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12010147 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21230 HOMESTEAD RD CONTRACTOR:MARCO ROOFING PERMIT NO: 12010147 OWNER'S NAME: VILLAGE GREEN ASSOCIATES P O BOX 1691 DATE ISSUED:01/24/2012 OWNER'S PHONE: 4087382500 FREMONT,CA 94538 PHONE NO:(510)656-6400 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT'_ PLUMB_. License Class A'�'S�'G2 Lic.# y0�gt:I 1 r— MECH RESIDENTIAL 3 COMMERCIAL ' Contractor Vh1lAe• F2!!!�P Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:BLDG 3,53 SQ,RE-ROOF TO COMP SHINGLES,EXISTING (commencing with Section 7000)of Division 3 of the Business&Professions SHEATHING REMAINS Code and that my license is in full force and effect. I lierebv 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 provided for by Sq,Ft Floor Area: Valuation:$19[30 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:32605085.00 Occupancy Type: APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct.€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 PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We)agree to save indemnity and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section L 9.18. Issued by: Date: (' Signature ,e aa__Date f ❑ OWNER-BUILDER DECLARATION RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for the following two reasons: inspection. 1,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, Signature of Applicant: Date: I"'O V-9 Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business$1.Professions Code). I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the Compensation.as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain performance of the work for which this pennit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Ouality Management District I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the pert6rmance of the work for which this permit is issued,I shall Health&Safety, Code,Sections 2.5505,25533,and 2.5534. 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 Owner or u oriz d agen become subject to the Worker's Compensation provisions of the Labor Code,I must Date: forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of mrk's I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.) correct.I agree to comply with all city and county ordinances and state laws relating Lender's Nain to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulatit-xis per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. Licensed Professional Signature Date REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION d 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333 •building cupertino.org PROJECT ADDRESS APN# 21230 Homestead Rd OWNER NAME PHONE E-MAM Village Green Gardens 408-738-2501 STREET ADDRESS CITY ZIP 21230 Homestead Rd Cupertt no, CA 95014 FAx APPLICANT NAME PHONE E-MAIL Marco Roofing 1510-656-6400 marcoroof@sbcglobal.net sTREETADDREss 43230 Osgood Rd �FsPAembnnt, CA 94539 FAX510-656-3021 ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAMELI ER LICENSE TYPE BUS.LIC.# Michael Creeden cET 2991 I B C-39 C2 21317 COMPANY NAME Marco Roofing F-4&rcoroof@sbcglboal.net FI10-656-3021 STREET ADOREssremont,, CA 94539 ZIP PH510- 656-6400 43230 Osgood Rd ' ARCHITECT/ENGINEER.NAME LICENSE NUMBER BUS.LIC.# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑ SFD or Duplex 1'KMulti-Family ROOF AREA: VALUATION: STRUCTURE: ❑ Commercial 5300 sq ft $199130.00 EXISTING ROOF TYPE: ❑BUILT-UP ROOF ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY) REMOVE/REPLACE DYES IF NO. TPLYWOODn�a❑ A" ❑ PL ❑ OSB PITCH y ROOF ❑NO #LAYERS THICKNESS: ❑ 5/8" TYPE: ❑ CDX 4 :12 CLASS: A PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ASPHALT SHINGLES ❑WOOD SHAKES ElWOOD SHINGLES 13OTHER ICC-ES REPORT# DESCRPT'IONOFWORK: remove existing roof shingles install, new Landmark TL shingles 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 b ild' g conqpction. I thorize representatives of Cupertino tc enter the above-identified proptrt;for inspection purposes. Signature of Applicant/Agent X Date: SUPPLEMENTAL INFORMATION REQUIRED ' "` _ If building is associated with a Home Owner's Association,provide letter PLasT ca>; cxa � 1.17 , Ou of approval from HOA. c[1 j �xE -,7W—'7!!