10030145 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22130 WALLACE DR CONTRACTOR:R E ROOFING& PERMIT NO: 10030145
CONSTRUCTION INC
'NER'S NAME: ANASTOLE GUS AND DOROTHY 15230 CLYDELLE AVE DATE ISSUED:03/25/2010
OWNER'S PHONE: 4082450225 SAN JOSE,CA 95032 PHONE NO:(408)626-9320
❑ LICENSED CONTRACTOR'S DECLARATION
�� __� G BUILDING PERMIT INFO: BLDG ELECT PLUMB
Li e a � Lic.# 1 I
_ MECH r RESIDENTIAL r COMMERCIAL
ontracfo(f Date
1. . .
I hereby-affiir_ that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:RE-ROOF REMOVE EXISTING WOOD SHAKE,INSTALL
(commencing with Section 7000)of Division 3 of the Business&Professions NEW
Code and that my license is in full force and effect. 1/2"CDX,30#FELT&LIFETIME COMP CLASS A 28SQ;
HOUSE&DETACHED GARAGE
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.Ft Floor Area: Valuation:$13000
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is APN Number:32603034.00 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, PERMIT 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 noxi paint s 1�,lations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION.
9.1
- ,
mature` `- Date y� �� Issued by.- Date: ?-r-40
1
❑ 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 roofs shall be inspected prior to any roofing material being installed.If a roof is
1,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 structure is.not intended or offered for sale(Sec.7044, inspection.
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to Signature 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 have read the hazardous materials requirements under Chapter 6.95 of the
California 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.
permit is issued. Additionally,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 contaminants 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 maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Compensation laws of California. If,after making this certificate of exemption,I, e h&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.'., Ont�nQ r a d�g nt: ,
,� \ Date:--�
APPLICANT CERTIFICATION
CONSTRUCTIO 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 hereby 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 which this permit is issued(Sec.3097,Civ C.)
the above mentioned property for inspection purposes.(We)agree to save Lender's Name
unify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the Lender's Address
gran, this pe dditionally,the applicant understands and will comply
with all non- t source re- atigns per upertino Municipal Code,Section ARCHITECT'S DECLARATION
9.18. f f
(� I understand my plans shall be used as public records.
Signature
- - - Licensed Professional
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 32603034 . 00
DATE ISSUED. . . . . . . : 03/25/2010
RECEIPT # . . . . . . . . . : BS000010026
REFERENCE ID # . . . : 10030145
SITE ADDRESS . . . . . : 22130 WALLACE DR
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : ANASTOLE GUS AND DOROTHY
ADDRESS . . . . . . . . . . : 22130 WALLACE DR
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-0125
RECEIVED FROM . . . . : R E ROOFING& CONSTR
CONTRACTOR . . . . . . . : PROCTOR, PAUL LIC # 20615
COMPANY . . . . . . . . . . : R E ROOFING & CONSTRUCTION INC
ADDRESS . . . . . . . . . . : 15230 CLYDELLE AVE
CITY/STATE/ZIP . . . : SAN JOSE, CA 95032
TELEPHONE . . . . . . . . : (408) 626-9320
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 13, 000 .00 1. 00 0 . 00 1 . 00 0. 00
1BSEISMICR VALUATION 13, 000 .00 1 . 30 0 . 00 1 .30 0. 00
1REROOFRES SQ FEET 28 .00 364 . 00 0 . 00 364 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 366 .30 0 . 00 366 .30 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 366 .30 #2169
---------------
TOTAL RECEIPT 366 .30
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
CITY OF
CITY OF CUPERTINO
REROOF
CUPERTINO PERMIT APPLICATION
APN# C, Date:
Building Address: ,2, 2-
Owner's
Owner's Name: ��l-�(�;tea 41A
�� Phone #:
2 022
HOA: Yes ❑ No If Yes, provide letter from HOA
Contractor: (; Phone #:
Fax#:
� 6 b
Cupertino Business License #: l Contractor License #:
Type of Roof Covering:
Existing: Proposed: -
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles Asphalt Shingles
Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other (Specify)
Number of existing coverings ❑ Provide I.C.C.E.S. Report#
�To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description: „t, � l ti w� /�L�l �1 /�tti� lel j
tesidential Commercial
Green Building: Please complete relevant portion of 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 r 3 0 dd �I' 2� 1�` /
I Have derstan d Will Co with Cupertino's Tear-Off Policy:
Signature- --'�
Revised 02/05/09
CITY OF
CITY OF CUPERTINO
[M REROOF
CUPERTINO 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
2 1RER00FRES Re-roof Residential B 1SFDWLR00F
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
1BSEISMICRE Seismic Residential B
1REROOFMRES Re-roof Multi-Family B 1MFDWLROOF
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
1BSEISMICRE Seismic Residential B
1BUSLIC Business License B
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
Fax: (408)777-3333
Building Department
Subject: Re-roofing policy for the City of Cupertino
1. Prior to permit issuance,you must agree to comply with 2007 CBC Standards
and manufacturers specification's on re-roofing. All roofs are Class"A" per Cupertino
municipal code 16.04.080.
