13050184CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20156 PACIFICA DR
CONTRACTOR: A4 . ,5-
PERMIT NO: 13050184
OWNER'S NAME: OSTENDORF HAROLD ET AL
DATE ISSUED: 05/24/2013
OWNER'S PHONE: 4088574392
PHONE NO:
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL[
13 LICENSED CONTRACTQOR'S DECLARATION
J 3,Z
(25 SQ'S) TEAR OFF (E) WOOD SHAKE, INSTALL (N)
License Class Li.. # 1
CLASS A COMP ROOF SYSTEM. UPGRADE (E) 100 AMP
'� C Q S -r 2�emo�✓ Date -531 2)
PANEL TO 200 AMP, SAME LOCATION & REPLACE (E)
Contractor / t
I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000) of Division 3of 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
Valuation: $15000
performance of the work for which this.permit is issued.
Sq. Ft Floor Area:
I have and will maintain Worker's Compensation Insurance, as provided for by
APN Number: 36928020.00
Occupancy Type:
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
PERMIT EXPIRES IF WORK IS NOT STARTED
correct. I agree to comply with all city and:coumy ordinances and state laws relating
WITIIIN 180 DAYS O T 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 DAYS F AS ALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
City in of the
17,
costs, and expenses which may accrue against said consequence
Issu
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.
— Date_ /h
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
Signature
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
S
❑ OWNER DECLARATION
-BUILDER
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 R F COVERINGS TO BE CLASS "A" OR BETTER
I, 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)
1, 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:
I have and will maintain a Certificate of Consent to self -insure for Worker's
Health & Safety Code, Section 25532(a) should I store or handle hazardous
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
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and.
performance of the work for which this permit is issued.
I have and will maintain Worker s'Coru&nsation Insurance, as provided for by
this
the Health &Safety Code, Sectio 5533, an
Section 3700 of the Labor Code, forthe.performance of the work for which
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
CONSTRUCTION LENDING AGENCY
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
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'CERT IFICATION
Lender's Address
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
ARCHITECT'S DECLARATION
indemnify and keep harmless the City of 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
CONSTRUCTION PERMIT APPLICATION ^�
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION �J
10300 TORRE.AVENUE • CUPERTINO, CA 95014-3255
(4Q8) 777-3228 • FAX (408) 777-3333 • building(cDcupertino.org
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PROJECT ADD)2ES
APN #
OWNERNAME 2D1_YrV OTS! c+V f—
PHO 4tj �7_ 4392-
E-MAIL
STREET ADDRESS I pa GI S -ck Pi
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FAX
CONTACT NAME C�1 A Tl
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STREET ADDRESS. '
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CITY, STATE, ZIP
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FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCFIIrECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRA TO i N
LICENSE NUMBER
LICENSE TYPE
BUS. LIC #9-3, 4 /
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COMPANY NAME `
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E-MAIL%trI-?,A sA--`lL. YQ�ino. Com
STREET ADDRESS ..
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ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CrTY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
4rv6L (/if cl;E
:. eoo - Zoo P
EXISTING USEPROPOSED
'
USE
CONSTR. TYPE
# STORIES
USE TYPE OCC.
SQ.FT.
VALUATION ($).
EXISTG
AREA
NEW FLOOR
. AREA
DEMO
AREA
TOTAL
NET AREA
BATHROOM -
REMODEL AREA -
twuI N
REMODEL AREA
OTHER
REMODEL AREA
-
. PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA: DETACH
❑ ATTACH
.. #DWELLINGUN_S:'
ISA'SECONDUNrr ❑YES
BEING ADDED? ❑ NO
SECOND STORY [YES
ADDITION? []NO
- TOTAL VALUATION:
PLANNINGAPPL# ❑NO PLANNING APPROVAL LETTER EICHLERHOME? ❑ 5/j03
-. PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF . IS THE BLDG AN ❑YES - CE �towt
By my signature below, I certify to each ofthe following: I am the property owner orauthorized agon a prop ty ownees 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 buildin s fiat I authorize r es of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENT ORMATION REQUIRED
c e : • . oUT c`
New SFD or Multifamily dwellings: Apply for demolition permit for
v� co BUILDING .L `°
existing buildirig(s):. Demolition permit is required prior to issuance of building
permit for new building.
