15060196 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20380 TOWN CENTER LN CONTRACTOR:BIGHAM TAYLOR PERMIT NO: 15060196
ROOFING CORP
OWNER'S NAME: FUND VIII CUPERTINO LLC 22721 ALICE ST DATE ISSUED:06/30/2015
OWNER'S PHONE: 4089730783 HAYWARD,CA 94541 PHONE NO:(510)886-0197
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL
l REMOVE EXISTING B.U.R ROOF AND REPLACE WITH(N)
License Class �" Lic.# y �//�/ FIRESTONE 60 MIL T.P.O 1/4 DENS DECK(40 SQUARES)
Contractor Date 6-30"Z.�
1 hereby affirm that m 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:541000
tfl�ave 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:36940059.00 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 180 DAYS OF 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 DAYS FROM LAST 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 XC1�S
granting of this permit. Additionally,the applicant understands and will comply Issued by: J Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
ff ^Z,, RE-ROOFS:
Signature Date l9 All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed without first obtaining an inspectiAlreeo remove all new materials for
inspection.
OWNER-BUILDER DECLARATION (-O -3Signature of Applicant: rDate.
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: ALL ROOF COVER S 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(x)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 LtheCupertiiZ
AAir Quali Management District I
performance of the work for which this permit is issued. will maintain compliance witMunicip Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,S05,2 33,and 534.
Section 3700 of the Labor Code,for the performance of the work for which this G 3 L
permit is issued. Owner or authorized agent: Date:
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.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 jsyo()J%,
COMMUNITY DEVELOPMENT DEPARTMENT- BUILDING DIVISION
10300 TORRE AVENUE-CUPERTINO, CA 95014-3255
CUPERTINO (408)777-3228- FAX(408)777-3333- buildingCa)-cupertino.org
PROJECT ADDRESS / APN#
OWNER NAME `.40 /L PHONE E-MAIL
STREET ADDRESS t7 O L/ CITY, STATE,ZIP �` FAX
r.✓t, K � �.� s p C11+
CONTACT NAME PHONE E-MAIL
STREET ADDRESS CITY,STATE, ZIP FAX
❑ OWNER ❑ OWNER-BurLDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRAON� / LICENSE NUMBER LICENSE TYPE BUS.LIC.#
COMPANY NAME!. /67 fl*'
E-MAIL f F�1
STREET ADDRESS A / �� �� CITY,STA ,ZIP /70/
/� PHONE_49/O O
f— (—�
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC.#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑ $FD or Duplex El Multi-Family ROOF AREA: VALUATION:
STRUCTURE: Commercial �l 005110
EXISTING ROOF TYPE: ILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY)
REMOVE/REPLACE ES IF NO. PLYWOOD i' ❑ TIPLYwD ElOSB PITCH: �j. ROOF
❑NO #LAYERS: THICKNESS: ❑ 5/8" TYPE: ❑ CDX ( '12 CLASS: A
RE
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF E3 ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES 910 ICC-ES OZ
DESCRIPTION OF WORK: Y u/ —
17 J a�4/4_1
t C Gtal
By my signature below,I certify to each of the following: I am the property o r authorized agent to act on the property owner's behalf. I have read this
application and the information I have provide-as co ect. I haver d the Des I ' and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to bui2tt�;
I aut r e rep tat' es of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date:
IF
SUPPLEMENTAL INFORMAT N REQUIRED OFFICE USE ONLY
_If building is associated with a Home Owner's Association,provide letter PLAN CHECK TYPE ROUTING SLIP
of approval from HOA. ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW
Provide Planning approval to verify if there any restrictions. ❑ EXPRESS ❑ PLANNING PLAN REVIEW
Provide copy of Manufacturer's Installation Specifications. ❑ STANDARD ❑ FIRE DEPT
_Provide signed copy of Cupertino's Tear-Off Policy. ❑ OTHER:
ReroofApp_2011.doc revised 03/16/11
CITY OF CUPERTINO I � ��`C
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 20380 TOWN CENTER LN DATE: 06/30/2015 REVIEWED BY: PAUL
APN: 369 40 059 BP#: 'VALUATION: 1$41,000
;�PERIMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY PENTAMATION
USE: Commercial Building PERMIT TYPE: 1 COMMLROO
WORK Remove existing B.U.R roof and replace with N firestone 60 mil T.P.O 1/4 dens deck 40 Squares)
SCOPE
FEE ID ROOF AREA
s.f.
1REROOFCOM 4,000
T T_
,Meeh. Plan Check Plumb. flan Check Elec..Plan Check
Mech. Permit Fere F,"lumb, Permit Fc<e: Elec. Permit F ,
Other Afech. Insp. Other Plumb Insp. Other Elec.Insp. 0
14ech. Insp. Fee: Phtnib. htsp. Fee Elec. Insp. Fee:
NOTE: This estimate does not include fees due to other Departments(i.e. Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). Thesefees are based on the prelimina information available and are only an estimate Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution II-053 E . 7/1/13FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Suerpl. PC Fee
Plumh../_Mech.%Elec
Permit Fee: $394.00
S1tpr)l. Insp F'ee
Plumh.111ech.iFlec
Plunih.lkfech.!Elec Permit Fee:
Construction Tax: F
Administrative Fee:
Work Without Permit? Yes O No $0.00
i,11'(1aced Phmning Fees:
T rm,el Documental i
Strong Motion Fee: 1BSEISMICO $11.48 Select an Administrative Item
Bld.p Stds Commission Fee: IBCBSC $2.00
SUBTOTALS: $407.48 $0.00 TOTAL FEE: $407.48
Revised: 05/07/2015