10080054 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7548 LEEDS AVE CONTR►CTOR:FFF ROOFING PERMIT NO: 10080054
SPECIAL IST
WNER'S NAME: LANCON RAYMOND R AND BARBARA L 451 STRO UD PL DATE ISSUED:08/06/2010
OWNER'S PHONE: 4089738537 SAN JOSE,CA 95116 PHONE NO:(408)365-0553
❑ LICENSED CONTRACTOR'S DECLARATION JOB DE+CRIPTION: RESIDENTIAL L1 COMMERCIAL
License Class C�3 Lic.# ONE LAYER WOOD SHAKES,TEAR OFF WOOD SHAKES,
qT� INSTALL ONE OSB PLYWOOD,ONE LAYER 30LB FELT
Contractor �" >.,(, Date �s / l0 AND
I hereby affirm that I am licensed under the provisions of Chapter 9 40 YEE►R COMP,CLASS A,31 SQUARES
(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. Sq.Ft Floor Area: Valuation:$13578
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 APN Nu mher:36616068.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 130 DAYS FROM LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments, p
costs,and expenses w, h may accrue against said City in consequence of the Id 1)y:
granting of this perm'Y. ssueAdditionally,the applicant understands and will comply
with all non-point urce regulations per the Cupertino Municipal Code,Section
9.18. i
����,1 RE-ROOFS:
Date_5v<; G All roofs shall be inspected prio any roofing material being installed.If a roof is
ins ection,I agree to remove all new materials for
installed without firs[obtaigi� p g
inspecti<n.
❑ OWNER-BUILDER DECLARATION
Signatur;of Applic - � Date: !C
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: ALL 0167OF COVERINGS TO BE CLASS"A"OR BETTER
1,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 HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). I have r!ad the hazardous materials requirements under Chapter 6.95 of the
Califori is Health&Safety Code,Sections 25505,25533,and 25534. I will
I hereby affirm under penalty of perjury one of the following three maintai i compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the C, rtino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 2 05,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
Owner ►r authorized agenj,' Date:
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 CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. work's t)r which this permit is issued(Sec.3097,Civ C.)
Lender s Name
APPLICANT CERTIFICATION Lender s Address
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
,n the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION
emnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section License i Professional
9.18.
Signature Date
CITY OF CUPER7INO
4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 36616068 . 00
DATE ISSUED. . . . . . . : 08/06/2010
RECEIPT #. . . . . . . . . : BS000011317
REFERENCE ID # . . . : 10080054
SITE ADDRESS . . . . . : 7548 LEEDS AVE
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER LANCON WYMOND R AND BARBARA L
ADDRESS . . . . . . . . . .
CITY/STATE/ZIP CUPERTINO CA, 95014-5219
RECEIVED FROM . . . . : FRANK CAr1OLONGA
CONTRACTOR . . . . . . . : FRANK M C'AMOLONGA LIC # 28519
COMPANY FFF ROOF_:NG SPECIALIST
ADDRESS 451 STROUD PL
CITY/STATE/ZIP . . . : SAN JOSE, CA 95116
TELEPHONE . . . . . . . . : (408) 365-0553
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ----------- ---------- ---------- ----------
1BCBSC VALUATION 13, 578 . 00 1 00 0 . 00 1 . 00 0 . 00
1BSEISMICR VALUATION 13, 578 . 00 1 40 0 . 00 1 .40 0. 00
1BUSLIC FLAT RATE 1 .00 114 00 0 . 00 114 . 00 0. 00
1REROOFRES SQ FEET 31 . 00 403 00 0 .00 403 . 00 0 . 00
------- --- ---------- ---------- ----------
TOTAL PERMIT 519 .40 0 . 00 519 .40 0. 00
METHOD OF PAYMENT AMOUNT RE:?ERENCE NUMBER
----------------- --------------- ---- ----------------
CASH 519.40
---------------
TOTAL RECEIPT 519 .40
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- - ------- ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
CITY OF
CITY OF CUPERTINO
III REROOF
CUPERTINO PERMIT APPLICATION
Date:
APN # 3�CD I ID 0(-,o � �c
Building Address:
Owner's Name: Phone #: zta� aq3 v,6,5 3
41 P,,' ,-cam c a r\
HOA: Yes ❑ No yes, provide letter front HOA
Phone #:
Contractor: ytG� 3 6S c S 5 3
gR e ct4\ Fax#: '-to $ 45 a Jr 5
Contractor License #:
Cupertino Business icense #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof Li Built-Up roof
❑ Asphalt Shingles j Asphalt Shingles
Wood Shakes Ll Wood Shakes
❑ Wood Shingles u Wood Shingles
❑ Other(Specify) a Other (Specify)
Number of existing coverings [3 Provide I.C.C.E.S. Report#
❑ To be Removed ii Provide Mfgr. Installation Specs.
Job Descnption: J y
Jf1S �� &.Al U
i�1- G c ► f> LO ►� o.,
Residential - Commercial ✓f
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:
I Have Read inderstand and Will Comply with Cuper:ino's Tear-Off Policy:
ature
Revised 02/05/09
CITY OF CUPER7[NG DIVISION
FEE ESTIMATNO
OR—BUIL'D
DATE: O
REVIEWED BY:
I
ADDRESS: *VALUATION: $13,578
APN: 3(�(p
BP#: 0 v�; �
' 'n Permit PLAN CHECK TYPE: Alteration (Addition / Repair
-kPERMIT TYPE: Building APPLICATION 1$FDWLROOF
M7 t+ 3 ; TYPE.
