13040163 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 11143 WILKINSON AVE CONTRACTOR:FALCON ROOFING PERMIT NO:13040163
OWNER'S NAME: WEI JOHN S AND WEN-LING 13088 POTTS DR DATE ISSUED:04/23/2013
OWNER'S PHONE: 4084838869 SAN JOSE,CA 95111 PHONE NO:(408)225-1705
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL El COMMERCIAL
License Class Lica#_ T. REMOVE(E)WOOD SHAKE,INSTALL 1/2" OSB PLY&
LITE TILE S 5LBS 60Z PER SQ EAGLELITE(3000 SQ FT)
Contractor ate
I hereby affirm that I am licensed under the provis' ns of apter 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. Sq.Ft Floor Area: Valuation:$20460
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 APN Number:35617042.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.I agree to comply with all city and.county ordinances and state laws relating WITHIN 180T F PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the.above.mentioned property for inspection purposes. (We)agree to save 180 D CALLED INSPECTION
indemnify and keep;harmless the City.,of Cupertino against liabilities,judgments,
costs,and expenses which.may accrue against said City in consequence of the ssued b
granting of this permit: Additionally,the applicant understands and will comply y Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature Date �3 All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
❑ OWNER-BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: ALL RO COVERINGS TO BE CLASS"A" R BET4R
1,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure isnot intended or offered for sale(Sec.7044,
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business,&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. I will
I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533,and 25534.
Section 3700.of the Labor Code,for the performance of the work for which this Owner or authorized agent Date:
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 CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANT:CERTIFICATION Lender's Address
I certify that I have read.this application and state that the above information is
correct:d 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 ARCHITECT'S DECLARATION
indemnify and keep harmless the Cityof Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting of this permit;Additionally,the.applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18:
Signature Date
i
REROOF PERMIT APPLICATION a
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTlhlO (408)777-3228•FAX(408)777-3333•b___g@Lertino.org
_p
PROJECT ADDRESS: f/j� APN# 3--
OWNERNAME PHONE
STREET ADDRESS CITY,STATE,ZIP FAX
a
CONTACT.NAME PHONE E-MAIL
STREET ADDRESS CITY,STATE,ZIP FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC.#
1
COMPANY NAME + EMAIL FAX
STREET ADDRESSCITY,STATE,ZIP PHO
+%
ARCHITECT/ENGINEERNAME LICENSE NUMBER BUS. C.it
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF E3 'SFD Or Duplex E] Multi-Family ROOF AREA: VALUATION:
STRUCTURE: . .❑ Commercial .. _ .
EXISTING ROOF.TYPEd_:❑BUILT-UP ROOF 1]ASPHALT SHINGLES WOOD S ❑WOOD SHINGLES OTHER(SPECIFY)
p�
REMOVE/REPLACE; _YES IFNO, PLYWOOD jW'h" ❑ PLYWD OSB PTTCH: ROOF
❑NO LAYERS: THICKNESS: ❑ 518" TYPE: ❑CDX '12 CLASS: A
ICC-ES REPORT#
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER I
DESCRIPTION OF WORK L/
-7—
-7/ t-,
✓✓✓
�i
c
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building construction. I authorize etptiveq Of CUP911ino to enter the above-idofitified pro rty for inspection purposes..
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORMATION REQUIRED -'
If building is associated with a Home Owner's Association,provide letter.
of approval from HOA.
Provide Planning approval to verify if there any restrictions.
Provide copy of Manufacturer's Installation Specifications.
Provide signed copy of Cupertino's Tear-Off Policy.
ReroofApp 2011.doc revised 03/16/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 11143 WILKINSON AVE DATE: 04/23/2013 REVIEWED BY: MELISSA
APN: 356 17 042 BP#: "VALUATION: $20,460
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY SFD or Duplex PENTAMATION 1 SFDWLROO
USE: p PERMIT TYPE: i
WORK REMOVE E WOOD SHAKE INSTALL 1/2 " OSB PLY& LITE TILE S 51LBS 60Z PER SQ
SCOPE EAGLELITE (3000 SQ.FT)
gfj
Mech.Plan CheckI Is Phanb,Platt Check Elect.Plan Check'
Mech.Permit Fee: Plumb.Permit Fee: Elec. Permit Fee:
Other dlech.Insp. Other Plumb Insp. Other Elec.Insp.
Mech.Insp..Fee: Plumb. Insp.Fee: Elec.Insp.Fee:
NOTE:This estimate does not include fees due to other Departments(i.c Planning,Public Works,Fire,Sanitary Sewer District,School
District,eta). Theseees are based on the prelimina information available and are only an estimate- Contact the De t or addn'l in o.
FEE ITEMS(Fee Resolution 11-053 Eff. 711112) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 3,000 s.f. Re-roof
Suppl.PC Fee: (F) Reg. 0 OT0.0 hrs $0.00 $450.00 IREROOFRES
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl.Insp.Feeig Reg. 0 OT [0,01hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Conslr ztctiT7E
on:T car:
Administrative Fee:
Work Without Permit? 0 Yes (E) No $0.00 0
Advanced Planning Fee: $0.00 Select a Non-Residential 0
Building or Structure
Travel Documentation Fees` �
Strong Motion Fee: 1BSEISMICR $2.05 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00
$3.05 $450.00 $453.05
Revised: 04/01/2013