10090111 CITY OF CUPERTITS 0 BUILDING PERMIT
BUILDING ADDRESS: 1566 PRIMROSE WAY CONTRACTOR:SIMON SAYS ROOFING PERMIT NO: 10090111
OWNER'S NAME: GEORGIA LISOVSKY 3012 BECKLEY DR DATE ISSUED:09/15/2010
;ER'S PHONE: 4085044728
SAN JOSE,CA 95135 PHONE NO:(408)531-9700
❑ LICENSED CONTRACTOR'S
DECLARATION BUILDING PERMIT INFO: BLDG� ELECT r PLUMB
S/ r
License Class Lic.#. E d�'/ 9_ MECH r RESIDENTIAL F COMMERCIAL r
_ Z-Q 1 a
Contractor Date
JOB DESCRIPTION:RE-ROOF TEAR OFF ENTIRE ROOF&1/2 OSB 30LB FELT
I hereby affirm that I am licensed under the provisions of Chapter 9 40 YR COMP CLASS A ROOF 24 1/2SQ
(commencing with Section 7000)of Division 3 of the Business ssions
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 Sq.Ft Floor Area: Valuation:$8900
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. APN Number:36615012.00 Occupancy Type:
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 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-point source regulations per the Cupertino Municipal Code,Section
9.18. _ Issued by: Date: J
Signature
Li 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 for one 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
ate:
will do the work,and the structure is not intended or offered for sale(Sec.7044, Si ature of Applicant:
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's I 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. I will maintain
compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
performance of the work for which this permit is issued.
by Safety Code,Section q should I store or handle hazardous material.
I have and will maintain Worker's Compensation Insurance,as provided for I use e
Additionally,should use equipment or devices which emit hazardous air
Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will
permit is issued. 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,Sections 25505,25533,and 25534.
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 Owne ho ed a nt: Date: �� ID
become subject to the Worker's Compensation provisions of the Labor Code,I____
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 this 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 relatir g Lender's Name
to building 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
unify and keep harmless the City of Cupertino against liabilities,judgments,
,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION
granting of this permit.Additionally,the applicant understands and will comply
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 hate
CITY OF ,CUPERTINO
FEE ESTIMATOR--BUILDING DIVISION
ADDRESS: DATE: REVIEWED BY:
APN: BP#: ''VALUATION: 1$8,900
*PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PENTAMATION
PRIMARY SFD or Duplex �)�"�a: 1SFDWLR00F
USE: 1-"I C�t)Iz"I1/� I. PERMIT TYPE:
WORK
SCOPE
FEE ID ROOF AREA
J.
1REROOFFRES 2,500
1:�<It. (Yrx�,( It.z k 111,m C/w� A
C�dlr Afo,'h. Irr�,'�. OilvrP+ lF;Trs> Utir�`l�f<'r. lush.
Pflimh Ill,/l,
NOTE: These fees are based on the preliminairy in ormation available and are only an estimate. Contact the Dept for addn'1 info.
FEE ITEMS (Fee Resolution 09-051 Ef. 7;'Ii7pj FEL QTY/FEE MISC ITEMS
1'lun C'hC°c:k f'ei�:
I'itrtrzl�.:.�tec�l�.il;lCt: 'lute Check:
k:
Permit Fee: $325.00
.Sit/)I)l. Irr.sp FCC
%nit FCC.
f>/rarrtir.:1 ft�t/.:I:lc,t,f'et r�7it 1-cc,
;�i�:ousJit'ct1 hc't't�'ti'Fe't':
Work Without Permit? Q Yes 0 No 50.00
1'lunrtin�>Fc :
Tl-avel 0ocifincntutit�rt FCC'S°
Strong Motion Fee: IBSEISMICR $0.89 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $326.89 $0.00 TOTAL FEE: $326.89
Revised: 9/14/2010
Simon Says Roofing
3012 Beckley Dr
San Jw-e, Ca 95135
Tele: 408-531-9700 Fax: 408-531-1815
Bonded &Insu red License#784948
September 15,2010
To Whom It May Concern:
I,Darryl Simon,owner of Simon Says ]Roofing,am requesting that Allen Simon, be
authorized to pull permits on behalf of the company. If you have any questions,
please feel free to contact me at anytime. Thank you in advance for your time.
