. If,after making this certificate of exemption,I Health&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. Own erdFi6thoulzed agent: _ O
�--�� Date: fy !�/
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 her:by 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 H hich 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 Len(ier's Address
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Signature Date
Licensed Professional
CITY OF CUEERTINO
2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Iot:
APN 31635( 08 . 00
DATE ISSUED. . . . . . . : 06/29/ 2010
RECEIPT #. . . . . . . . . BS000( 10726
REFERENCE ID # . . . : 10060_.76
SITE ADDRESS . . . . . : 19721 MERRITT DR
SUBDIVISION . . . . . .
CITY CUPER-INO
IMPACT AREA . . . . . .
OWNER ISHII JOHN R JR AND JANICE M
ADDRESS 19721 MERRITT DR
CITY/STATE/ZIP . . . : CUPER'CINO CA, CA 95014-2406
RECEIVED FROM . . . . : CONRAI) ROOFING SVC
CONTRACTOR . . . . . . . : KEITH CARNAHAN LIC # 22297
COMPANY CONRA:) ROOFING SERVICE
ADDRESS 332 P:IELAN AVE
CITY/STATE/ZIP . . . : SAN JOSE, CA 95112
TELEPHONE . . . . . . . . : (408) 294-7615
FEE ID UNIT QUANTITY AMO JNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---- ------ ---------- --------
1BCBSC VALUATION 13, 000 . 00 1 . 00 0 . 00 1 . 00 0 . 00
1REROOFRES SQ FEET 30 . 00 390 . 00 0 . 00 390 . 00 0 . 00
- ---------- ---------- ---------- ----------
TOTAL PERMIT 391 . 00 0 . 00 391. 00 0 .00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 391 . 00 #13025
---------------
TOTAL RECEIPT 391 . 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 l0 U ( O 1 ,7 (,0
f RERCIOF
CUPEkTINO PERMIT APPLICATION
_ Q' �
APN # ;�, o Date:
Building Address:
Owner's Name: 7o ham. 1.t i Phone #: 768 - ( 3.51
HOA: Yes ❑ No ® If Yes, provide letter � rom HOA
Contractor: Go o o �C-�g ,.S.�v,�,�. �. Phone #: '7_7 Y-
Fax #: 2A V— 9?6(
Cupertino Business License #: Contractor License #:
Zt l L52-
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles x Asphalt Shingles
)r Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other (Specify) ❑ Other (Specify)
Number of existing coverings I ❑ Provide I.C.C.E.S. Report#
XL To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description: 7,,,<- .,F� sk-fk,5
Residential Commercial
Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if
Green Building Checklist & attach it to the appli ration or if there are any restrictions: ❑
applicable, include in plan set & the sheet index.
Valuation: If 13 f
3, C,C.>T�>
I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
Signature
Revised 02/05/09
CITY OF
CITY OF CUPERTINO
REROOF
CUPERTINS, FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1REROOFCOM Re-roof Commercial B 1COMMLROOF
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
1BSEISMICO Seismic Commercial B
1REROOFRES Re-roof Residential B 1SFDWLROOF
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
1BSEISMICRE Seismic Residential B
1RER00FMRES Re-roof Multi-Family B 1MFDWLROOF
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
1BSEISIVIICRE Seismic Residential B
1BUSLIC Business Liconse B
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDIN 3 OFFICIAL
10300 TORRE AVENUE•CUPERTINO, CA X15014-3255
CUPERTINO
(408)777-3228 FAX(408)777-3333•building
(okugertino.org
PROJECT ADDRESS \Ci-7 APN# i
OWNER NAME 1j ( / 1I L\, PHONE (1L g l� I E-MAIL
STREET ADDRESS 1°�� �1 ��L {��"f"' CITY, STATE, /' /� c� FAX
1 (�V{. f
��a LICENSE NUMBER I 1 LICE`Nri1:'YPE BUS.LIC.#
CONTRACTOR NAME&O
COMPANY NAME 6,0 w /�\ ��' ;Al E-MAIL GGr ?? FAX I _7`1r
STREET ADDRESS 3 Z /p�j - ,.14_.� CITY,STATE,ZII (, % _ Q M"1/ PHONE 1 i ,- / 7/L
I UNDERSTAND AND AGRLE TO THE FOLLOWING:
1. The re-roof project shall comply with all applicable X rovisions of the 2007 California Building Code.
2. You must schedule all needed inspections a minimuri 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 fo-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 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 aii in-progress roof inspection to verify building is
weather tight after installation of approximately 250/c 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 obtained fro n the building inspector when the re-roofing is
complete. To receive a final sign-off, the following tems 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 f re-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-in;pection 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. erst nd agree to comply with the re-roof policy stated above.
Signature
g
nature of PP G(
Si A licant/Agent: Date: 6 — 10 —
ReroofPolicy_2010.doc revised 05/17/10
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
CU PERTI NO Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: 'Z /�.- cc��- Inc- PERMIT#
OWNER'S NAME: PHONE# 1-9)Lf " 74i5
GENERAL CONTRACTOR: BUSINESS LICENSE#
ADDRESS: 3Z N�.-Lo- CITY/ZIPCODE:
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY
ORS INSPECTION(S)
HAVE OBTAINED A CITY OF CUPERTINO
UNTIL THE
GENERAL CONTRACTOR AND AL
BUSINESS LICENSE. l — 1-1-(0
I am not using any subcontractors: Date
Signature
Please check applicable subcontractors and complete t he following information:
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
7,L4�
Owner/Contractor Signature Date