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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