- _Provide Planning approval to verify if there any restrictions. mg- Provide copy of Manufacturer's Installation Specifications. ---"Provide signed copy of Cupertino's Tear-Off Policy. T �`ros8 ReroofApp_.M1.doc revised 03/02111 \O CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION I ADDRESS: 21230 homestead rd DATE: 01/24/2012 REVIEWED BY: bob s. 1, APN: BP#: VALUATION: 1$19,130 -� PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration /Repair PRIMARY Multi-Family Dwelling Buildina is PENTAMATION 1 R2ROOF USE; 1 >3 Stories O Yes O No PERMIT TYPE: WORK re-roof to comp shingles, existing sheathing remains. SCOPE Lj _L_ Ll NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc.). These ees are based on therelinina in ormation available and are o!!! an estimate. Contact the De t or addn 7 in o. FEE ITEMS 't= t t'_` 3 + 7 :`II FEE QTY/FEE MISC ITEMS Platt Check Fee: $0.00 F75,3001 s.f. Re-roof Suppl.PC Fee: Q Reg. Q OT 0.0 ht'S $0.00 $742.00 1RER00FMRE PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. FeeQ Reg. Q OT 0 0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Ll O Work`'Without Permit? 0 Yes Q No $0.00 G e , r __s,riwry l $0.00 Select a Non-Residential (7 Building or Structure O 1 `:;.5#iY't��- IBSEISMICR $1.91 Select an Administrative Item i l i ,fl Con-ifnission_Fee� IBCBSC $1.00 SUBTOTALS: $2.91 $742.00 TOTAL FEE: $744.91 Revised: 1/19/2012 Building Department ILM City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 C U P E RT I N O Telephone: 408-777-3228 Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: ZZ30 Hd.~s d L+l PERMIT# OWNER'S NAME: U, f/ ,-,, ��,�j• PHONE# sirle- .WV—,2-9,7 GENERAL CONTRACTOR: 41 Vc4 4 BUSINESS LICENSE# ADDRESS: `t-/,36 L !e+ �c CITY/ZIPCODE: Ste" *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 SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature 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 IL^0 Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date /404h MARCO ROOFING 1/24/12 To Whom It May Concern: This letter hereby authorizes PAUL QUALLS to sign for any and all building permits and licenses required by our company for the job at 21230 Homestead Rd., Cupertino, CA. Sincerely, Michael Creeden, President P.O. Box 1691 Fremont, CA 94538 (510) 656-6400 Fax (510) 656-3021 CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . 32605085. 00 DATE ISSUED. . . . . . . : 01/24/2012 RECEIPT #. . . . . . . . . : BS000015827 REFERENCE ID # . . . 12010147 SITE ADDRESS . . . . . 21230 HOMESTEAD RD SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . VILLAGE GREEN ASSOCIATES ADDRESS . . . . . . . . . . 130 E DANA ST CITY/STATE/ZIP . . . MOUNTAIN VIEW, CA 94041-1508 RECEIVED FROM . . . . MICHAEL J GALVIN CONTRACTOR . . . . . . . CREEDEN, MIKE LIC # 21317 COMPANY . . . . . . . . . . MARCO ROOFING ADDRESS . . . . . . . . . . P 0 BOX 1691 CITY/STATE/ZIP . . . FREMONT, CA 94538 TELEPHONE . . . . . . . . (510) 656-6400 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 19, 130 .00 1. 00 0 .00 1 .00 0 .00 1BSEISMICR VALUATION 19, 130 .00 1. 91 0 . 00 1.91 0.00 1REROOFRES SQ FEET 53 .00 742 . 00 0. 00 742 .00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 744 . 91 0 . 00 744 . 91 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- ------------ -- -------------------- CREDIT CARD 744 .91 VISA --------------- TOTAL RECEIPT 744 . 91 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 309 EXTERIOR LATH 311 SCRATCH COAT 600 PRE-INSPECTION 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 603 ROOF BATTENS 604 ROOF IN-PROGRESS 605 FINAL REROOF