11050199 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10121 EMPIRE AVE CONTRACTOR:R E ROOFING& PERMIT NO: 11050199
CONSTRUCTION INC
OWNER'S NAME: WANG JERRY ET AL 15230 CLYDELLE AVE DATE ISSUED:05/24/2011
ER'S PHONE: 4087721159 SAN JOSE,CA 95032 PHONE NO:(408)626-9320
❑ LICEN
SED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG� ELECT PLUMB�
Li Class Lic.# C/OA
(� it MECH r RESIDENTIAL COMMERCIAL
Contrac Date
I here y affirm at I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:RE-ROOF REMOVE EXISTING 1 LAYER OF WOOD SHAKE,
(commencing with Section 7000)of Division 3 of the Business&Professions INSTALL NEW UOOD-CLASS A 2&LIFETIME COMP*HAS
Code and that my license is in full force and effect. EXISTING PLYWOOD-CLASS A 26SQ
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:$11000
permit is issued.
APPLICANT CERTIFICATION APN Number:32624057.00 Occupancy Type:
1 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.
wi n-point ource regulati a Cupertino Municipal ode,Se tion
.18. _
i nate Date �.� ( Issued by:f "" Dater Z I-(- 4
L OWNER-BUILDER DECLARATION
RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one ofA shall be inspected prior to any roofing material being installed.If a roof is
the following two reasons: installed w no ing an ins ection,I agree to remove all new materials for
1,as owner of the property,or my employees with wages as their sole compensatio , inspection.
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code) Signatu e o pli t: Date:
I,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:
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 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. 1 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.
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 t orker's Health&Safety C tions 25505,25533,and 25534.
Compensation laws of California. If,after making this certific a of exemption,I
become subject to the Worker's Compensation provisions oft e Labor Code,I st n an tht'or e n
forthwith comply with such provisions or this permit shall be med revoked. Date: !�
v
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
1 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 work'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
i- " -.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
gr Wring 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
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32624057. 00
DATE ISSUED. . . . . . . : 05/24/2011
RECEIPT #. . . . . . . . . : BS000013553
REFERENCE ID # . . . : 11050199
SITE ADDRESS . . . . . : 10121 EMPIRE AVE
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . . :
OWNER WANG JERRY ET AL
ADDRESS . . . . . . . . . . : 10121 EMPIRE AVE
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : R E ROOFING & CONST
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 11, 000 .00 1. 00 0 . 00 1 .00 0. 00
1BSEISMICR VALUATION 11, 000 .00 1. 10 0 . 00 1 .10 0 . 00
1REROOFRES SQ FEET 26 . 00 338 . 00 0 . 00 338. 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 340 .10 0. 00 340. 10 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 340. 10 #3461
---------------
TOTAL RECEIPT 340. 10
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
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO, CA 95014-3255
CUPERTINO (408)777-3228• FAX(408)777-3333• buildinclacupertino.org
PROJECT ADDRESS f ,i j ` TAPN
#
OWNER NAME � �\ PHONE'Li —� ? j� E-MAIL
STREET ADDRESS ( � (� n/ CITY, STATE,IZIP N
APPLICANT NAMES ` 7 � �I PHONE / G Mn
\. ,C� �) lJ Gni t t l/
STREET ADDRESS J CITY,STATE, ZIP t' FAX'S f -7 �(
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAMEAl CENSE NUMBER ^j ' ` LICENSE BUS.LIC.#
COMPANY NAME E-MAIL ( 1` FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
ARCF=CT/ENGINEER NAME LICENSE NUMBER BUS.LIC.#
COMPANY NAME lVv E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OFSFD or Duplex El Multi-Family ROOF AREA: VALUATION:
STRUCTURE: ❑ Commercials
EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES _)KOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY)
c
REMOVE/REPLACE 5YES IF NO, PLYWOOD ❑ '/v, ❑ PLYWD 1:1OSB PITCH: ROOF
❑ NO #LAYERS: THICKNESS: ❑ 5/8" TYPE: ❑ CDX :12 CLASS: A
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT#
DESCRIPTION OF WORK: I / LAM, vvv�
IvJM 7 k� i�lS
r
Ak
By my signature beloyy t ceiti 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 i formation I hav rovided"o t. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state(daws relating to b �tonstructtoqm.r on presentatives of Cupertino tc enter the aboveridentifi d property for inspection purposes.
