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10020092 . CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10311 JOHNSON AVE CONTRACTOR:ROOF ROOFING PERMIT NO: 10020092 OWNER'S NAME: SANTOS FAMILY LLC 5577 VASSAR DRDATE ISSUED:02/16/2010 JER'S PHONE: 9254474760 SAN JOSE,CA 95118 PHONE NO:(408)265-9270 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG I- ELECT[_ PLUMB License Class Lic.# (9,37?1_6 y � MECH RESIDENTIAL COMMERCIAL Contract ,�� Date -lQ ' /V JOB DESCRIPTION:RE-ROOF REMOVE EXISTING TAR&GRAVEL&INSTALL I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business&Professions A TAR&GRAVEL BUILT UP 17SQ 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 Sq.Ft Floor Area: Valuation:$5800 permit is issued. APPLICANT CERTIFICATION APN Number:37518034.00 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply 180 DAY ROM LAST CALLED INSPECTION. with all non-point source regulations per the Cu rtino Municipal Code,Section 9.18. Issued by: Date: Signature Date G OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for I,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(Scc.7044, Business&Professions Code) Signature of Applican: Date: oo� el I,as owner of the property,am exclusively contracting with licensed contractors to Cl construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE 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 I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. 1 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. Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534. 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 Owner or 'yr�z _ ! - forthwith comply with such provisions or this permit shall be deemed revoked. Dater CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save nify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applic understands and will comply ARCHITECT'S DECLARATION with all non-point source re tions r th pertino Municipal Code,Section 9.18. I understand my plans shall be used as public records. Signature Date �1"r�, Licensed Professional CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk : Lot: APN 37518034 . 00 DATE ISSUED. . . . . . . : 02/16/2010 RECEIPT #. . . . . . . . . BSC00009759 REFERENCE ID # 1OC20092 SITE ADDRESS 10. 11 JOHNSON AVE SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER SA[dTOS FAMILY LLC ADDRESS 10:311 JOHNSON AVE CITY/STATE/ZIP CU:?ERTINO, CA 95014 RECEIVED FROM HENRY W OLOCKI CONTRACTOR . . . . . . . : HX4K OLOCKI LIC # 26739 COMPANY ROOF ROOFING ADDRESS . 5577 VASSAR DR CITY/STATE/ZIP SAv JOSE, CA 95118 TELEPHONE (438) 265-9270 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- -- 00 1BCBSC VALUATION 5, 800 .00 1. 00 0 . 00 1 .00 0 • 1BSEISMICR VALUATION 5, 800 .00 0 .60 0 . 00 0 . 60 0 . 00 1REROOFRES SQ FEET 17 .00 221. 00 0 . 00 221 . 00 0 . 00 ---------- ---------- ---------- ---- TOTAL PERMIT 222 .60 0 . 00 222 . 60 0 .00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- ------------------- CREDIT CARD 222 . 60 MC --------------- TOTAL RECEIPT 222 . 60 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ------ ------------------- __ _ -- -- ---------- _ 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 604 ROOF IN-PROGRESS 605 FINAL REROOF CITY OF C'UPERTINO y '` REROOF CUPCITY F PERMIT APPLICATION Date: F _-7 __ I W —1 -11 � . I___� 0 Building Address: pp�� !hore#: Owner's Name: �� Zz-. HOA: Yes ❑ No If esprovide let-.er from HOA Phone #: Contractor: `�- Fax #: #: Cupertino Business License #: 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: Q�.�,,.�, L� •� � -�, k Residential Commercial : Please complete relevant portion of the Confirmed with Planning Dept. if Green Building p ❑ Green Building Checklist & attach it to the supplication or if there are any restrictions: applicable, include in Ian set & the sheet index. 0 Valuation: ter' Sys-�--�- I Have Read, Under nd and Will Comply with Cupertino's Tear-Off Policy: Signature Revised 02/05/09 CITY OF C'UPERTINO a. REF:OOF 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 Commissio a Fee 1BSEISMICO Seismic Commercial B 1RER00FRES Re-roof Residential B 1SFDWLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commissio i Fee / 1BSEISMICRE Seismic Residential B 1REROOFMRES Re-roof Multi-Family B 1MFDWLROOF / 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commissio:l 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 IBC Standards and manufacturers specifications on r,�-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 buildir►g 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 Ciiy,the following steps are required: 1) Pre-inspection and/or tear off approval. 2) In-progress inspection approval. 3) Final inspection approval. a) Spark arrester installation. 5. If plywood is installed,a plywood na it inspection is required. 6. Any roofing which is applied withou:first obtaining an inspection, will require the removal of all new material down to the sheathing, so a proper City inspection can be pe:-formed. 7. NOTE: If you call for a plywood nail inspection and the job is not ready, you will be charged a re-inspection fE e of$176.18. The re-inspection fee must be paid before another insyection can be scheduled. IMPORTANT: 1. Flat roofs must have a minimum of li. " per foot slope and demonstrate that there is no ponding. 2. An I.C.B.O. report is required to be o:i the job site at the time on inspection. I understand and will comply with the above stated policy on re-roofing. Homeowner's Name: Job Site Address: Roofing Company Name: Applicant's Signature: �� Date: Greg Casteel Building Official Revised 07/30/08 Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 Fax(408)777-3333 CITY OF :UPEPNTINO Buildin De artment JOB ADDRESS: PERMIT # 0O 'L d,-,, C�<Q O R'S NAME: S--`!o, ��--,, L PHONE #imAg M&TV L2 T4 S GENERAL CONTRAR: FAX # CTO I am not using any subcontractors: ;2 Si€nature Date Please check applicable subcontractors and complete the followinginformation: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass/ Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Date Owner/Contractor Signature