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12050171 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22683 ALCALDE RD CONTRACTOR:MAXIMUM ROOF CARE PERMIT NO: 12050171 CORP ON'NER'SNAME: MARIANIST NOVITIATE 1182 OLIVE BRANCH LN DATE ISSUED:0522/2012 OWNER'S PHONE.: 4083093996 SAN JOSE,CA 95120 PHONE.NO:(408)441-0933 ❑ LICENSED CONTRACTOR'S DEECLLA(RATTION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r License Class (.� 3 G Lic.N <_A_' 03 7 4 -- ,pI -f� /�f -yf1-- MECH f RESIDENTIAL r COMMERCIAL r Contractor /3_�/X Date _<^ I hereby affirm that I'aam-licensed under the provisions of Chapter 9 JOB DESCRIPTION: RE-ROOF TEAR OFF WOOD SI IAKE REPLACE WITH COMP (commencing with Section 7000)of Division 3 of the Business&Professions SHINGLES CLASS A 35 SQFT Code and that my license is in full force and effect. 1 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 Sq.Ft Floor Area: Valuation:$16228 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION APN Number:3422905100 Occupancy Type: I certify that I have read this application and stale that the above information is cored. 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 PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We)agree to save indemnify 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 points r e regulal s per 1 e Cupertino Municipal Code,Section 9.18. Issued by: � /� /1TGrI Date: Signature Date - L ❑ 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 formic of installed without first obtaining an inspection,I agree to remove all new materials for the following two reasons: inspection. 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, Signature of Applicant: Dale: Business&Professions Code) 1,as Owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALI,ROOF COVERINGS TO BE CLASS"A"OR BETTER 1 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 1 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. t will maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& 1 have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(x)should 1 store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should 1 use equipment or devices which emit hazardous air permit is issued- contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code IStion,25505,25537,end 25574. not employ any person in any manner so as to become subject to the Worker's Compensationlawsof California. If,after making this certificate of exemption,I Ownero a o,•t,.A l: become subject to the Worker's Compensation provisions of the Labor Code,1 must Dale: 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 work's I certify that I have read(his 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 Name to budding 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(he City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply ARCH ITECI"S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9 18 Licensed Professional Signature Date CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 34229051. 00 DATE ISSUED. . . . . . . : 05/22/2012 RECEIPT #. . . . . . . . . : BS000016883 REFERENCE ID # . . . : 12050171 SITE ADDRESS . . . . . : 22683 ALCALDE RD SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : MARIANIST NOVITIATE ADDRESS . . . . . . . . . . : PO BOX 1775 CITY/STATE/ZIP . . . : CUPERTINO, CA 95015-1775 RECEIVED FROM . . . . : STEVEN HUNTER CONTRACTOR . . . . . . . : STEVE HUNTER LIC # 22369 COMPANY . . . . . . . . . . : MAXIMUM ROOF CARE CORP ADDRESS . . . . . . . . . . : 1182 OLIVE BRANCH LN CITY/STATE/ZIP . . . : SAN JOSE, CA 95120 TELEPHONE . . . . . . . . : (408) 441-0933 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---- ----------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 16,228 .00 . 1 . 00 0. 00 1 . 00 0. 00 1BSEISMICR VALUATION 16,228 .00 1.62 0. 00 1 .62 0. 00 1REROOFRES SQ FEET 35. 00 490. 00 0. 00 490 .00 0. 00 -- ---------- ---------- ---------- TOTAL PERMIT 492 .62 0. 