17070243 r
CITYOF CUPERTINO BUILDING PERNUT
BUILDING ADDRESS: 10125 SWAN OAK LN CO.N'I'RAC`fOR:I'I TERSFEN-DEAN INC ('ISRMITNO: 12070243
OWN11US NAME: JYOII RANK 7980 ENTF:RI'RISE Illi DATE* ISSUED:07/302012
OWNER'S PHONE: NEWARK,CA 94560 PuoSF\'p:(510)494-9952
)� LICENSED CON'1'RA'CII''Olt•SS DECLARATION BUILDING PEER IIT INFO: BLDG r IiLLCf r PLUMB r
License Gass C `3 1,ic.4 / 66 //7 r r r
�,,� teen RESIDENTIAL coCOMMERCIALContractor ?g..I 1'CAsetlAe � Date 7-30—/ Z
I heretic allimn that Ian licensed under the provisions of Chapter') •1011 DESCRIPTI ON:TEAR OFF WOOD SHAKE AND REPLACE WI'fll COME'
(coil] ncing with Section 7000)ol'Di%ision 3 ofthe Business l ProfeI I SQUARES S
ssions I'IQUAR
Code and that my license is in full force:rod effect.
1 hereby affirm under penalty of perjury one of the folluwin-too 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,us provided for by
Section 3700 ofthe Labor Code,for the performance ofthe work for which this Sq. [it Moor Arca: Valuation:$6357
permit is issued.
.\I'1'LICANI'CER'1'11'ICATION AIN Number:31232134.00 Occupancy Type:
I certify that I have read this application mull 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 it)save PLRiMII L\PIRT.SIhIVORKISNOT .STARTISD
indemnify and keep harrless the City of Cupcnino against Iiabilitics.judgments. _ r
costs,and expmucs which may accrue against said Cit•in consequence ofthe WITHIN 180 DAYS OF PERMIT ISSUANCES OR
granting of this permit. Additionally,the applicant understands and will complyr
ith all non-pain M
source •gulations per the Cupertino unicipal Code, 180 DAIS FR
nr0�1 LAS•1- CALLED INSPECT-ION.
9.18. �j
y_3� Z Issued 1_• Dale: _Je4-%,
Signature YN�.
Date /
❑ O\\'NISILI41II1111[12
DECLARATION
RE-ROODS:
1 hereby affirm That 1:un exempt from the Contractor's License Lase I'll"one of All nnfs 51,111 be inspected prior to any roofing material being installed If a roof is
the following hyo reasons: installed without Ii6t obtaining an'ispection.I agree to remove all new materials I'm
E,as owner ofthe progeny,or my employees with wages as their sole compensation, inspection.
will do the work,and the structure is not intended or altered for sale(Sec.7044.
Business R Professions Code) .,i InauL_ iCi•<rl/pelican hate:
I,as ownet of flic property,inn exclusively contmecting%%ilh licensed contractors to L
construct the project(Sec.7044,Business A Professions Code).
ALL ROOF COVERINGSTO BE CLASS"A"Olt HE1-fER
I herchy affirm under penalty of perjury one of the following three
declarations:
I have and will maintain a Certificate of Consent to self insure for Workcr's IL\'/.AItUOIIS]b�I'ICItLU,S IIISCLOSIIIt Ii
Compensation,as provided for by Section 3700 ofthe I.abor Code,for Lite I have read the hazardous materials requirements under Chapter 69.5 of itle
performance of the work for which this permit is issued. California I leallh&Safety Code.Sections 25505,25533,and 25534. 1 will maintain
I have and will maintain Worker's Compensation Insurance,-as provided for by cum plia lice with the Cupertino Municipal Code.Chapter 9.12 and the health
Section 3700 ollhc Labor Code,for the performance of the work for which this
Safciv Code,Section 25532(x)should 1 store or handle hazardous material.
Additionally,should 1 use equipment or del ices which emit hazardous air
permit is issued con to mina ens:es dclined by the Bay Arca Air Quality\L•nal;emenl District I will
I certify than in the perlbnnanee ofthe%cork Iia which this permit is issued I shall maintain compliance n'ith the Cupertino Municipal Code.Chapter 9.12:tell the
not employ any person in any manner so as to become subject to the Worker's I leallh&Safety Code.Sections 25505.25533,and 25534.
