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10020062 CITY OF CUPERTITIO BUILDING PERMIT BUILDING ADDRESS: 10590 WHITNEY WAY CONTRACTOR:SHELTON ROOFING PERMIT NO: 10020062 OWNER'S NAME: BARKER VALARIE J TRUSTEE 1988 LEGHORN ST DATE ISSUED:02/11/2010 1ER'S PHONE: 4082550244 MOUNTAIN VIEW,CA 94043 PHONE NO:(650)961-7699 ❑ LICENSED CONTRACTOR'S DECLARATIONr— F- BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class (�—_3 ! Lic.# 26 lQ 2 /r I— r— MECH RESIDENTIAL COMMERCIAL Contractor � �� 7 Date c2.- /1—/D I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REROOF TAKE OFF OLD SHAKE ROOF,INSTALL 1/2 INCH (commencing with Section 7000)of Division 3 of the Business&Professions CDX PLYWOOD INSTALL 40 YEAR COMPOSITION ROOFING. 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 Sq.Ft Floor Area: Valuation:$18638 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:36939021.00 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. 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. Issued by: Date: Signature Date 0 V OWNER-BUILDER DECLARATION RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for the following two reasons: inspection. I,as owner of the property,or my employees with wages as their sole compensation, V will do the work,and the structure is not intended or offered for sale(Sec.7044, Signature of Applicant: Date: Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to 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 HAZARDOUS MATERIALS DISCLOSURE declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534. 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 Owne or ant ized a n mt: become subject to the Worker's Compensation provisions of the Labor Code,I ust � � � Date:C e- forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.) correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address i-' -unify and keep harmless the City of Cupertino against liabilities,judgments, and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. Licensed Professional Signatu Date a r -/i^ lC� CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36939021 . 00 DATE ISSUED. . . . . . . : 02/11/2010 RECEIPT # . . . . . . . . . : BS000009734 REFERENCE ID # . . . : 10020062 SITE ADDRESS . . . . . : 10590 WHITNEY WAY SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER BARKER VALARIE J TRUSTEE ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4442 RECEIVED FROM . . . . : SHELTON ROOFING CO CONTRACTOR . . . . . . . : WRAY, RICHARD LIC # 20755 COMPANY . . . . . . . . . . : SHELTON ROOFING ADDRESS . . . . . . . . . . : 1988 LEGHORN ST CITY/STATE/ZIP . . . : MCUNTAIN VIEW, CA 94043 TELEPHONE . . . . . . . . : (650) 961-7699 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 18, 638 . 00 1. 00 0 . 00 1. 00 0 . 00 1BSEISMICR VALUATION 18, 638 . 00 1. 90 0 . 00 1 . 90 0. 00 1REROOFRES SQ FEET 37 .00 481. 00 0 . 00 481 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 483 . 90 0 .00 483 . 90 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 483 . 90 18291 --------------- TOTAL RECEIPT 483 . 90 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 604 ROOF IN-PROGRESS 605 FINAL REROOF CITY OF CUPERTINO I.DI_7 REROOF 0 C 7 CITY OF CUPS TINO PERMIT APPLICATION APN # (0`l ?D C, �-I Date: tz C I Ito Building Address:.0 S�� `, lu�_ 4X-1 Owner's Name: Phone #: HOA: Yes ❑ No If Yes, provide letter from HOA Contractor: Phone #: 9� ` Fax #: i p--!& Cupertino Business Licen ��- Contractgr license'70 #: el/ Type of 11oof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles X Asphalt Shingles X_Wood Shakes ❑ Wood Shakes ❑ Wood Shingles o 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: •��,2�e�,(il d� � j�y,� �� / �� "'UU �—Iqs c Residential 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 inc.ex. Valuation: � 7 � p/- /9� 6 ?; -0, � 7 I Have Read, Understand and Will Comply wits Cupertino's Tear-Off Policy: of V� r Sign"af4e Revised 02/05/09 J CITY OF CUPERTINO CITY OF RE ROOF CUPEkTINO FEE SCHEDULE Number of Fee ID Fee Description Fee Permit Type Squares Group 1 REROOFCOM Re-roof C ammercial B 1 COMMLROOF TB Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1 BSEISMICO Seismic Commercial B E -1 3 7 1REROOFRES Re-roofRi,sidential B 1SFDWLR00F J 1BCBSC Cal Bldg standards B ALL PERMIT TYPES Commission Fee 1 BSEISMICRE Seismic Rosidential B 1 REROOFMRES Re-roof Ml ilti-Family B 1MFDWLROOF 1 BCBSC Cal Bldg S tandards B ALL PERMIT TYPES Commissicn 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 a;ree to comply with 2007 IBC Standards and manufacturers specifications on re-roofing.All roofs are Class "A"per Cupertino municipal code 16.04.080. 2. New roof coverings shall not be app ded 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: 1) Pre-inspection and/or tear off ap Droval. 2) In-progress inspection approval. 3) Final inspection approval. a) Spark arrester installation. 5. If plywood is installed,a plywood n iil 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 na:1 inspection and the job is not ready, you will be charged a re-inspection iee of$176.18. The re-inspection fee must be paid before another inspection can be scheduled. IMPORTANT: 1. Flat roofs must have a minimum of 14 "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. Homeowner's Name: s 4V14_.5 Job Site Address: /. �� !// " Roofing Company Name: Z4 f Applicant's Signature: i Date: i V Greg Casteel Building Official ReN ised:07/30/08