00 492 .62 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 492.62 AMEX --------------- TOTAL RECEIPT 492.62 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: 22683 alcalde rd! I DATE: 05/22/2012 REVIEWED BY: bobs. APN: I BP#: 'VALUATION: 1$16,228 *PERMIT TYPE: Building Permit I PLAN CHECK TYPE: Alteration/Repair PRIMARY SFDorDulex PENTAMATION USE: p PERMITTVPE: 1SFDWLR00� WORK I tear off wood shake replace with com0 shinales. SCOPE :11erh. Plan(.'herd I I Pbmrh, Plnn Cheek I I Bleu. Plan(:lu-ck I I Alrch. l'�•rmi/Fee: I Plarnh. Pernut Fm: I tiler. Permit Fe,:: Other Ahrh. Imp. Other Plumb Imp. Li Other Elcc trap. L� ,Nerh. hisp. Fee Minh btsp. Fee: Etcc.ln.,p. Fee: NOTE: This estimate does not includejees due to other Departments(ie.Planning,Public Works, Fire,Sanitary Sewer District,School District,etc). These lees are based on the preliminary information apailable and are oniy an estimate Contact the Dept for addn'l info. FEE ITEMS (Fee Resohnion 11-053 E2 7111/l) FEE QTY/FEE I MISC ITEMS Plan Check Fee: $0.00 3,500 s.f. Re-roof Suppl. PC Fee: Q Reg. O OT 0.0 hrs $0.00 $490.001 IREROOFRES I A PME Plan Check: $0.00 Permit Fee: $0.00 1 1 Suppl. Insp. Fee:Q Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 1 1 PME Permit Fee: $0.00 Consnitclion Tee: n AdInini.enrnice lire-, Q Work Without Permit? O Yes (F) No $0.00 1 1 0 Advanced Plannine Fee: $0.00 Select a Non-Residential 0 1 1 Building or Structure 0 o Travel Ununienlatinn Fecs': A Strone Motion Fec: IBSEISMICR $1.62 Select an Administrative Item Blde Stds Commission Fee: IBCBSC $1.00 1 SUBTOTALS: $2.62 $490.00 TOTAL FEE: I $492.62 Revised: 04/01/2012 I Z,oS v� -7 ! REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CU PERTI NO' (408)777-3228• FAX(4108)777-3333•buildina0cuoertino.ora w, �P]�;E�j�GORESSy�D�/—•SO� .'Vr g I APN(p? Q/7 q�/ J ` , JUERRN/AME ✓�l�/�1 j .�'C kLjI `.�/ PRO"f C1-i"�"1 I v E-MAIL STREET ADDRESS r��13 Ale �.3,1 - T� I CRY. ASTATE �/� FAX CONTACT NAME �"^IOM I PH- .ER_ (�'t/j E-MAIL STREET ADDRESS CRY.LSTTATE ZIP I T I FAX ❑OWNER ❑ OwvER-Out-om ❑ OwNERAGEER ❑ CONTRACTOR ❑CONTRACTORAGENT ❑ ARCHRECf ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACT RNAMIE LICE7JS�VUM®E0. LIC SE TOPE BUS LIC 0 2 Z/ � .1 ytl,.v� Ronk c mt•� I o x-0.5` �-3G / q COMPANY NAME �J �T([��.p� _ L 1 _ E-MAIL FAX �/' ✓�(��G STREET.ADDRESS I(�j� Dk VV JteAl 11UR �a CRl'.S)IJZIS�VV1"\ t*' (JAy0 PHaNE,D�'IC`710ce ARCHITECTIENGINEER NAME / .� I LICENSE NUM®ER BUS LIC.p `f COMPANY NAME N E-MAIL FAX STREET ADDRESS CITY,STATE ZIP PHONE USE OF SFD or Duplex ❑ Multi-Family. ROOF AREA VALUATION STRUCTURE ❑ Conu erclal I I y Sot EXISTING ROOF TYPE ❑BUILT-UP ROOF )IASPHALT SHINGLES ❑WOOD SHARES 9WOOD SHINGLES ❑OTHER(SPECIFY) REMOVE/REPLACE XIYES I IF NO, I PLYWOOD W- ❑ PLYWD XOSB PITCH: 12 I ROOF 13 No 0LAYERS THWKNESS 11 vs., TYPE ❑ Cox CLASS ?rye PROPOSED ROOF TYPE ❑BUILT-UP ROOF ASPHALT SHINGLES ❑WOOD SHAKES 11 WOOD SHINGLES ❑OTHER lone c-I �n L DESCRIPTIaN OF WORK' _ Year 04 61­3VVf (4 rY, iliaw+) 96 meek a P) (L Pip (°� , 1 �Sdecf� CST Pty r, tv\b-CrUm'i By my signature below.1 certify to each of the following: 1 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 provide4isilorrect. 1 have read the Description of Work and verify it is accurate. 1 agree to comply with all applicable local ordinances and stare laws relating to building n. tion. awn representatives ofCupenmo to enter the above-identciifledd property for inspection purposes. JigWmrc of ApplicanUAgent: Date: 0. '� S Li '� 7 - SUPPLEMENTALINFORMATIONREQUIRED OFFICE USE ONLY _If building is associated with a Home Owners Association,provide letter PI-+NCHECKTYPE Rourmc SLIP of approval from HOA. g� ^� - aPP OVER-TIC-COUM'ER -❑ BUILDING PLAN REVIEW Provide Planning approval to verify if there any restrictions. ❑ EXPRESS - ❑ PLANNINr PLAN REVIEW Provide copy of Ma ufacturer s Installation Specifications. ❑ STANDARD ❑ FIRE DEPT vide signed copy of Cupelvno's Tear-Off Policy. - ❑ RnIER: Reroofdpp_201 l.doc revised 03/l6i lI