Compensation Imus of California. If,alter making this cenifeme of exemption.I
become subject to the Worker's Compensation provisions ollhe Labor Code,I must Osvnr t d ti`zrd agent: — 3a� /�
forthwith comply with such provisions-or this permit shall be deancd revoked Dam:
C0NS'1'RIICfION LEN111NG AGE=NCY
AITIACAN-T CEIt'I'IFICATION
I cenify that I Imre read this application and state that the above information is I hereby affirm thin there is a construction lending agency for the.perfomnanec in work'.,
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,mid hereby authorize representatives ofillis city It enter Lender's Name
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep harmless the City ol'Cupertino against liabilities,judgments. Lender's Address
costs,and espenses which may accrue against said City in consequence ofthe
granting of this permit.Additionally,the applicant understands and will complyARC:I11'I'EC'I"S DIiCI„ARA'1ION
,%ah all non-point source regulations per the Cupertino Municipal Cade,Section
9.18. 1 understand my phos shall be used is public records.
Signature Date Licensed Professional
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
:91 ADDRESS:f51/2—r fCl. s f DATE: 07/3012012 REVIEWED BY: bobs.
APN: BP#: 'VALUATION: 1$6,357
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PREMARY
SFD Or DU12X PENTAMATION
USE: pPERMITTYPE: 1SFDWLR00 i
WORK tear off wood shake and install comp shingles.
SCOPE
,Mech. Plan Check Plumb. Plan Check Flec. Plan Check
blech.Permit Fee Plumb. Permir Fee: Elce. Permit Fee:
Ocher Akvh. Insp. Other Plumb Insp. Other Elce. Insp.
,I-Iech.Insp.Fee: Plumh. hrsp. Fee: Eler.Insp.Fee:
NOTE: This estimate does not include fees clue to other Departrnews(i.e. Planning, Public Works, Fire,Sanitary Server District,School
District,etc.). These fees are based on the prelintinarl information available and are only an.estimate Contact the Dept for addn'l into.
FEE ITEMS 1ee Resolution 11-053 EA UUI U FEE QTl'/FEE I MISC ITEMS
Plan Check Fee: $0.00 1,100 s.f. Re-roof
Suppl. PC Fee: Reg. 0 OT TO.0 hrs $0.00 $165.00 IREROOFRES
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee Q Reg. 0 OT FO,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Consimction Tax:
Administrative Feu,: 0
Work Without Permit? 0 Yes (D No $0.00 E)
Advanced Planning Fee: $0.00 Select a Non-Residential Q
Trrmel Docwnattatiun Fees: Building or Structure 0
i
Strong Motion Fee: IBSEISAIICR $0.64 Select an Administrative Item
Bldg Sids Commission Fee: IBCBSC $1.00
SUBTOTALS:; $1.64 $165.00 ,y' i,(;TA`L FEES $166.64
Revised: 07/01/2012
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE• CUPERTINO, CA 95014-3255
(408)777-3228 •FAX(408)777-3333 • building0cuperlino.org
( CUPERTINO /;,o700-V3 -
PROJECT ADDRES-/01 ` S� -� J APNM 3,2
^/2
OWNER NAM"3 ,l • h PHONE E-MAIL 'J
N
STREET ADDRESS - CITY,STATE.ZIP �r FAX
CONTACT NAME /�lP ONE E-MAIL ee lJ-Cf'Pnl ` o$ - 21 Fs-57 Z 7
STREET ADDRESS ^x f (�^ CI V_.STCATE. Z P ^'V� 60 FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT lJ�(C-ONTRACTOR ❑1 CONTRACTOR AGENT 11 ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTt J LICENSE NjIyI�B 117 LICENSE CT'7E BIJS.LIC.M/'/`o z o
e!`SC' C'Qti1 C70 (/J 'f jj / J 7 J ll
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE ZIP PHONE
7 So�ils�cr I s c F` ,( Or, < 5'56 G
ARCHITECVENGINEER NAME LICFTSENUMBER BUS.LIC.M
COMPANY NAME E-MAIL FAX
STREET ADDRESS CIN.STATE,ZIP PHONE
