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13070068 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 11746 PINE BROOK CT CONTRACTOR:DAN ELLIOTT'S ROOFING PERMIT NO; 13070068 CO OWNER'S NAME: LEE DAVID S AND MAY P P O BOX 26878 DATE ISSUED:07/10/2013 OWNER'S PHONE: 4083914505 SAN JOSE,CA 95159 PHONE NO:(408)559-7327 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r- ELECT r PLUMB� License Class 7_301 Lic.# l 3 /- q MECH RESIDENTIAL r COMMERCIAL Contractor � (/ S Date 7—/-� 3 I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:RE-ROOF TEAR OFF EXISTING NO PLYWOOD REQUIRED (commencing with Section 7000)of Division 3 of the Business&Professions 25SQ Code and that my license is in full force and effect. GAF GRAND CANYON 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 proyided for by Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area: Valuation:$10648 permit is issued. APPLICANT CERTIFICATION APN Number:36604073.00 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 DAYS FROM LAST CALLED INSPECTION. with all non-point source regulations per tl a Cupertino Municipal Code,Section 9.18. Issued by: Date: Signatu �. Date 7" g"J3 ❑ 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 1,asowner 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(Sec.7044, Business&Professions Code) Signature of A plican r_ Date: I,as owner of the property,am exclusively contracting with licensed contractors to ,45 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: 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 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. 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. 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 011n oat r', e il forthwith comply with such provisions or this permit shall be deemed revoked. Date: 7 APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY 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 indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address costs,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. I understand my plans shall be used as public records. SignaturV Date`��3 Licensed Professional .30-7vv44 REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPERTIINO (408)777-3228•FAX(408)777-3333•buildinaftypertino.ora PROJECT ADDRESS , ` APN# ✓ /� ©� l (/ s OWNER NAME o ( P qs� E-MAIL STREET ADDRESS s A ` l 0 CITY,STATE,ZIP FAX CONTACT NAME W < E-M[AIL CE - STREET ADDRESS �l 4-� CITY,STATE,ZIP� --,Si)�� ci ; �� F `�� ❑OWNER ❑ OwNER-BuiLDER .OWNER AGENT N CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCFIrrECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTORNAME - LICEN LICENSET BUS.LIC.# fi. 'D ER C- 1369 COMPANY N % • j Co E-MAIL, FAX ^✓ 36 STREET ADDRESS ^a ( / CITY,STATE,ZIP c�( -sv�p� PHONE ARCIMCT/ENGINEER NAME LICENSE NUMBER ` BUS.LIC.# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF S SFD or Duplex ❑ Multi-Family ROOF AREA: VALUATION: STRUCTURE: ❑ Commercial Q )(0-70— EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES I&WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY) REMOVE JREPLACE la YES IF NO PLYWOOD 13 K- ❑ PLYWD ❑OSB PITCH: ROOF ❑ #LA ❑s,s- ❑CDX :12 1CLASS: A PROPO.SEDROOF TYPE: ❑BUILT-UPROOF IR ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD sumLES ❑OTHER ICC-ES REPORT# DESCRIPTION OF WORK: ' t fl Cp 4 �1 T) � dY1 �Ah 0 1!cn-55 ` ' e Q 5 S l-e e 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 buil ' on. I a rite rep sentatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: ^� SUPPLEMENTAL INFORMATION REkVdED OFFICE USE ONLY _If building is associated with a Home Owner's Association,provide letter PLS CEMCKTYPP ROUTING SLIP of approval from HOA. ❑ OVER-TEE-COUNTER ❑ BUILDING PLAN REVIEW _Provide Planning approval to verify if there any restrictions. ❑ ExPMss ❑ PL&"ING PLAN REVIEW Provide copy of Manufacturer's.Installation Specifications. ❑ STANDARD ❑ FIRE DEPT Provide signed copy of Cupertmo's Tear-Off Policy. ❑ OTHER: C-3 ReroofApp_2011.doc revised 03/16/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 11746 pinebrook ct DATE: 07/10/2013 REVIEWED BY: larrys APN: BP#: "'VALUATION: 1$10,648 %PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof PRIMARY SFD or Duplex PENTAMATION 1SFDWLR00 USE: PERMIT TYPE: WORKtf existin no plywood required, of rand canyon SCOPE FEE ID ROOF AREA s.f. 1REROOFFRES 2,500 Mech.Plan Check Plumb. Plan Check flee.Plan Check iRvlech.f ennit Tee: Plumb.Permit Fee: Elec. Permittee: t)iher:Hech.Ins, . Ofher Plumb Insp. Other Elec.Ins", t ec —I— h.Inr"..l ize: Plumb. lusp.Fee: Elec.Ins", fee: NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). These ees are based on therelimina information available and are only an estimate- Contact the De t or addn'l info, FEE ITEMS(Fee Resolution 11-053 E . 711/12) FEE QTY/FEE MISC ITEMS Plan Check Fee: Suppl. P(..:Fee Plumb.111ec:h./Plec Permit Fee: $400.00 .Suppl. Insp Fee Plumb.111fech lElec Plurnb..Ivlech./L lec;Permit Fee: Construction Tax: <4drninhstrcative.Fee: Work Without Permit? 0 Yes (E) No $0.00 Advcanced Planning Fees: � . Tr Uvel Docurnenttaoon F'ees: 4© A Strong Motion Fee: IBSEISMICR $1.06 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 40 $402.061 $0.00 Revised: 07/0.1/2013