10110028I CITY OF CUPERTINO BUILDING PERMIT I
BUILDING ADDRESS: 10444 ALICIA CT I CONTRACTOR: WOODS ROOFING I PERMIT NO: 10110028 1
OWNER'S NAME: NELSON DAVID H AND ELIZABETH L
iER'S PHONE: 4082523698
LICENSED CONTRACTOR'S DECLARATION
License Class 4— 13 Lic. # 3 Z 513
Contractor 5 —I At Date �)
I hereby affirm that I am license der the provisions of Chapter 9
(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.
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. /6�
APPLICANT CERTIFICATION
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
to building constriction, 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,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source re lations per the Cupertino Municipal Code, Section
9.18.
Signature Date % t
L� OWNER- BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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)
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
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
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.
I certify that in the performance of the work for which this permit is issued, I shall
not employ any person in any manner so as to become subject to the Worker's
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
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION
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
nnify and keep harmless the City of Cupertino against liabilities, judgments,
, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Signature.
Date
17700 SERENE DR
MORGAN HILL, CA 95037
DATE ISSUED: 11/04/2010
PHONE NO: (831 )637 -5576
BUILDING PERMIT INFO: BLDG F ELECT r PLUMB r
MECH r RESIDENTIAL F COMMERCIAL f—
JOB DESCRIPTION: RE -ROOF TEAR OFF EXISTING SHAKE.NO RESHEET,
INSTALL 30# FELT, LIFETIME COMP SHINGLE CLASS A
35SQ
Sq. Ft Floor Area: I Valuation: $19003
APN Number: 34245024.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued Date:
RE- ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
Signature of Applicant: Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
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
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
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
Health & Safety Code, Sections 25505, 25533, and 25534.
Ow
ne or authorized agen
Date: 11
ONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
I v I 1 (-:) Q-13
CITY OF CUPERTINO
FIRM FFF ESTIMATOR - BUILDING DIVISION
FEE ID ROOF AREA
(s.f.)
1REROOFFRES 3,500
ADDRESS: 10444 alicia dr.
7DATE:
11/04/2010
REVIEWED BY:
APN:
I BP#:
*VALUATION: 1$19,003�
*PERMIT TYPE: Minor Building Permit
PLAN CHECK TYPE: Re-roof
PRIMARY
SFD or Duplex
USE:
0, 1 P! L, i,
PENTAMATION
1 SFDWLROOF
PERMIT TYPE:
WORK
sllppl. Illsp I- 1v
SCOPE
FEE ID ROOF AREA
(s.f.)
1REROOFFRES 3,500
/Vf)TF• Thovo foot arp havod nit tho nnoliminany ininrmatinji avoilahip and are nn1v an estimate_ Contact the Dent fnr addn'l inta.
FEE ITEMS (Fee Resolution 09-051 Elf 0)
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11
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FEE ITEMS (Fee Resolution 09-051 Elf 0)
FEE
QTY/FEE
MISC ITEMS
P/oll Chcc k Fuv:
slfpjd PC [-cc
P/al/ Chcck:
Permit Fee:
$455.00
sllppl. Illsp I- 1v
1"I'llil FCC',
Plltrilh. , ]",lcu Pc rmil 1,cc',
C_ of 7"n,
Fcc:
Work Without Permit? 0 Yes 0 No
$0.00
lllmlllbl,, FccN:
il-avc/ 1)(w!lnwt1,!wi(M
Strong Motion Fee: IBSEISMICR
$1.90
Select an Administrative Item
Bldg_Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$457.90
$0.001 TOTAL FEE::
$457.90]
Revised: 10/17/2010
CITY OF CUPERTINO
3 ITEMS OF 10 PERMIT RECEIPT OPERATOR: patg
COPY # : 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 34245024.00
DATE ISSUED.......: 11/04/2010
RECEIPT #.........: BS000011919
REFERENCE ID # ...: 10110028
SITE ADDRESS .....: 10444 ALICIA CT
SUBDIVISION ......
CITY .............. CUPERTINO
IMPACT AREA ......
OWNER ........
ADDRESS ......
CITY /STATE /ZIP
RECEIVED FROM
CONTRACTOR ...
COMPANY ......
ADDRESS ......
CITY /STATE /ZIP
TELEPHONE ....