USE OF ❑ SFD or Duplex R(Multi-Family ROOF AREA: VALUATION:// J
STRUCTURE: E] Commercial /� Z ( ( /
EXISTING ROOF TYPE: 11 BUILT-UP ROOF ❑ASPHALTSHINGLES y.WOOD SHARES ❑WOODSHMGLES 6 OTHER(SPECIFY)
REMOVE/REPLACEMYES IF NO. PLYWOOD �''/r" ❑ PLYwD `P OSB PITCH: ROOF
❑NO N LAYERS'
THICKNESS ❑ sM" TYPE ❑COX :12 CLA55: A
11 BUILT-UP ROOF .®,ASPHALT SHINGLES ❑WOODSHARES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT
PROPOSED ROOF TYPE:
135q
DESCRIPTION OF WORK: (� �^',n!^G (l�� �1•LG I� �/d S-Y �C-CS(CA G'A 1-(4 I J�f/� '�
z Rn�d'VV'4 Irl wool 6 Fe
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 prov' ed is correct. I have read the Description of Work and verify it is accurate. 1 agree to comply With all applicable local
ordinances and slate laws relating to yiI i to stn¢lion. authorize rcprucnmtivcs of Cupertino to enter the above-identified property for inspection purposes
Signature of ApplicanNAgenC / Date:
SUPPLEMENTAL INFORMATION REQUIRED OFFICE use ONLY
If building is associated with a Home 0xvner's Association,provide letter PLAN CHECK TYPE`= t" ' I' ' ROUTING SLIP
Ofapproval from HOA. ❑. OVER-TIIE-COUNTER•:.. •r ❑ BUILDING PLAN REVIEW
Provide Planning approval to verify if there any restrictions. ❑ M1_1- D'. . ( I'c I " ' t
EXPRESS ❑ PLANN'ING'PLANREVIEW "
•' ...• -
Provide Copy Of Manufacturer's Installation Specifications. ❑ STpFDARD"' !' '-' ' ❑ FIRE DEPT
Provide signed copy of Cupertino's Tear-Off Policy. ❑ OTHER:
ReroofApp_2011.doc revised 03/i6/II
CITY OF CUPFRTINO BUILDING PERMIT
IMILD1NG ADDRESS: 10175 SWAN OAK LN CONTRAC1,01t:PIS'I'BRs1iN-DGAN INC I'li It\II'I'Nll: 120702A4
O\\'NIIR'SNAME: SCI IIJCI]TING.IAMLS I,AND ARDEN 79H0 ENTERPRISE.DR DA'I'S ISSIIISD:07130r2012
r
OXVNIC('S 11IIONE: NEWARK,CA 94561) pIIOSF NO:(91n)494A982
LICENSED CO.YFRA CI'OR's DECLARATION r r r
- /(y '7 13UILDLNG I'IS lti\IIT LN FO: BLDG FLEC'1' I'LUAIR
license Class C_z I,ic.o Ib 8 'l 1 ! r r r
J D11?CII 126SIDFN'I'L\I, COMMERCIAL
Gn,tm:lm he�ers eve Dale 7-31- ��.-
1 het cli alien that 1 not licensed under the prurisions of Clea liter 9 .1015 DESCR IPTI ON: OFF OFF WOOD SI LAKE AND REPLACE Wfl'll COMP
(Commencing o'ith Section 7000)of Dirisian 3 oft lie Business\ Prufes%iuns SI IQUAINGLES
Code and that nn'license is in full force and effect. I SQW\RIiS
I hereby affirm,under penalty'of perjury one of the Ildloo in,,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 Compensminn Insurance.as provided for by
Section 3700 of the Labor Code,for the perfornanee mflhe%cork fin which this Sy.Ft Flour Arca: Valuation:S6357
peralil is issued.
A 11 MA CANT CER 11FICTION APN Number:34232139.00 Occupancy Type:
I certify that I have read this application and state that the above infornation is
correct. I agree to comply with all city laid county ordinances and stale laws relating
to building construction,and hereby authorize representatives of this ciq•to enter
upon the above mentioned property for inspection purposes. (We)agree In save PIs WHIT EXPIRES IF WORK IS NOT STARTED
indeninity and keep harmless the City of Cupertino against liabilitics.judgmctds.
costs,andexpenses whichmay accrue against said Cil% inconsequence ol'the WITH IN 180 DAYS OF PLRMIT ISSUANCE OR
granting of this permit. Additionally,the applicant understands and will comply A
with all norpoints Irce regulations per the Cupertino Municipal Code.Section 180 DAYS FROlM LAST CALLED INSPECTION.
