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11050106 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10697 ROSEWOOD RD CONTRACTOR:GORMAN ROOFING PERMIT NO: 11050106 SERVICES,INC OWNER'S NAME: ESSEX PROPERTY TRUST 2229 E UNIVERSITY DR DATE ISSUED:05/23/2011 ER'S PHONE: 6508151622 PHOENIX,AZ 85034 PHONE NO:(602)262-2423 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class ic.# � -` s,� MECH f— RESIDENTIAL' COMMERCIAL f— b Contractor br. Date ) I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:APTS A-D,RE-ROOF OVERLAY EXISTING ROOF WITH (commencing with Section 7000)of Division 3 of the Business&Professions POLYURETHABE FOAM,27 SQUARES 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. 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 Sq.Ft Floor Area: Valuation:$9450 permit is issued. APPLICANT CERTIFICATION APN Number:31643004.10697 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-points urce regulations per the Cupertino Municipal Code,Section 9.18. Signature Datj' 3 f, Issued by: Date: Y C� 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 I,as owner 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 ppli t: Date: 1,as owner of the property,am exclusively contracting with licensed contractors to 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: HAZARDOUS MATERIALS DISCLOSURE 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 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(x)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 Owner or author+ ge : 3 L forthwith comply with such provisions or this permit shall be deemed revoked. Date: 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"ork'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 �nify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address 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. Signature Date Licensed Professional REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408)777-3228• FAX(408)777-3333•buildingancupertino.o[ Cl PwrlNQ C /moiJ C0/ t�(p 1 �0.1�(✓Uo (�^M. I PROTECT ADDRE S APN# I (^ / T �L r I 01 OWNER NA'E e < PHONE STREET ADDRESS CITY, STATE,ZIP J! FAX E L rieH APPLICANT NANgPHONE E-MAII STREET ADDRESS L CITY,STA c a 1 O n FAX( }' 1 5-� (5-2-7 c ��aA ` g NS t L J I .7 ❑OWNER ❑OWNER-BUILDER ❑ OWNER AGENT 2/co�RACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAVM mC LICENSE NUMBER + LICENSB„TY BUS.LIC.# - COMPANY NAME K Jl% E-MAL S ` FAX STREET ADDRESS19 4D J C r I Cr V r #'e CTTY,y�'(C,ZIP J G n,/� �� PHONE 1 J 1 J S3 ARCHITECT/ENGINEER NAME LICENSE NUMBER �i/'N BUS.LIC.# COMPANY N.4IvIE E-MAIL FAX STREET-ADDRESS CITY,STATE,ZIP PHONE USE OF ❑ SFD or Duplex ulti-Family ROOF AREA: VALUATION: (,� STRUCTURE: ❑ Commercial D'I 0® i , iso• EXISTING ROOF TYPE: BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY) REMOVE/REPLACE ❑,YES IF NO, 1 PLYWOOD F." ❑ PLYWD ❑ OSB PTTCH ROOF 91'NO #LAYERS: l THICKNESS: Cl 5/S" TYPE: ❑ CDX ,�/ 12 CLASS: `� PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ETHERICC-ES REPORT# DESCRIPTION OF WORK: 1/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 provideA is correct. I have read the Description of Work and verify it is accurate. I agree o comply with all applicable local ordinances and state laws relating to bui on tru tion. I authorize representatives of Cupertino to enter the above- entified propertj for inspection purposes. Signature of Applicant/Agent: Date: 0� SUPPLEMENTAL ORMATION REQUIRED = 3 _If building is associated with a Home Owner's Association,provide letter E S E AGUTIIv SLIP _ of approval from HOA. cotri� ❑J su>zls�c Art R�vlr w� –� ff_ — z Provide Planning approval to verify if there any restrictions. ❑ dpL�rrRz;vi iv —Provide copy of Manufacturer's Installation Specifications. ILL�� _ a Provide signed copy of Cupertino's Tear-Off Policy. - ❑ o1�x - ReroofApp_2011.doc revised 03/02/11 �=t CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: rosewood/maplewood 0j,Lz;,,. DATE: 05/11/2011 REVIEWED BY: bobs. APN: j �, #: ''VALUATION: $9,450 *PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof PRIMARY Multi-Family Dwelling Building is PENTAMATION 1 R2ROOF USE: 1 >3 Stories 0 Yes E) No PERMIT TYPE: WORK overlay existing roof with polyurethane foam. SCOPE FEE ID ROOF AREA s.f. 1REROOFMRES 2,700 NOTE. Thesefees are based on the prelindnary information available and are only an estimate. Contact the De t or addn'1 info. FEE ITEMS (I ee.Resolution 09-051 E'. '%1.-70) FEE QTY/FEE MISC ITEMS asl �.. a..- t°'<..... F A Permit Fee: $351.00 Work Without Permit? Q Yes E) No $0.00 F' 11 TT II y t f f , Strong Motion Fee: IBSEISMMR $0.95 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $352.95 $0.00 TOTAL FEE: $352.95 Revised: 04/29/2011