10050003CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19045 PENDERGAST AVE CONTRACTOR: WORK FORCE ROOFING
WFR
+ER'S NAME: WADE 1U 5569 CAMDEN AVE
OWNER'S PHONE: 4087772972 SAN JOSE, CA 95124
LICENSED CONTRACTOR'S DECLARATION
.icense Class Lic. #
ontractor ADwitC c �— llate
f hereby affirm that I am licensed under 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:
l 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.
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
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 regulations per the Cupertino Municipal Code, Section
9.18.
BUILDING PERMIT INFO: BLDG
PERMIT NO: 10050003
DATE ISSUED: 05/03/2010
I PHONE NO: (408) 892-5096
ELECT PLUMB r
MECH r RESIDENTIAL r—
COMMERCIAL
JOB IIESCRIPTION: RE -ROOF REMV EXISTING ASPHALT SHINGL ROOF,
INSTA �L
30# 36' UNDERLAYMNT FELT PAPER. INSTALL 40YR
CERT/JNTEED LANDMARK PLUS ASPHALT SHINGLE OVR
Sq. Ft Floor Area:
APN slumber: 37537045.00
Valuation: $9187
Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
`'VITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
iture �tii t,,eI Date O 2aj?l Issued by,. �—
❑ 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)
1, 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
the above mentioned property for inspection purposes. (We) agree to save
mnify 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 regulations per the Cupertino Municipal Code, Section
9.18.
Signature 1" `iC vel 6' `n 1 Date
Date- 3- jr 6
RE -ROOFS:
All rc ofs shall be inspected prior to any roofing material being installed. If a roof is
instal ed without first obtaining an inspection, I agree to remove all new materials for
inspe;tion.
f 1'^� ' fit""` rDate-
ALL
Sign<ture of Applicant: �r� 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
Cali ornia Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
com Aiance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safe ty Code, Section 25532(a) should I store or handle hazardous material.
Add,tionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
mahitain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Hea th & Safety Code, Sections 25505, 25533, and 25534.
Owl orized a nt:5 �10 I
Date:
CONSTRUCTION LENDING AGENCY
I hei eby 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
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Lie _used Professional
3 ITEMS OF 3
CITY OF CUPE:ZTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 37537045.00
DATE ISSUED.......: 05/03/2010
RECEIPT #......... BS000010300
REFERENCE ID # ...: 10050003
SITE ADDRESS .....: 19045 FENDERGAST AVE
SUBDIVISION ......
CITY CUPERTINO
IMPACT AREA ......
OWNER'****'*'*'''
WADE JLC
ADDRESS 19045 FENDERGAST AVE
CITY/STATE/ZIP CUPERT]NO, CA 95014
OPERATOR: patg
COPY # : 1
RECEIVED FROM MIGUEL A NOYOLA
CONTRACTOR .......: MIGUEL ANGEL HERNANDEZ NOYOLA LIC # 30357
COMPANY WORK FORCE ROOFING WFR
ADDRESS . 5569 CAMDEN AVE
CITY/STATE/ZIP ...: SAN JOSE, CA 95124
TELEPHONE ........: (408) :392-5096
FEE ID UNIT
QUANTITY
AMOUNT
PD -TO -DT
----------
THIS REC
NEW BAL
-----------------------
1BCBSC VALUATION
----------
9,187.00
----------
1.00
0.00
1.00
0.00
0.00
1BSEISMICR VALUATION
9,187.00
1.00
0.00
1.00
260.00---
1REROOFRES SQ FEET
20.00
250.00
0.00
----------
----------
--
TOTAL PERMIT
----------
262.00
0.00
262.00
0.00
METHOD OF PAYMENT
-----------------
CREDIT CARD
TOTAL RECEIPT
AMOUNT
---------------
262.00
---------------
262.00
VOICE ID DESCRIPTION
-------- ----------------------------
601 ROOF TEAR OFF
REFERENCE NUMBER
--------------------
VISA
VOICE ID DESCRIPTION
-------- ----------------------------
602 ROOF PLYWOOD NAIL
604 ROOF IN -PROGRESS 605 FINAL REROOF
CITY OF
CITY OF CUPERTINOM4
REROOF
CUPERTINO PERMIT APPLICATION
APN # .� �3
Date:
Building Address:
v S- A v�
Owner's Name:
Phone #: ct02
HOA: Yes ❑ No 2<1f Yes, provide letter from HOA
Contractor: r
Phone #:
Fax #:
Cupertino Business License #:
Contractor License #:
C-39 4f 6633
Type of Roof Covering:
Existing: P roposed:
❑ Built -Up Roof ❑ Built -Up roof
0 Asphalt Shingles 0 Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other (Specify) ❑ Other (Specify)
Number of existing coverings 2-v ❑ Provide I.C.C.E.S. Report #
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description: fl e
` ZFI,,,s 4,0, (1 30 # 3�`` c - r �-he,
(r) n As _oLI
Residential Commercial
Green Building: Please complete relevant portion of the Confirmed with -Planning Dept. if
Green Building Checklist & attach it to the applical ion or if there are any restrictions: ❑
applicable, include in plan set & the sheet index.
