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12010181 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20727 RODRIGUES AVE CONTRACTOR:R E ROOFING & PERMIT NO: 12010181 CONSTRUCTION INC OWNER'S NAME: PELOSI ANTHONY J AND ALINE K 15230 CLYDELLE AVE DATE ISSUED:01/31/2012 OWNER'S PHONE: 4088872034 SAN JOSE,CA 95032 PHONE NO:(408)626-9320 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG F_ ELECT F PLUMB License Class C �`,f Lic.# 7.7-17 �— ,D G 4fp MECH RESIDENTIAL COMMERCCOMMERCIALContractor /1 62oy,I,411 � Date �1 �- l Z JOB DESCRIPTION: RE-ROOF 5 SQ-REMOVE EXISTING WOOD SHAKE AND I hereby affirm that I am licensed under the provisions of Chapter 9 REPLACE WITH CLASS A WOOD SHAKE (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:$3000 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:35910059.00 Occupancy Type: permit is issued. -�� -2 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. 1 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 DA S 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 ti Nd-al Date: granting of this permit. Additionally,the applicant understands and will comply Issued by: with all non-poin rce r gulations p�tkte Cupertino Municipal Code,Section 9.18. / RE-ROOFS: Signature Date All roofs shall be inspe ted-pri r to any roofing material bejng installed. If a roof is installed without fir t o taingan inspection,I agremove all new materials for inspection. _-7❑ OWNER-BUILDER DECLARATION i' /�`.., Signature of ApplrEant / .e- Date: I hereby affirm that I am exempt from the Contractor's License Law for one of7 the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BET'T'ER 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) 1,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. 1 will 1 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 wi h the Cupertino NJaTficipal Code,Chapter 9.12 and 1 have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Coecti s 253.533,and 25534. / T Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized went: / Date: permit is issued. I certify that in the performance of the work for which this permit is issued,1 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 1 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 1 certify that 1 have read this application and state that the above information is correct.1 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 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: o Z © J-4/ PERMIT# OWNER'S NAME: PHONE# — zU GENERAL CONTRACTOR: voG BUSINESS LICENSE# _ ADDRESS: G �, C CITY/ZIPCODE: �' Z- *Our municipal code req fres 1 busines es working in the city to have a City of Cupertino business icense. NO BUILDING FINAL OR FINAL OCCUPAN ECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUAC�T ONTRORS HAVE O TAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: f Signature Date Please check applicable subcontractors and complete the following information: 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 Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date REROOF TEAR-OFF POLICY COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 GUPERTINO (408)777-3228• FAX(408)777-3333•building Ccr�cupertino.org PROJECT ADDRESS ,,j y f" �'�^;. !' a;.` f APN# OWNER NAME PHONE { r`•-7 t E-MAIL STREET ADDRESS T Y� sa, ,CITY, STATE,ZIP ? FAX LICENSE ),IC.# CONTRACTOR NAMENUMBER 'A 4JOENSE TY BUS,' � - `�. -v1 3 FAX COMPANYNAME !' E-MAIL r i D.191 CITY,STATE,,ZIP PHONE STREET ADDRESS!! ✓�F f t t /' ` L, } I UNDERSTAND AND AGIfEE TO THE FOLLOWING: 1. The re-roof project shall comply with all applicable provisions of the 2010 California Codes. 2. An inspection request can be scheduled up to the day before the inspection date. Please call (408)777- 3228 from 7:30 - 3:30pm (Mon-Thurs) or 7:30 - 2:30pm(Friday) to schedule the next day inspection. For Tear-Off and Nailing Inspections, you must also call on the day of the inspection only after that phase of the work is completed. The building inspector will be available within one hour. Progress and Final Inspections will be given a two hour window. 3. Tear-&Inspection is required. Any and all dry-rotted wood shall be replaced prior to this inspection. Unless new plywood roof sheathing is propose ifou6i6ut, all the nails/fasteners shall be either completely knocked-down or removed `or to this inspection. 4. If plywood is installed, a plywood Nailing Inspection is required. 5. Roofing shall not be applied without first�btaining all prior inspection and written approvals from the building inspector. Any roofing which is/applied without first obtaining an approved inspection will require the removat,of all new material do p to the sheathing p a proper,ipspeetion,can be performed. ,. 6. Progress Ins�pect_iM is required when approximately 50% of roof covering is installed. 