10060062-- W&
/-■ 0 l _ W.A
I CITY OF CUPERTINO BUILDING PERMIT
ILDING ADDRESS: 10240 PHAR LAP DR CONTRACTOR: ARMSTRONG PERMIT NO: 10060062
INSTALLATION
OWNER'S NAME: RAMI RUBIN 14575 SAN PABLO AVE I DATE ISSUED: 06/10/2010 I
OWNER'S PHONE: 4082521238 I EMERYVILLE, CA 94608 I PHONE NO: (510)777-1234 I
JXO LICENSED CONTRACTOR'S DECLARATION
License Class G 3 Lic.#
, �/? �, 0/ -
Contractor ate U
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.
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.
APPLICANT CERTIFICATION
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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in c sequence of the
granting of this permit. Addi � nally, the applicant under ds and will comply
all non -point source r ulations per the Cupertino icipal Code, Section
Signature ate U
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
1, as owner of the property, or my employees with wages as their sole compensation,
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 to
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
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.
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
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.
APPLICANT CERTIFICATION
'rtify that I have read this application and state that the above information is
,.rect. 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,
costs, and expenses which may accrue against said City in consequence of the
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.
Signature Date
JO11 DESCRIPTION: RESIDENTIAL U COMMERCIAL
TEAR OFF GARAGE ONLY REPLACE WITH TORCH
DOWN
ROLLED ROOFING 5 SQUARES
Sq. Ft Floor Area:
APV Number: 32639026.00
Valuation: $35000
Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
cam �� j
Issued by: ` J Date: 7^!
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
ins ailed without first obtaining an inspection, I agree to remove all new materials for
ins )ection.
Signature of Applicant:
Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will
ma intain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
ma terial. Additionally, should I use equipment or devices which emit tozardous
air contaminants as defined by the Bay Area Air Quality Manageme istrict I
wil I maintain compliance with the Cupertin unicipal Code, Cha a 9.12 and
th4 Health & Safety Code, Sectio 5505 5�3,nd 25534.
Owner or authorized agent: a e: �le C
CONSTRUCTION LENDING AGENCY
I h;reby affirm that there is a construction lending agency for the performance of
we rk's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
4 ITEMS OF 4
CITY OF CUFERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 32639C26.00
DATE ISSUED.......: 06/10/2010
RECEIPT #......... BS000C10604
REFERENCE ID # ...: 10060062
SITE ADDRESS .....
SUBDIVISION ......
CITY .............
IMPACT AREA ......
10240 PHAR LAP DR
CUPERTINO
OPERATOR: SylviaM
COPY ## : 1
OWNER RAMI F'.UBIN
ADDRESS ..........: 10240 PHAR LAP DR
CITY/STATE/ZIP ...: CUPERTINO, CA 95014-1116
RECEIVED FROM ....: ARMSTPONG INSTALL
CONTRACTOR .......: MITCH FINE. LIC # 22581
COMPANY ARMSTPONG INSTALLATION
ADDRESS 4575 SAN PABLO AVE
CITY/STATE/ZIP ...: EMERYVILLE, CA 94608
TELEPHONE ........: (510)"77-1234
FEE ID
UNIT
QUANTITY
AMOUNT
PD -TO -DT
THIS REC
NEW BAL
----------
----------
1BCBSC
-------------
VALUATION
----------
35,000.00
----------
2.00
----------
0.00
----------
2.00
0.00
1BSEISMICR
VALUATION
35,000.00
3.50
0.00
3.50
0.00
1BUSLIC
FLAT RATE
1.00
_.14.00
0.00
114.00
0.00
1REROOFRES
SQ FEET
5.00
65.00
0.00
65.00
0.00
----------
TOTAL PERMIT
-----------
:.84.50
----------
0.00
----------
184.50
0.00
METHOD OF PAYMENT
-----------------
CHECK
TOTAL RECEIPT :
AMOUNT
---------------
184.50
---------------
184.50
VOICE ID DESCRIPTION
-------- ----------------------------
601 ROOF TEAR OFF
REFERENCE NUMBER
---------------------
1`'09
VOICE ID DESCRIPTION
-------- ----------------------------
602 ROOF PLYWOOD NAIL
604 ROOF IN -PROGRESS 605 FINAL REROOF
CITY OF
CITY OF CUPERTINO
REROOF
'
CUPERTINO PERMIT APPLICATION
APN # � �U
Date:
Building Address:
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Owner's Name: R / `
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Phone
HOA: Yes ❑ No -M If yes, provide letter ftom HOA
Contractor: �""�q �f'n ��� . �'�` GF
Phone #: 5ld-777 Z_'�
�s�s soh % Eng XG
Fax #: _f/0
Cupertino Business License #:
Contractor License #:
Type of Roof Covering:
Existing: Proposed:
)8 Built -Up Roof *
Built -Up roof
❑ Asphalt Shingles ❑
Asphalt Shingles
❑ Wood Shakes ❑
Wood Shakes
❑ Wood Shingles ❑
Wood Shingles
❑ Other (Specify) ❑
Number of existing coverings ❑
Other (Specify)
Provide I.C.C.E.S. Report #5c
To be Removed ❑
Provide Mfgr. Installation Specs.
Job Description:
uVtd ,red/ z w✓ 14 Wo
,
Residential
Commercial ❑
Green Building: Please complete relevant portion 3f 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:
3 G
00
I Have Read, Unders d and Will Comply with up�-.rtino's Tear -Off Policy:
Signature
Revised 02/05/09
9
CUPERTINO
REROOF TEAR—OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMEN-- - BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE - CUPERTINO, CA 9.1,014-3255
(408) 777-3228 - FAX (408) 777-3333 - buildinclacupertino.org
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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)777-3,,,28 between 7:30-3:30 (Mon -Fri).
3. Tear -off roof inspection is required. Please call 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 available wifiin 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% A 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 tie sheathing so a proper inspection can be
performed.
7. A final inspection and approval shall be obtained frons the building inspector when the re -roofing is
complete. To receive a final sign -off, the following it -.ms will be verified:
a. Flat roofs shall have a minimum of I/4" per foot o "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-ins;)ection fee shall be paid before another
inspection can be scheduled.
By my signing below, I certify each of e following is tru I am the property owner or authorized agent to act
on the property owner's behal I u r tand and e amply with the re -roof policy st / d a ove.
Signature of Applicant/Agent: Date:G / U
ReroofPolicy_2010.doc revised 05/17/10
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