Valuation:
I Have Read, Understand and Will Comply with Cupertino's Tear -Off Policy:
Signature
Revised 02/05/09
CITY OF
CITY OF CUPERTINO
96 REROOF
CUPERTINO FEE SCHEDULE
Number of Fee ID
Squares
Fee Description
Fee
Group
Permit Type
1REROOFCOM
Re -roof Commercial
B
1COMMLROOF
1BCBSC
Cal Bldg Standards
Commission Fee
B
ALL PERMIT TYPES
1BSEISMICO
Seismic Commercial
B
1RER00FRES
2�
Re -roof Resident:.al
B
1SFDWLR00F
1BCBSC
/
Cal Bldg Standar3s
Commission Fee
B
ALL PERMIT TYPES
1BSEISMICRE
Seismic Residential
B
1REROOFNIRES
Re -roof Multi-FE.mily
B
1MF'DWLROOF
1BCBSC
Cal Bldg Standards
Commission Fee
B
ALL PERMIT TYPES
1BSEISMICRE
Seismic Residential
B
1BUSLIC
Business License
B
CUPERTINO
REROOF TEAR -OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE - CUPERTINO, CA 9EO14-3255
(408) 777-3228 - FAX (408) 777-3333 - buildin ina cupertino.orq
I UNDERSTAND AND AGREE TO THE FOLLOWING:
1. The re -roof project shall comply with all applicable p.-ovisions of the 2007 California Building Code.
2. An inspection request shall be scheduled the day before the inspection date. Please call (408)777-
3228 between 7:30 - 3:30pm (Mon -Fri) to schedule the next day inspection.
3. After the roof is torn off and the nails/fasteners have been removed and all the dry -rotted wood has
been replaced, you must call for a roof inspection. A building inspector will be available with one hour.
There are special hours for the 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. 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.
6. 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 item will be verified:
a. Flat roofs shall have a minimum of 1/" per foot of slope and demonstrate there is no ponding.
b. A listing from an approved testing agency shall be available on-site to review at the time of the
inspection.
c. Proper spark arrestor installation.
7. NOTE: If you call for a plywood nailing inspection and the job is not ready, you will be charged to a re-
inspection fee of $126.00. The re -inspection fee shall be paid before another inspection can be
scheduled.
"y my signature below, I certify to each of the following: I am the property owner or authorized agent to act on
_.ie property owner's behalf. I understand and agree to comply with the re -roof policy stated above.