2. New roof coverings shall not be applied without first obtaining all inspection
and written approval from the building inspector. A final inspection and
approval shall be obtained from the building inspector when the re-roofing
is completed.
3. All roofs shall be inspected prior to any roofing installation.
4. To receive a final sign off from the City,the following steps are required:
Pre-inspection and/or tear off approval.
a) AT TEAR OFF PULL OUT ALL ROOF FASTENERS.
2) In-progress inspection approval.
3) Final inspection approval.
a) Spark arrester installation.
5. If plywood is installed,a plywood nail inspection is required.
6. Any roofing which is applied without first obtaining an inspection,
will require the removal of all new material down to the sheathing,
so a proper City inspection can be performed.
7. NOTE: If you call for a plywood nail inspection and the job is not ready,
you will be charged a re-inspection fee of$126.00. The re-inspection fee must
be Raid before another inspection can be scheduled.
IMPORTANT:
1. Flat roofs must have a minimum of 1/4" per foot slope and demonstrate
that there is no ponding.
2. An I.C.B.O. report is required to be on the job site at the time on inspection.
I understand and will comply with the above stated policy on re-roofing.
AJHomeowner's Name: 3u,�,UPq-\4 A
Job Site Address: 2-
Roofing Company Nam . T_\0 C_ J�
Applicant's Signature: Date:
Albert Salvador
Building Official
Revised 3/09/10
M.Indoor Air tnt
Quality and shes INPUT Resources Energy IAQ,'Heaftr'
1.Use Low/No-VOC Paint 1 IAQ/Health pts y=yes 0
2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y—yes 0
3.Use Low/No VOC Adhesives 3 IAQ/Health pts y—yes 0
4.Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes 0
5.Use Engineered Sheet Goods with no added Urea
Formaldehyde 61AQ/Health pts y=yes
0
0
6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y—yes
7.Seal all Exposed Particleboard or MDF 4 IAQ/Health pts y=yes 0
8.Use FSG Certified Materials for Interior Finish 4 Resource pts y=yes 0
9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y=yes 0
10.Install Whole House Vacuum System 3 IAQ/Health pts y—yes 0
1 1 1
N.Flooring
1.Select FSC Certified Wood Flooring 8 Resource pts y=yes 0
2.Use Rapidly Renewable Flooring Materials 4 Resource pts y=yes 0
3.Use Recycled Content Ceramic Tiles 4 Resource pts y--yes 0
4.Install Natural Linoleum in Place of Vinyl 5 IAQ/Health pts y=yes 0
5.Use Exposed Concrete as Finished Floor 4 Resource pts y=yes 0
6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes 0
1 i 1
Total Points Available: 1 1401 130 57
Total Points Project Received: 01 01 0
G:data/progslgreenbuildinoguidelinestremodelers/greenpointsfinal212-D4protected.xis
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
CUPERTINO Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
pq
JOB ADDRESS: L, 1 C PERMIT# 60 G �5
OWNER'S NAME: -1ZC)il /k -ru � PHONE # (A- Z - CO2-0
GENERAL
0Z-
GENERAL CONTRACTO tC Todr-jhjW BUSINESS LICENSE # -2- U 3 1(;-
ADDRESS: ` ' , CITY/ZIPCODE: 2
*Our municipal code requires all businesses working in 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 ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE. 4 Z�j 1
I am not using any subcon actors:
- 'Signature Date
Please check applicable subcontractors and complete the following information:
6/ 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
Owner/Contractor Signature Date