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11090200 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20777 GREENLEAF DR CONTRACTOR:WESTERN ROOFING PERMIT NO: 11090200 SYSTEMS OWNER'S NAME: PETER WILSON 1328 WHITE OAKS RD DATE ISSUED:09/28/2011 'iER'S PHONE: 4088236351 CAMPBELL,CA 95008 PHONE NO:(831)278-1837 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r- ELECT r PLUMB License Class Lic.# t.( -_;l-'l-;�-2!�— /+ MECH RESIDENTIAL COMMERCIAL � Contractor Date I hereiyaffirm that I am licensed r the provisions of Chapter 9 JOB DESCRIPTION:RE-ROOF TEAR OFF CONCRETE TILE RE-ROOF WITH (comming with Section 7000)of Division 3 of the Business&Professions METAL TILE PER ER5218 EXISTING PLYWOOD REMAINS.INSTALL Code and that my license is in full force and effect. PVC MEMBRANE ON NEW PATIO COVERS; 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 permit is issued. Sq.Ft Floor Area: Valuation:$40000 APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is APN Number:32609002.00 Occupancy Type: 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 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 granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non-point source regulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION. 9.18. Signat a Date Z Issued by: Date: %-��' L( OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS: the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is I,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I 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) a I,as owner of the property,am exclusively contracting with licensed contractors to Signature of Appli t. Date: construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS T04 CLASS"A"OR BETTER declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS 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 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(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,I shall contaminants as defined by the Bay Area Air Quality Management District I will not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Compensation laws of California. If,after making this certificate of exemption,I Health&Safety Code,Sections 25505,25533,and 25534. become subject to the Worker's Compensation provisions of the Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized ag t: Date: g- IV K7 APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY 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 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, and expenses which may accrue against said City in consequence of the Lender's Address ting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION 9.18. I understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 32609002 . 00 DATE ISSUED. . . . . . . : 09/28/2011 RECEIPT #. . . . . . . . . BS000014886 REFERENCE ID # . . . : 11090200 SITE ADDRESS . . . . . : 20777 GREENLEAF DR SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER PETER WILSON ADDRESS 20777 GREENLEAF DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : MICHAEL D LUNNEBORG CONTRACTOR MICHAEL LUNNEBORG LIC # 25896 COMPANY . . . . . . . . . . : WESTERN ROOFING SYSTEMS ADDRESS 1328 WHITE OAKS RD CITY/STATE/ZIP . . . : CAMPBELL, CA 95008 TELEPHONE . . . . . . . . : (831) 278-1837 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 40, 000 .00 2 . 00 0. 00 2 .00 0. 00 1BSEISMICR VALUATION 40, 000 .00 4 . 00 0 . 00 4 . 00 0 . 00 1REROOFRES SQ FEET 52 . 00 728. 00 0. 00 728.00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 734 . 00 0 . 00 734 . 00 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 734 . 00 VISA --------------- TOTAL RECEIPT 734 . 00 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 _ 1 REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPERTlNO (408)777-3228 • FAX(408)777-3333 • building a)cupertino.oro PROJECT ADDRESS 2-0 �� / r r� �� L� APN OWNER NAME (, y I S v PHONE Z� (` r ` E-MAII. STREET ADDRESS CITY, STATE, FAX APPLICANT NAME J u[r M PHONE ()r 3 y 4r E-MAIL `k 4Lie4 , STREET ADDRESS I ` G CITY,STAIZIP FAX Zf v ❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME IC,, t LICENSE NUMBER Z'r' LICENSE Y E BUS.LIC.# COMPANY NAME G-4^'I E-MAIL. FAX STREET ADDRESS CITY,STATE,ZIP PHONE ARCHITECT/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: STRUC`URE: ❑ Commercial 15-7 yv Uv✓ EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES OTHER(SPECIFY)REMOVE/REPLACE k9YYES IF NO. PLYWOOD ❑ 'h" ❑ PLY)ArD ❑ OSB PTTca L ROOF ❑ NO #LAYERS: THICKNESS: ❑ 5/S" TYPE: ❑ CDX •12 ��CLASS: A PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES OTHER r^�l+1 l P-C-ES REPORT# DESCRIPTION OF WORK +W v{7L n S�?. U M e�b ca•e d N /�e,� P,}t J c d u, r (L d r S r)-e a2e(LE�� d s-f .et4- ¢ire a (f J By my signature below,I certify to eac5 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 provided is correct 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 uilding co ction. I authorize.representatives of Cupersno to enter the above-identified propels L;for inspection purposes. Signature of Applicant/Agent Date: SUPPLEMENTAL INFORMA �SSSOQc UIRED ._ arr sryiotin�s noc�rt�i rr�iP T —�T^ _If building is associated with a Home Owniation,provide letter ''' __ _ : of approval from HOA. —Provide Planning approval to verify if there any restrictions. ss _Provide copy of Manufacturer's Installation Specifications. rovide signed copy of Cupertino's Tear-Off Policy. ReroofApp_2011.doc revised 03/02/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 20777 greenleaf DATE: 09/28/2011 REVIEWED BY: bob s. APN: BP#: WVALUATION: 1$40,000 RPERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof PRIMARY SFD or Du lex PENTAMATION 1SFDWLR00F USE: P PERMIT TYPE: WORK SCOPE FEE ID ROOF AREA s.f. 1REROOFFRES 5,200 T-7 F-1 I Lj Li NOTE. This estimate does not include fees due to other Depts(i.e.Public Works,Sanitary Sewer District,School District,etc.). Thesefees are based on the preliminary in ormalion available and are only an estimate. Contact the Dept-for addn7 info. FEE ITEMS (fee Resohition 11-053 Lk 7`1/11) FEE QTY/FEE MISC ITEMS Permit Fee: $728.00 Work Without Permit? Q Yes C) No $0.00 Strong Motion Fee: IBSEISMICR $4.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $2.00 SUBTOTALS: $734.00 ]:000 TOTAL FEE: $734.00 Revised: 09/02/2011 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: Z cJ PERMIT# OWNER'S NAME: -cam PHONE# GENERAL CONTRACTOR: BUSINESS LICENSE# ADDRESS: / CITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: =VSUBCONTRACTOR 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 ��t�c t �.�� ,� Ztv `64 ('0 Septic Tank Sheet Metal Sheet Rock Tile Owner(/Co tractor Signature Date REROOF TEAR-OFF POLICY 10 COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333•building (a)-cupertino.org PROJECT ADDRESS APN# OWNER NAME MAIL n / / 't ) PHONE YZE- 3 63�-� STREET ADDRESS Z U ,l // It p� CITY, STATE,ZIP FAX CONTRACTOR NAME/ l//_ (nom / LICENSE NIJMB�R LICENSE TYPE BUS.LIC.# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE I UNDERSTAND AND AGREE 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-Off Inspection is required. Any and all dry-rotted wood shall be replaced prior to this inspection. Unless new plywood roof sheathing is proposed throughout, all the nails/fasteners shall be either completely knocked-down or removed prior to this inspection. 4. If plywood is installed, a plywood Nailing Inspection is required. 5. Roofing shall not be applied without first obtaining all prior inspection and written approvals from the building inspector. Any roofing which is applied without first obtaining an approved inspection will require the removal of all new material down to the sheathing so a proper inspection can be performed. 6. Progress Inspection 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'/" 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 and agree to comply with the re-roof policy stated above. I also understand that smoke detectors and carbon monoxide detectors are required to be installed in accordance with Sections R314 and R315 of the 2010 California Residential/Code. Signature of Applicant/Agent: Date: 2 �� ReroofPolicv_2011.doc revised 02/16/]l