Signature of ApplicanVAgent: Y -- -- Date: , l
SUPPLEMENTAL INFORMATION REQUIRED
_If building is associated with a Home Owner's Association,provide letter PE .zt6u.TiNa sL>P
of approval from HOA. R_THE COUNTER BUILDING PLAN REVIEW
Provide Planning approval to verify if there any restrictions.
0`,EXPRESS' ❑``'PLANNINCPLANREYIEwF'
Zprovide
'de copy of Manufacturer's Installation Specifications. szAxnnRD ❑:FIREDEPT
signed copy of Cupertino's Tear-Off Policy. r! 'OTHER
ReroofApp_2011.doc revised 03/02/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 10121 empire ave. DATE: 05/24/2011 REVIEWED BY: bobs.
APN: BP#: "VALUATION: Isi1,000
PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD or Duplex PENTAMATION 1SFDWLR00F
USE: PERMIT TYPE:
WORK remove existing shake replace with new underla ment with lifetime comp shingles.
SCOPE
FEE ID ROOF AREA
s.f.
1 REROOFFRES 2,600
Li
NOTE. Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addn 7 info,
FEE ITEMS (Fee Resolution 09-OSI Is'ff.7/f,I0) FEE QTY/FEE MISC ITEMS
Permit Fee: $338.00
Work Without Permit? 0 Yes E) No $0.00
Strom Motion Fee: IBSEISMICR $1.10 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $340.10 $0.00 TOTAL FEE: 1 $340.10
Revised: 04/29/2011
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
CUPERTINO 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255
(408)777-3228• FAX (408)777-3333- building65)cupertino.org
PROJECT ADDRESS t,t'�J , ` i yt �} TAPN#
OWNER NAME ' / ( ?/ PHONE ( -7 E-MAIL
-�'(I E-MAIL
STREET ADDRESS Y�f ? (� CIT Y, STATE,ZIP O� 1(, FAXJ
CONTRACTOR NAME /7�,t � ,i,� t t�i 7 LICENSE NUMBEIC-M 6 {aC LICENSE F & +? BUS.LIC.#
COMPANY NAME
E-MAI
U t L( .�l ( 1� FAX r i _
UoI n_ `qtr, f-7
1L�
STREET ADDRESS CITY,STATE PHONE I I
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 shall be scheduled 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.
On the day of the inspection, a building inspector will be available within one hour for either a Tear-Off
Inspection or Nailing Inspection if you call again on that day between the hours specified.
3. The following inspections are required:
a. 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.
b. If plywood is installed, a plywood Nailing Inspection is required.
c. Progress Inspection is required when approximately 50% of roof covering is installed.
4. New roof coverings shall not be applied without first obtaining all 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.
5. 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 I/4"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.
6. 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 unde d and agree to comply with the re-roof policy stated above. I also understand that
smoke detectors and carbo monoxide tectors a,@ rezltxi ed to be.msttalled in accordance with Sections R314 and R315 of
the 2010 California Resi ential Code. < < � ,
Signature of Applicant/Agekt: 1_ — �—� Date:
— ReroofPolicy_2011.doc revised 02/16/11
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: �&-K—,4
` ' PERMIT# O 0 l
OWNER'S NAME: Wjk-V PHONE # U'— to 2J0 32 C.J
GENERAL CONTRACTOR:" F'C u-tri BUSINESS LICENSE #
ADDRESS: 230 J vbxu–i� , A-Ve, , CITY/ZIPCODE: r ct(j Z
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINA AL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONT CTOR AND SUB V S HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICEN �
I am not using any sucontractors:
i nature Date
Please check applicable subcontractors and complete the following information:
s/ 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