Regards,
DARRYL SIMON
OWNER
Simon Says Roofing
simonsaysroofiniE&aol.com
3012 Beckley Dr. San Jose,Ca 95135
408.531.9700 direct
408.531.1815 fax
-C1 XU:-1 13Cd3Sd1 dH WdLE : T O T 02 ST dos
M.Indoor A&Quality and Finishes
1.Use Lowffilo-VOG;i'aW 1 IAQMealth pts y=yes 0
2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Hsalth pts y=yes 0
3.UseLow� VOC sines 3 IAQ/Health pts y=yes 0
4.Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes 0
5.Use Engineered Sheet Goods with no added Urea
Formaldehyde 61AQ/Health pts y=yes 0
6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 0
7.Saalali��giolsailiP< fiaalaAdaariillDF 4IAQ/Health pts y=yes D
B.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes 0
9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y=yes 0
10.Install Whole House Vacuum System 3 IAQ/Health pts y=yes 0
1 1 1
N.Flooring
1.Select FSC Certified Wood Flooring B Resource pts y=yes 0
.UseRapidlyl3enewahlafloorfriglylateria+s 4Resource pts y=yes 0
3.Use Recycled Content Ceramic Tiles 4 Resource pts y=yes 0
4.Install Natural Linoleum in Place of Vinyl 5 IAQ/Health pts y=yes 0
5.Use Exposed Concrete as Finished Floor 4 Resource pts y=yes 0
6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes 0
r
Total Points Available: 1 1401 1301 57
Total Points Project Received: , 01 01 0
G:data/progs/gn!enbuBcOngguidelineslremodelerslgreenpointstina1212Uprolectedxls
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPART�9ENT•BUILDING DIVISION
ALBERT SALVADOR,P.E.,C.B.O.,BUILDING OFFICIAL
10300 TORRE AVENUE•CUPERTINO,GA 95014-3255
CUPERTINO
(408)777-3228-FAX(408)777-3333•bL ilding _cupertino.orq
APN#
FPROJECTS � cPHONE E-MAIL
JJ � FAX
CITY, STA�,ZIP
STREET ADDRESS Ie
`fir F/_ � vl,� l`m
J V LICENSE TYPE BUS.LIC.#
LICENSE NUMBEF
[CONTRACTOR NAME!� C c w.`06�J S F�+ ' EE-MAIL FA Li CMPANY NAME � T
STREET ADDRESS -E,ZIP S f\,�y���J� PHONE O r�) `, �'r
I UNDERSTAND AND AGREE TO THE FOLLOWING:
1. The re-roof project shall comply with all applicable provisions of the 2007 California Building Code.
2. You must schedule all needed inspections a mini-num of one day before the requested inspection date.
Please schedule inspections online or call (408)7'17-3228 between 7:30-3:30 (Mon-Fri).
3. Tear off roof inspection is required. Please ca.l for tear-off�inspection ood shall be replaced prior to thid all
dry-rotted
the nails/fasteners have been removed. Any and all ry
inspection. A building inspector will be availabl�-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 ._oran 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 dove n 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 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 inspecti)n.
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.
Ethe
gning below, I certify each of the following is true: I am the property owner or authorized agent to act
operty owner's behalf. I understand and agr-,e to comply with the re-roof policy stated above.
Date:
f Applicant/Agent:
Rero0JPolicy_2010.doc revised 05/17/10
CITY OF
CITY OF C UPERTINO
REROOF
cuPER t PERMIT APPLICATION
Date:
APN # ` i ej 15 10
Building
++ Address:
Gas C_
• Phone #:
Owner's Name: (S e o R
HOA: Yes ❑ No �/If es, rovide letter from HOA Phone #: c.�08 31 °I�t°o
Contractor:
Sean -�AyS �°°�``''�q Fax#:
Cupertino Business License #:
J Contractor License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles o Asphalt Shingles
m,—Wood Shakes o Wood Shakes
❑ Wood Shingles 4--Wood Shingles
❑ Other (Specify) ❑ Other (Specify)
Number of existing coverings ❑ Provide I.C.C.E.S. Report#
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description:
i.,..4t oxk Z O S t
({d �-/2
Residential - Commercial
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: 8 �6 U
I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
Signature
Revised 02/05/09