The URL can be used to link to this page

12090240 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21062 WHITE FIR CT CONTRACTOR:POUR SEASONS ROOFING PERMIT NO: 12090240 OWNER'S NAME: HIITA RUTII F PO BOX 1668 DA'Z'E ISSUF-D:09272012 OWNER'S PHONE: 4086297775 SAN JOSE,CA 95109 PRONE NO:(408)278-0330 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB License Class r- 39 Lia# !�:Z_'2 10 b r r. rl -��`(� N 9-;2-7- NISCH RESIDENTIAL COMMERCIAL Contractor 77!.-(1aF� Date %-�7- �� hereby affirm that 1 am licensed under the provisions of Chapter 9 .JOB DESCRIPTION:TEAR OIT EXISTING WOOD SHAKE ROOCINSTALL (conrnerming with Section 7000)of Division 3 of the Business S Professions I2"CDN Code and that my license is in full force and effect. PLYWOOD&30'3 PELT UNDERLAYMENT.INSTALL 13 SQ CERTAIN FEED PRESIDENTIAL COMP 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 Ibis permit is issued. 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 permit is issued. Sq. Ft Floor Arca: Valuation:54500 APPLICANT CERT'IFICAT'ION 1 certify that I have read this application and state that the above information is APN Number:35905107.00 Occupancy Type: carred.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 indemnify and keep harmless the City of Cupertino against liabilities,judgments, PERMIT EXPIRES IF WORK IS NOT STARTED costs,and expenses which may accrue against said City in consequence of the W ITHI F IT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 180 DAYS LLED INSPECTION. 9.18. ///J SignatMe{y�L_ R./ Date2`�' Ly Issued by: ate: ❑ OWNER-RUILDER IIECLARAT'ION hereby affirm that I am exempt from the Contractor's License Lav for one of RF-ROOFS; the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is 1,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an ins hecti n,1 agree to remove all new materials for will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection. Business&Professions Code) 9/97/'7-- I,as owner of the property,run exclusively contracting with licensed contractors to Signature of Appli Date: construct the project(Sec.7044,Business R Professions Code). 1 hereby affirm under penalty of perjury one orthe following three ALL ROOF COVF.RINGS'TO BE CLASS"A"OR REI FFR declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's IIAZARDOUS MATERIALS DISCLOSURE 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 read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain Worker's Compensation Insurance,as provided for by California Health S Safety Code,Sections 25505,25533,and 25534. 1 will maintain Section 3700 of the Labor Code,for the performance of the work for which this compliance with the Cupertino Municipal Code,Chapter 9.12 and the I Icalth& p Safety Code,Section 25532(a)should I store or handle hazardous material. permit is issued Additionally,should I use equipment or devices which emit hazardous air I certify that in the performance of the work for which this permit is issued,l shall contaminants as defined by the Bay Area Air Quality Managemeta District I will not employ any person in any manner so as to become subject to the Worker's maintain compliance pith the Cupertino Municipal Code,Chapter 9.12 and the Compensation laws of California. IL after making this certificate of exemption,I Health S Safety Code.Sections 25505.25533,and 25534. become subject to the Worker's Compensation provisions of the Labor Code,I must O her or th zed agent: forthwith comply with such provisions or this permit shall be deemed revoked Dale: APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I cenify that I have read this application and stale that the above information is correct.1 agree to comply with all city and county ordinances and state laws relating I hereby affirm that there is a construction lending agency for the