NELSON DAVID H AND ELIZABETH L
10444 ALICIA CT
CUPERTINO, CA 95014 -2634
JEFF RAINEY
WOOD, LAWRENCE E LIC # 20810
WOODS ROOFING
17700 SERENE DR
MORGAN HILL, CA 95037
(831)637 -5576
FEE ID UNIT
QUANTITY
AMOUNT
PD -TO -DT
THIS REC
NEW BAL
---- - - - - -- ------- - - - -
1BCBSC VALUATION
-- ---- - - - - --
19,003.00
---- - - - - --
1.00
---- - - - - --
0.00
---- - - - - --
1.00
---- - - - - --
0.00
1BSEISMICR VALUATION
19,003.00
1.90
0.00
1.90
0.00
1REROOFRES SQ FEET
35.00
455.00
---- - -
0.00
----
455.00
0.00
TOTAL PERMIT
- - --
457.90
- - - - --
0.00
---- - - - - --
457.90
---- - - - - --
0.00
VOICE ID DESCRIPTION
-- - - - - -- ---------------------- - - - - --
309 EXTERIOR LATH
601 ROOF TEAR OFF
VOICE ID DESCRIPTION
-- - - - - -- ---------------------- - - - - --
311 SCRATCH COAT
602 ROOF PLYWOOD NAIL
604 ROOF IN- PROGRESS 605 FINAL REROOF
CITY F
CITY OF CUPERTINO
REROOF
CUPERT O PERMIT APPLICATION
Lc) ( 1 vv
APN # �qA O �1_ ! I Date: , r r I I
Building Address:
10 AAA L, 1 o (_q
Owner's Name: 1�> ft A,t_-L 15 Phone #:
HOA: Yes ❑ No ❑ If yes, provide letter from HOA `� C79 Z 5 Z __� i
Contractor: Phone #:
408- 605 -5115
WOOD'S ROOFING
Fax #: 408 - 267 -9999
Cupertino Business License M Contractor License M
325131
Type of Roof Covering:
Existing:
• Built -Up Roof
• Asphalt Shingles
Wood Shakes
• Wood Shingles
• Other (Specify)
Number of existing coverings C jr,
To be Removed
Proposed:
• Built -Up roof
• Asphalt Shingles
• Wood Shakes
• Wood Shingles
qC Other (Specify) '3D c� J-+, ► �-►�r� <
• Provide I.C.C.E.S. Report #
• Provide Mfgr. Installation Specs.
Job Description: ��� S -7 (,V'
S f-F A_ K_ ` C' Z f LC _T. lJ 7 7 4 L L
/, � �?�� 3 � Ste, ,/•�� -,- �
Residential n C� Commercial F-1
Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if
Green Building Checklist & attach it to the application or if there are any restrictions: ❑
applicable, include in plan set & the sheet index.
Valuation: �j (�
-
I Have Read, Understand and Will Comply with Cupertino's Tear -Off Policy:
Signature
Revised 02/05/09
9
CUPERTINO
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
(408) 777 -3228 - FAX (408) 777 -3333 - building acupertino.org
PROJECT ADDRESS 1 ' / A �' GI ^ ` (
`A" / r 7
APN #
OWNER NAME -
-��� (sc��
PHO E
u 2-52- 7
E -MAIL
STREET ADDRESS / 6 q 4 (-( CA A 5-
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CITYSTATE, L,M
7 5- 0 1 q
FAX
CONTRACTOR NAME
LICENSE NUMBER
3 i 3
LICENSE TYPE
C3 ry
BUS. LIC. #
COMPANY NAME
E -MAIL
FAX
STREET ADDRESS D 700 �` ., I D
CITY, STATE, P ;L , 4-A 1 '
AA
(
PHONE
I UNDERSTAND AND AGREE TO THE FOLLOWING:
The re -roof project shall comply with all applicable provisions of the 2007 California Building Code.
2. You must schedule all needed inspections a minimum of one day before the requested inspection date.
Please schedule inspections online or call (408)777 -3228 between 7:30 -3:30 (Mon -Fri).
3. Tear -off roof inspection is required. Please call for tear -off inspection after the roof is torn off and all
the nails /fasteners have been removed. Any and all dry- rotted wood shall be replaced prior to this
inspection. A building inspector will be available within one hour.
There are special hours for this service: 7:30 — 10:30am and 1:00 — 3:30pm (Mon — Thurs);
7:30 — 10:30am and 1:00 — 2:30pm (Friday).
4. If plywood is installed, a plywood nailing inspection is required.
5. In- Progress roof inspection is required. Call for an in- progress roof inspection to verify building is
weather tight after installation of approximately 25% of the roofing material.
6. New roof coverings shall not be applied without first obtaining all inspections 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.
7. A final inspection and approval shall be obtained from the building inspector when the re- roofing is
complete. To receive a final sign -off, the following items will be verified:
a. Flat roofs shall have a minimum of 1/4" per foot of slope and must 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.
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.
y 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.
Signature of Applicant/Agent:
Date: t t 1 '4 /
ReroofPolicy_2010.doc revised 05117110