E r
f
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
_
form if any Hazardous Materials are being used as part of this project.
y�
_ Copy of Planning Approval Letter or Meeting with Planning prior to
o d ait ,sER
submittal of Building Permit application.0
B1dgApp_2011.doc revised 06121/11
CITY OF CUPERTINO
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ADDRESS: 20156 PACIFIOWW Ve ,
DATE: 05/24/2013
REVIEWED BY: MELISSA
APN: 369 28 020
BP#:
*VALUATION:
$15,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY
SFD or Duplex
PENTAMATION 1SFDWLR00F
PERMIT TYPE:
USE:
WORK
25 SQ'S TEAR OFF E WOOD SHAKE INSTALL N CLASS A COMP ROOF SYSTEM. UPGRADE
SCOPE I
(E) 100 AMP PANEL TO 200 AMP, SAME LOCATION & REPLACE (E) FURNACE, SAME LOCATION
NOTE. This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District etc.). These fees are based on the prelimina
FEE ITEMS (Fee Resolution 11-053 E . 7f� /1/12)
Plan Check Fee:
Suppl. PC Fee: E) Reg. O OTFO.01 hrs
PME Plan Check:
Permit Fee:
Suppl. Insp. Fee:Q .Reg: O OT F0.01hrs
PME Unit Fee:
PME Permit Fee:
Construction Tax.
Administrative Fee: IADMIN
Work Without Permit? O Yes (E) No
Advanced Planning Fee:.
Travel Documentation Fee: ITRAVDOC
Strom; Motion Fee: IBSEISMICR
Bldg Stds Commission Fee: IBCBSC
motion available and are only an estimate. contact me ueptjor auun
FEE QTY/FEE I MISC ITEMS
$0.00 12,500 1 s.f. Re -roof
$0.00 $375.00 1REROOFRES
$0.00 r-2-0-0-1 amps Electrical
$0.00 $45.00 1 IBELEC200 Services
$0.00I ' # Mechanical
$0.00 $133.00 IMFR=<loo Furnace, Forced -Air
$90.00
$42.00
$0.00
$0.00
$45.00'
$1.50
$1.00
$1.79.501 $553.00
X
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Select a Non -Residential 0
Building or Structure
i
Select an Administrative Item
$732.50
4ev.ised: 04/29/2013
REROOF TEAR -OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
CUPERTIINO
(408) 777-3228 - FAX (408) 777-3333 • building
C@cupertino.ora
PROJECT ADDRESS ''f Q' .s6 :.1%A c i i CA IPyt l vt
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APN # .
OWNERNAME F A✓LIi�LC Y D
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PHOT(
STREET ADDRESS
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Cn'Y STATE, P ?. A/b A
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FAX
CONTRACTOR N�ME� A A �l CI
LICENSE NUMBER + J
J�l.�j`79
LICENSE TYPE
BUS. LIC.
COMPANY NAME /yv 1 . C 4_rV f_A ✓ G�) bJ J
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E-MAIL/y, A-�,
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FAX j,
STREET ADDRESS
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CITY STATE,'ZIPC�,
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I UNDERSTAND AND AGREE TO THE FOLLOWING:
1. The re -roof project shall comply with all applicable provisions of the 2010 California Codes.
2. An inspection request can be scheduled up to one business day before the requested inspection date.
Please call (408) 777-3228 from 7:30-3:30pm (Mon-Thurs) or 7:30-2:30pm (Friday) to schedule
inspection. For Tear -Off and Nailing Inspections, you must also call on the day of the inspection only .
after that phase of the work is completed. The building inspector will be available within one hour.
Final Inspections will be given a two hour window.
3. Tear -Off Inspection is required. Any and all dry -rotted wood shall be replaced prior to this inspection.
Unless new plywood roof sheathing is proposed throughout, all the nails/fasteners shall be either
completely knocked -down or removed prior to this inspection.
4. if plywood is: installed, :a plywood Nailing Inspection is required.
5. Roofing shall not be applied without first obtaining all prior inspection 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 the sheathing so a proper inspection can be performed.
6. A Final Inspection and approval shall be obtained from the building inspector when the re -roofing is
completed. To receive a final sign -off, the following items will be verified:
a. Flat roofs shall have a minimum of 1/4" per foot of slope and 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, vents painted, gutter/downspouts installed, debris removed.
7. 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. The re -inspection fee shall be paid before another inspection can be
scheduled.
By my signing below, l certify each of the following is true: I am the property owner or authorized agent to act on the
property owner's behalf. I understand and agree to comply with the re -roof policy stated above. I also understand that
smoke detectors and carbon monoxide detectors are required to be installed in accordance with Sections R314 and R315 of
the 2010 California Residential Code.
Signature of ApplicanVAgent: Date:
ReroofPo1icy_2012.doc revised 1017112
CUPERTINO
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: ZoI56 .9YZ- .
PERMIT # 13 QS,d S 4
OWNER'S NAME: G �2vLK oS rtiv)0 1Z-- r
PHONE # 4dP-) G,:2 -C 13 1
GENERAL CONTRACTOR:
BUSINESS LICENSE # q XZ.9--7
ADDRESS: / �2v ti >r o Lir
CITY/ZIPCODE: CA" JvlLr C 0 1Sll
*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 AND ALL SUBCO TORS. HAVE OBTAINED .A :`CITY 9F CUPERTINO
BUSINESS LICENSE. Aj
I am not using any subcontractors:
ature Date
Please check applicable subcontractors and complete the following information:
V
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