PRIMARY .SFD Or Dup�eX t'L UO1t' .0, q t r*
USE:
00
3 �
{k, "
t:fl.iIf:l Lt l:��Il' h
1'Ir-rmii f'!4ut i.ltrc'i:
i—i'Cis .r41/ti
he Dept
fees are based on the relimina in ormation available and are onl an estimate. CMISC ITEMS r addn'l in o.
NOTE: These FEE QTY/FEE
FEE ITEMS (Fee Resolution 09-051 Ftf 7,'l,'OII � 100 s.f. Re-roof
$0.00 2
Plan Check Fee:
$0.00 $403.00 I REROOFRES
Suppl.PC Fee: (E) Reg. 0 OT 0.0 hrs
PME Plan Check: $0.00
$0.00
Permit Fee:
Suppl. Insp.Fee:0 Reg.
Q OT 0.0 hrs $0.00
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
0
Acoustical Fee:
Q Yes Q No $0.00 E)
$0.00
Work Without Permit? O Yes 0 No Select a Non-Residential
$0.00 Building or Structure Q
PlanninjZ Fee:
�i111'I—'l ilrNltlNi'i7i<?`fill! �'r.'["<.
Select an Administrative Item
Strong Motion Fee: 1BSEISMICR $1.36
IBcasc $1.00 $405.36
I31do Stds Commission Fee:
�n
SZTB $2.36 $403.00
' pTLS
Revised: 8/06/2010
NdDDr AJr Qualityand Finishes
1.Use+LWNIO-00f uat 1 IAOJHBOth pts Y--yes 0
2.Use Lrnv VOC,Water-Based Wood Finishes 2 IAQ/He Oth pts y--yes 0
3.:Use Wvul*VOC Adhesives 3 IAWs dth pts Y--Yes 0
4.Use Salvaged Materials for Interior Finishes 3 Resour,e pts Yeses 0
5.Use Engineered Sheet Goods with no added Urea 0
Formaldehyde 5IAQ/HEan pts y--Yes
B.Use Exterior Grade PlNvood for Interior Uses 1 IAQMe an pts Y--Yes0
7.Seal l 4 IAOJHE alth 5 - es 0
S.Use FSC Certified Materials for Interior Finish 4 Resou-ce pts Y=Ye-s 0
9.Use Finger-Jointed or Recycled-Content Trim 1 Resou-ce pts Y--Yes 0
10.install Whole House Vacuum System 3 IAQ/Haan pts yeses =t0
1 1 1
N.Flooring
1.Select FSC Certified Wood Flooring B Resourm pts Y--yes 0
2.19s2Rap�c rt3eraeavahlefloarimlAat_D*s 4Resour,e pts Y--yes 0
3.Use Recycled Content Ceramic Tiles 4 Resour,e pts y--yes 0
4.Install Natural Linoleum in Place of Vinyl 5 IAQ/HE:alth pts Y--yes 0
5.Use Exposed Concrete as Finished Floor 4 ResDrlr:e pts y=Yes 0
6.Install Recycled Content Carpet with Low VOCs 4 ResowDo pts Y=yes 0
1 1 1
Total Points Availab a 140 130=
Total Points Project Received. 0 0 0
G:data/progWgreenbuildingi rL idelinestremoeierslgreenpointsfina1212%pnbr4edxis
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILD NG OFFICIAL
CUPERTINO 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228•FAX(408)777-3333•buil jing@cupertinn.org
PROJECT ADDRESS
APN#
OWNER NAME
I PHONE
J
STREET DRESS LV_3 E-MAIL
CITY, STATE, IP
CONTggCTOR NAME
C A FAX
711 LICENSE NUMBER
� LICENSE TYPE BUS.LIC.#
COMPA Y N ME
E- AIL
STREET ADDRESS
i 11 FAX
CITY,STATE,ZI,,
„ y PHONE
� L
I UNDERSTAND AND AGREE TO THE FOLLOWING:
1. The re-roof project shall comply with all applicable p•ovisions of the 2007 California Building
2. You must schedule all needed inspections a minimum of one da before the re nested ins a Code.
Please schedule inspections online or call (408)777-3,'28 between 7.30-3.30 (Mon-Fri). p ct�on date
3. Tear-off roof inspection is required. Please call for tear-off inspection after the
the nails/fasteners have been removed. Any and all dry-rotted wood shall be replaced proof is to thisrn off all
inspection. A building inspector will be available witl in one hour. prior s
There are special hours for this service: 7:30 — 10:3Oam 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% o:'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 appl ed 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 t le building inspector when the re-roof
complete. To receive a final sign-off, the following items will be verified: mg is
a. Flat roofs shall have a minimum of/4"per foot of s.ope and must demonstrate there is noondin
b. Listings from approved testing agencies for all pre-manufactured products used shall be avp g
on-site to review at the time of the inspection. ailable
c. Proper spark arrestor installation.
8. NOTE: If you call for a tear-off or plywood nailing insr ection and the work is not complete,
be charged a re-inspection fee of$126.00. The re-inspection fee shall be aid before another ou will
inspection can be scheduled. p
By my signing below, I certify each of the following is true: I Em the property owner or authorized com agree to a
on the property owner's behalf. I understand and a gent to act
g p y with the re-roof policy stated above.
Signature of Applicant/Agent:
Date:
RerooJPolicy_201 0.doc revised 05/17/10
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: 408-777-3228
CUPERTINO Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: Zj ce-) Y1v t PERMIT#
OWNER'S NAME: �, PHONE# �r -
GENERAL CONTRACTOR: .(� c�c c1 BUSINESS LICENSE#
ADDRESS: G$ 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 00-111PANCY INSPLCTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL S BCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors: Date
Signatui e
Please check applicable subcontractors and complete the following information:
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
O ner/Contractor Signature Date