9.1 S.
Issued bx Dale:
❑ O\\'NEB-I3lilhDlilt DECLARATION
RE-ROOFS:
1 herelw affirm that I:un exempt from the Contractor's Licenw L:%%fur one of All roofs shall be inspected prior to any roofing material being installed.If a roof is
the fullnwing two reasons: installed without fifsl obtaining al lispeclin,,I agree to remove all tie's, materials for
1,as owner of the property,or my employees%%ith wages as their sole compensation, inspection.
will do the work,and the structure is not intended or o creel for sale(Sec.70J4,
Business R'Professions Code) Si 'nun f A lien Dale:
1,as owner of the property,am exclusively contracting with licensed contractors to ^$
construct the project(Sec.7044,Business S Professions Code).
AI,[,ROOF C0\1F,RINGS'I'O Ill?CI,ASS"A"OR BF;I-1'ISIt
1 herch%affirm under penalty'of perjure'one of the fall....in-three
la
decration..:
HAZARDOUS MATERIALS UISCLUSUIt IC
I have and will maintain a Certificate of Consent to sell'-insure for Worker's
Compensation-as provided for by Section 3700 of the Labor Code,for the I ha,v read the hazardous materiak requiremenls under Chapter 695 ul the
performance of the work for which this permit is issued. California I Icalth S SaferCode,Section,25505,25533.and 25534. 1 will m:lininin
I have and will maintain Worker's Compensation Insurance as provided for by compliance%,ilh due Cupertino Municipal Code.Chapter 9.12 and the Ilealth S
ty'SafeCode.Section 2553_(.)should I sore or handle h:¢ardoue material.
Section 3700 o(the Labor Code,for the performance til the work Iim xchich this
Additionally,should I use equipmcm or device.which emit hazardous air
permit is issued. Cone mi nan is as defined by the Ilan'Area Air Quality 3hnaecinent District I%%ill
I eertif\'that in the performance of the work for which this permit is issued,I shall nmtinain compliance with t,f Cupertino Alunicipal Code,chapter 9.12 and the
mol employ any person in any manner so as m become subject m the Worker'sI Ie:lth L S:dety'Curie.Sections 255115,25533,and 25534.
Compensation la%cs of California. If,alter making this certificate of esemptiun.I
become subject to the Worker's Compensation pro%isiuns of the Labor Code,I must (h%'a �' rued agent: y_
forthwith comply with such provisions or this pennil shall be deemed revoked. D.tx —J/—
(:0N1 f1iJICTIfN I,h:NUING ACENCV
APPLIC N'T CERTIFICATION
I cenity than I have read this application and state that the above infunnation is I hereby affirm that there is a construction lending agency for the performance til\cork:s
correct. I agree to comply with all city and county ordinances and state la%vs relating for which this permit is issued(Sec.3097.Cie C.)
to building construction,and hereby authorize representatives of this city to enter Lender's Namc
upon We above mentioned property for inspection purposes.(We)agree to save
indemnity and keep harmless the City of Cupenino against liabilities.judgments. Lender's Address
costs,and expenses which may accme against said City in consequence of the
granting ofthis permit.Additionally,the applicant w ersunils and will comply AltClll'fh:Cl"S 11ECL.\It,\'ll(IS
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. 1 understand illy plans shall be used as public records.
Signature Dat: Licensed Profnsiotod
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
2 ADDRESS: /Onu- (` L' DATE: 07/30/2012 REVIEWED BY: bobs.
APN: BP#: `VALUATION: $6,357
'PERNIIT TYPE: Building Permit PLAN CHECK'rl'PE: Alteration / Repair
PRIMARY SFD or Duplex PENTANIATION
USE: pPERMIT TYPE: 1SFDWLR00
NVORK tear off wood shake and install comp shingles.
SCOPE
_1
,Neth.Plan Check Plumb. Plan C beck Elec. Plan Check
Alech. Permit Fee: Phrmb. Permit Fee: Elec. Permit.Fee:
Other A1ech. Insp. Other Plumb Insp. Ocher E/cr.Insp.
,ile.ch.blip.Fee: Plumb. brcp. Fee: Eler./wp.Fee:
NOTE: This estinmte does not incluelejees due to other Departments(i.e. Planning, Public Works, Fire,Sanitary Suver District,School
District, etc). These fees are based on the prelintinan information available and are o my an estinmte. Contact the Det for addn'1 into.
