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14110072 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 18691 BARNHART AVE CONTRACTOR:ANTHONY RAINIERI PERMIT NO: 14110072 ROOFING INC OWNER'S NAME: SAN JOSE,CA 95124 PHONE NO:(408)265-8010 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL [—] COMMERCIAL vv��// RE-ROOF 25 SQ' REMOVE EXISTING TAR GRAVEL ROOF License Class 3 Li,.# �,a'`I 7 6 INSATLL 3 PLY CAPSHEET Contractor/ Dated�,, I hereby affirm that I am licensed under the provisions of Chapter 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:$10000 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: Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information ispEi EXPIRES IF IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WIT 180 DAYS OF PERM ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter INSPECTI N. upon the above mentioned property for inspection purposes. (We)agree to save 180 D indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the Issue by: Date: 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. �1'� 3�I ROOFS: Signatur /) Date 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 _ 3--/ I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applican� � the following two reasons: ALL ROOF 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) 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 25505,2,V33),and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized age n� L_Y1�cltfll 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 CERTIFICATION 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 REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION \\ 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333•buildingCoDcupertino.org \ PROJECT ADDRES1 / ^ APN# � � Oyu v V OWNER NAME (� STREET ADDRESS iCITY, STA"TE,,ZZIP FAX CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY,STATE,ZIP FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT C RA��tNAME U1 `,+ y/ __a�`� LICEN7-Z BE-R6` L NST�T�P£ BUS.LIC.# COMPANY NAME (� S 1`U E-M C.7O Z� I � c� ^)M !J k C A�eV STREET ADDRESS16� fO„ l, , r k6- C , ATFL,ZIP O S /1W� ��•(Z�J PHg4.bg -Zb�-go O ARCHITECT/ENGINEER NAME �l{�, (i LICENSE NUMBER} C-• BUS.LIC.# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF SFD or Duplex ❑ Multi-Family ROOF AREA: V ATION: STRUCTURE: ❑ Commercial $� EXISTING ROOF TYPE: BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY) REMOVE/REPLACE XYES IF NO, PLYWOOD ❑ w, ❑ PLYWD ❑ OSB PITCH: ROOF ❑ NO #LAYERS: THICKNESS: ❑ 5/8” TYPE: ❑ CDX 12 CLASS: L1 PROPOSED ROOF TYPE:/BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT# DESCRIPTION OF WORK: ^ ---410 VO YL I C "VOL^ ^ �7—' C ,_S-r4L4_ 474 By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is correct. I hav d the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to b il&g constructs I — Date: SUPPLEMENTAL INFORMATION REQUIRED {w r oiFzcEusoNiY _If building is associated with a Home Owner's Association,provide letter =3 i�AC>�CxTmE� ROUrnvG s>IP of approval from HOA. [�� ' � ❑ OAR TSE COUITERt x �BUILDINGRLAN REVIEW i Provide Planning approval to verify if there any restrictions. x �- EXPRE$ � � -. y �; x�,`❑f PLANNINGPLANREVIEW, Provide copy of Manufacturer's Installation Specifications. 1uIizEDEr �f Provide signed copy of Cupertino's Tear-Off Policy. * ❑ OTHER ReroofApp_2011.doc revised 03/16/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 18691 barnhart ave DATE: 11/12/2014 REVIEWED BY: Mendez APN: BP#: *VALUATION: 1$10,000 *PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof PRIMARY SFD or Duplex PENTAMATION 1 SFDWLROOF USE: P PERMIT TYPE: i WORK re-roof 25 sq, remove existin .tar gravel roof insatll 3 ply ca sheet SCOPE FEE ID ROOF AREA s.f. 1REROOFFRES 2,500 If('cr ;Para Che. k Phwlb. Plan Ched..'A Alec, 1,10P('hecfc Peri1NL/`E.e: PltdtYtl'. Pe'm"I }fttr_7 ecrr. fi'-s,^ E?tite,Plum',)7nsP. EI 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 information available and are onl an estimate. Contact the Dept-for addn'1 info. FEE ITEMS (Fee Resolution 11-053 Ef. 7/1/13) FEE QTY/FEE MISC ITEMS Plan Permit Fee: $425.00 Pe=r•naiiFee: F71�:Fr:itt`tfW'Ir«tt f c3:1: Work Without Permit? ® Yes (F) No $0.00 P',::i-s'et Fe'E.'1': L A Strong Motion Fee: IBSEISMICR $1.30 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 $427.30 $0.00 _ TOTAL FEE: $427.30 Revised: 10/01/2014