7. A Final Inspection and approval shall be obtained from the building inspector when the re-roofing is completed. To receive a final sign-off, the following items will be verified: a. Flat roofs shall have a minimum of 1/" per foot of slope and demonstrate there is no ponding. b. Listings from approved testing agencies for all pre-manufactured products used shall be available on-site'to review at the time of the inspection. c. Proper spark arrestor installation, vents painted, gutter/downspouts installed, debris removed. 8. NOTE: If you call for a tear-off or plywood nailing inspection and the work is not complete, you will be charged a re-inspection fee of$126.00. The re-inspection fee shall be paid before another inspection can be scheduled. By my signing below, I certify each of the following is true: I am the property owner or authorized agent to act on the property owner's behalf. I understand ana agree to comply with the re-roof policy stated above. I also understand that smoke detectors and carbon monoxide detectors are requifed to be installed in accordance with Sections R314 and R315 of the 2010 California Residential'Code. ! r E Signature of Applicant/Agent: / Date: / ��:'r `✓ ReroofPolicv_2011.doc revised 02/16/11 CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot : APN 35910059 . 00 DATE ISSUED. . . . . . . : 01/31/2012 RECEIPT # . . . . . . . . . BS000015880 REFERENCE ID # • . . : 12010181 SITE ADDRESS 20727 RODRIGUES AVE SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER PELOSI ANTHONY J AND ALINE K ADDRESS . 20727 RODRIGUES AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-2964 RECEIVED FROM R E ROOFING CONTRACTOR PROCTOR, PAUL LIC # 20615 COMPANY R E ROOFING & CONSTRUCTION INC ADDRESS 15230 CLYDELLE AVE CITY/STATE/ZIP SAN JOSE, CA 95032 TELEPHONE (408) 626-9320 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ---------- ------ 1BCBSC VALUATION 3 , 000 . 00 1 . 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 3 , 000 . 00 0 . 50 0 . 00 0 . 50 0 . 00 1REROOFRES SQ FEET 5 . 00 70 . 00 0 . 00 -----70_00 -----0_00 ---------- ---------- TOTAL PERMIT 71 . 50 0 . 00 71 . 50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- ------ CHECK 71 . 50 4195• --------------- TOTAL RECEIPT 71 . 50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION - -------- ---------------------------- ------- ---------------------------- 309 EXTERIOR LATH 311 SCRATCH COAT 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 604 ROOF IN-PROGRESS 605 FINAL REROOF CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 20727 rodrigues ave. DATE: 01/31/2012 REVIEWED BY: bobs. 1 APN: BP#: "VALUATION: $3,000 PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof PRIMARY PEENTAMATION 1SFDWLROOF USE: SFD or Duplex ERMIT TYPE: WORK remove existing wood shake replace with class a wood shake. SCOPE FEE ID ROOF AREA s.f. 1REROOFFRES 500 Li NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . These&es are based on the prelimina information available and are o!!lE an estimate. Contact the Dept Lor addn 7 info. FEE ITEMS s i-a ?e ale> �>�r 1 [' �'t 1'11 i FEE QTY/FEE MISC ITEMS Permit Fee: $70.00 Work Without Permit? 0 Yes (D No $0.00 +:;1 P z�ti r WW IBSEISAKCR $0.50 Select an Administrative Item BIcI TadsCarl rcdssicyn.l eek IBCBSC $1.00 SUBTOTALS: $71.50 $0.001 TOTAL FEE: $71.50 Revised: 1/19/2012 REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 (408)777-3228• FAX(408)777-3333 •buildingacupertino.org CUPERTtN4 C PROTECT ADDRESS �< ,�✓� '`PN# S°� 1b USCI OWNER NAME CS PHONE O v rJ E-MAI G !/� STREET ADDRESS ��2 �O 1 � CITY. STATE,ZIT'� /Q Gj// FAX APPLICANT NAME „ fjf•f De n/� yJ PHONE �'/ � /� O � .�O(J ��� rPdL • Gp ';/ STREET ADDRESS CITY.STATE, ZIP4. / ❑OWNER [3OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME p ~ LICENSE NUMBER / LICENSE BUS.LIC.# YNAME E-MAIL COMPANQ FAX STREET ADDRESS CITY,STATE,ZIP PHONE ARCHTTECT/ENGINEER NAME LICENSE NUMBER BUS.LIC.# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF SFD or Duplex ❑ Multi-Family ROOF AREA: VALUATION: STRUCTURE: Commercial EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES XWOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY) REMOVE/REPLACE KYESIF N0, PLYWOOD ❑ h" ❑ PLYWD ❑ OSB PITCH: /J :12 . El NO #LAYERS: / THICKNESS: El 5/ 1 TYPE: ❑ CDX 7 ICC-ES REPORT# PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES XWOOD SHAKES ❑WOOD SHINGLES ❑OTHER DESCRIPTION OF WORK n U X__ Gi By my signature below,I certify to each the follo : I am the property owne uthorized agent to act on the property owner's behalf. I have read this application and the infom�ation I have rovided is rrect d th cription of Work and verify it is accurate. I agree to comply with all applicable]ocal ordinances and state laws relating to uilding�stru a representatives of Cupertino tc enter the above-ide 'fled pmr , for inspection purposes. Signature of Applicant/Agent: =' Date: / , s—m SUPPLEMENTAL INFORMATION REQUIRED If building is associated with a Home Owner's Association,provide letter , of approval from HOA. � x" ar NO=. C1�4�PLi17�IILEYITsW Provide Planning approval to verify if there any restrictions. z Provide copy of Manufacturer's Installation Specifications. rovide signed copy of Cupertino's Tear-Off Policy. � F'm _ _max, ReroofApp_2011.doc revised 03/02/11