FEE ITEMS (Fee Resolution 11-053 E2 7/1/11) FEE QTY/FEE NIISC ITEMS
Plan Check Fee: $0.00 [Tj6fl s.f. Re-roof
Suppl. PC Fee: Q Reg. Q OT 0.0 firs $0.00 $165.00 1REROOFRES
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee:Q Reg. Q OT p.p hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Consnviction Tax:
Administrative Fee:: Q
Work Without Permit? O Yes Q No $0.00
Advanced Planning Fee: $0.00 Select Non-Residential
Tremel Docinnatation Fees: Building or Structure 0
Strong Motion Fee: IBSEISAIICR $0.64 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS:. $1.64 $165.00 ; _ TOTnerFEE:r $166.64
Revised: 07/01/2012
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE• CUPERTINO, CA 95014-3255
C U PERTI N O (408)777-3228 • FAX(408)777-3333•building0cuDertino.ora
0-2'Iflf
PROIECTADDRES- 17S SC-1J A)- L L_N APN0
OWNER NAM° t,0//vPHONE E-MAIL
STREET ADDRESS ^ A^� CI Y.STATE.ZIP FAX
hONTACi NAME fyiI le- ���- I PVONE G _ 21 Fs-57 Z E-MAIL
STREET ADDRESS Z `20 Itir N QC LT �V�.r'S]T''ATEOZ P ^ /� 60 FAX
CA
❑OWNER ❑ OWNER-BUILeDER ❑eo/j ,OW'NERAGENT 'CONTRACTOR `❑1 CONTRACTOR AGENT 11 ARCHITECT 11 ENGINEER ❑ DEVELOPER 11TENANT
CONTRAR AeME
m
OA)d1W AJ" LICENSE N)191�f'//Z
COMPANY NAME E-MAIL FAX I7 J V LICEN E'�E BIb.LIC.N fqo Z n
J
STREET ADDRESS - CITY.STATE ZIP PHONE
7 90��sjr s c 0(� 4f• < 5'56 G
ARCHITECTIENGINEER NAME LICENSE NUMBER BIS.LIC.I
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY.STATE.ZIP - PHONE
USE OF ❑ SFD or Duplex Multi-Family ROOFAREA: VALUATION: a
STRUCTURE: ❑ Commercial 10''s6,3S7, 0
11
EXISTING ROOF TYPE: ❑BUILT-UPROOF ❑ASPHALT SHINGLES gWOODSHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY)
REMOVE(REPLACE LYES IF NO. PLYWOOD JAL R" ❑ PLYWD )Q OSB PITCH: \y ROOF
❑ NO R LAYERS- THICKNESS ❑ s/a" TYPE: ❑fD%
PROPOSED ROOF TYPE ❑BUILT-UP ROOF �ASPHALTSHINGLES ❑WOODSHAKES ❑WOODSHINGLES ❑OTHER ICC-ES REPO TO
FYI,_J /\� 1(� 1f/ / Iy/� CI 3F5<t
DESCRIPTION OF WORK: JNI�J
c zC lei Z Rq( " F PI0000 6-4 r
By my Signature below,1 certify to each of the following: I am the property oVTcr or authorized agent to act on the property owner's behalf. I have read this
application and the information I have prod ed is correct. I have read the Description of Work and verify it is accurate. 1 agree to comply with all applicable local
ordinances and slate laws relating to b I it col tructico. authorize representatives ofCupertina to enter the above-identif ed property for inspection purposes.
f
Signature oAppliwnVAgcm: �� Date:
SUPPLEMENTAL INFORMATION REQUIRED OFFICE,115E ONL\'. •• -
_If building is associated with a home O"mer's Association,provide letter PCANCHECK TV PK. t" '',-„'I ''•° ROUTING SLIP
Ofapproval from HOA. vER-TIIE-COUNTER S LTR-UILDING PIAN RF.VIEN{'
A
_Provide Planning approval to verify if there any restrictions. ❑ EXpRFSS' I': . ! 13PLANNING'PLAN REVIEW
Provi opy of Manufacturer's Installation Specifications. ❑'STANDARD” ❑ DEP
FIRET
Provide signed copy of Cupertino's Tear-OtT Policy. ❑ OTHER:
RerooJA1)p_2011.doc revised 03116111