performance of work's to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.) upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the Lender's Address granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Cade,Section ARCHTTFCT•S DECLARATION 9.18. I understand my plans shall be used as public records. Signature Date Licensed Professional _ l2Gc( pzy J REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING.DIVISION 10300 TORRE AVENUE -CUPERTINO.CA 95014-3255 CUPERTINO (408)777-3228' FAX(408)777-3333•buildincIp-cupertino.oro PROIECI'AD E 6 `�APN: 6n1. o'!5 r1N (/ J OWNER NAME PHONE E-MAIL 0 62 77 STREEI'.AI E' CIT' STATE LIP FAX Q� o So CONTACT NAME PHONE 'O E-VIAIL STREETADDRESS SCZ CITY.ST.A'I F..ZIP 94LA Tose', CA FAC ❑ OWNER ❑ ClaNER-RURGER 13 OWNER AGENT A(COWRACTOR ❑CONTRACTOR AGENT 13ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSENCAIBER LICENSEPE BUS.LICa Z COMPANYNAMG E-MAIL FAX STREET ADDRESS CITY.STATE ZIP I PHONE �_O S'07- w o e C ARCHI FECDENGINEER NAME LICENSE NUMBER BUS,LIC. COMPANY NAME E MAIL FAX STREET ADDRESS CITY.ST.ATE ZIP PHONE USE OF ❑ SFD or Duplex J( Multi-Family ROOF AREA: i VALUATION: y O STRUCTURe ❑ Commercial ��// ^J W $-Q EXISTING ROOP TYPE: ❑BUILT-UPROOF ❑ASPIIALTSHINGLES ;GOODSHAKES ❑WOODSHINGLES ❑OTHE.R(SPECIFY) REMOVE:REPLACE WYES IFNO. PLYWOOD jdPi' ❑ PLl'W'D ❑OSB MICH� 17 ROOF ❑ N LAYERSCKNF ❑ A- PE• PROPOSED ROOF TYPE: ❑BUIt.T-UPROOF 96SPH.ALTSHINGLES ❑WOODSII.AKES ❑.w OODSHINOLES ❑OTHER I ICC-ES REPORT DESCRIPTION OF WORK: `/Z C' QDX ��w99d +1+en 30# �'el�- under�t� •_Fil►wLl_�_F �nck41 C�er�e„ 4*eA Prestdeak;ol conn S61A es _ 00 a By no signature below.I cerifv to each of the tbllowing: Iam the property owner or authorized agent to act on the property owner's behalf. I have read this application and the im''trmation I have provided is coDect. 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 building cons m tion. I a aria represe tiv of Cupertino to enter the above-identified property for inspection purposes. Signa ;e of AppliwnUAgunt Date: SUPPLEMENTAL INFORMATION REQUIRED OFFICE use ONLY _If building is associated With a Home Owner's Association.provide letter PLANCHECR 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 REVIEl1' Provide copy ofManufacturer's Installation Specifications. ❑ STANDARD -❑ FIREDEPT Provide signed copy of Cupertino's Tear-Off Policy. ❑ OTHER: ReroofApp_201 Ldoc revised 03/16/11 CITY OF CUPERTINO FEE ESTIMATOR— BUILDING DIVISION ADDRESS: (,v (,-Z- WJ — `PATE: REVIEWED BY: IM-.4 APN: BP#: 'VALUATION: JS4,500 *PERMIT TYPE: Minor Building Permit PLAN CII ECK TYPE: Re-roof PRIMARY SFD or Duplex PENTAMATION 1SFDWLR00F USE: PERMIT TYPE: WORK TEAR OFF EXISTING WOOD SHAKE ROOF.INSTALL 1l2" CDX PLYWOOD &30# FELT SCOPE UNDERLAYMENT.INSTALL 13 SQ CERTAINTEED PRESIDENTIAL COMP SHINGLES:COLOR: p FEEID ROOFAREA 1REROOFFRES 1,300 iF Meeh. Plan Cheek Piva11J. Plan Owk Elec Plan Check alu:h. Permit Fee: P/umh.Permit Fee: Elec. Permit Fee: other,ifech.lrsp. 0111G.Plumh hr..p. Other Elm/nsp. ,ifrh.Insp. Fee: Plumb. Inap.Fee: E1er./rtvp. Fee: NOTE: This evtinmle does not include fees due to other Departments(i.e. Planning, Public Works, Fire,Sanitary Sewer District,School District,etc.). These eev are based on the prelininan in ortnation available and are otdv an ewinuae. Contact the Det for addn'I into. FEE ITEMS (Fee Resol tion 11-053 FIT 7/1/111 FEE QTY/FEE MISC ITEMS Plan Check Fee: Supp/.PC Fee. Ph un h..`.11ech.rFl ec Permit Fee: $195.00 SuppL Insp Fee Plnmh.:blech.:Flec 1'Iaml.;.L1i c)r.:Flcr.Permit Fee: Caustrnclion Tax: Administrative Fee: Work Without Permit? O Yes (D No $0.00 Advanced Planning Fee,: Travel Documentation Fees: Strong Motion Fee: 18SEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 'SUBTOTALS: $196.50 $0.00 W TOTAL FEEh $196.50 Revised: 07/01/2012