I
M1
n Date: 3. Signature of Applicant/Agent: yv 15 u e- / — --
ReroofPolicy_Z0l0.doc revised 04114/10
N#
PROJECT ADDRESS
PHONE
E-MAIL
OWNERNAME r
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G -
STREET ADDRESS
CITY, STATE, ZIP
FAX
CONTRACTOR NAME L k f 4 F✓�
LICENSE NUMBER
LICENSE TYPE
BUS. LIG #
COMPANY NAME :.�� `c vLy W �>Z
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E-MAIL
FAX
7 1 ` A L D
STREET ADDRESS (o I"` J' PA
CITY, STATE, ZIP
PHONE
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I UNDERSTAND AND AGREE TO THE FOLLOWING:
1. The re -roof project shall comply with all applicable p.-ovisions of the 2007 California Building Code.
2. An inspection request shall be scheduled the day before the inspection date. Please call (408)777-
3228 between 7:30 - 3:30pm (Mon -Fri) to schedule the next day inspection.
3. After the roof is torn off and the nails/fasteners have been removed and all the dry -rotted wood has
been replaced, you must call for a roof inspection. A building inspector will be available with one hour.
There are special hours for the 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. 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.
6. 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 item will be verified:
a. Flat roofs shall have a minimum of 1/" per foot of slope and demonstrate there is no ponding.
b. A listing from an approved testing agency shall be available on-site to review at the time of the
inspection.
c. Proper spark arrestor installation.
7. NOTE: If you call for a plywood nailing inspection and the job is not ready, you will be charged to a re-
inspection fee of $126.00. The re -inspection fee shall be paid before another inspection can be
scheduled.
"y my signature below, I certify to each of the following: I am the property owner or authorized agent to act on
_.ie property owner's behalf. I understand and agree to comply with the re -roof policy stated above.
I
M1
n Date: 3. Signature of Applicant/Agent: yv 15 u e- / — --
ReroofPolicy_Z0l0.doc revised 04114/10
M. In oor Air Quality aMinislas
1. Use Low/ND-VOC Paint
1 IACJHealth pts
y=yes
2. Use Low VOC, Water -Based Wood Finishes
2 IACJHealth pts
y=yes
3. Use Low/No, VOC Adhesives
3 IACIHealth pts
y=yes
4. Use Salvaged Materials for Interior Finishes
3 Re3ourDa pts
y=yes
5. Use Engineered Sheet Goods with no added Urea
Formaldehyde
6. Use Exterior Grade Plywood for Interior Uses
7. Seal aft Emxzed t'�o�' laloiaard or IJIDF
B. Use FSC Certified Materials for Interior Finish
9. Use Finger -Jointed or Recycled -Content Trim
10. Install Whole House Vacuum System
H. Flooring
1. Select FSC Certified Wood Flooring
2. Use RapigUy Renewable Flooring Materials
3. Use Recycled Content Ceramic Tiles
4. Install Natural Linoleum in Place of Vinyl .
5. Use Exposed COncrefe as Finished Floor
6. Install Recycled Content Carpet with Low VOCs
6IAO/HeaJth pts
y=yes
1 IAO/Health pts
y=yes
41AO/Health pts
y=yes
4 Re3Dufce pts
y=yes
1 Resource pts
y=yes
3 IADJHealth pts
y=yes
Total Points Available:
Total Points Project Received:
8 RecoUFce pts
y=yes
4 Re: ource pts
y=yes
4 Resource pts
y=yes
5 IACJHealth pts
y=yes
4 Res ource pts
y=yes
4 Re: ource pts
y=yes
1 1401 130 57
0 0 0
G:datalprogs/greenbuilc ngguidelinestremodelers/greenpointsfinal?IIU4proleoteci is
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
Fax: 408-777-3333
CUPERTINO
CONTRACTOR / SUBCONTRACTOR LIST
PERMIT #
JOB ADDRESS: t q O PHONE
OWNER'S NAME:
GENERAL CONTRACTOR: lo -clLc e
aC ��2 BUSINESS LICENSE #
ADDRESS: ?-G/ 0� CITY/ZIPCODE:
*Our municipal code requi s all businesses working in the city to have a City of Cupertino business license.
BE HUNTIL THE
NO BUILDING FINAL OR FINAL OCCUPANCY INSPF-CTIOCITY OF CUPERT[NO
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A
BUSINESS LICENSE. `• ( /I, I -Or/ 03 /201 6
I am not using any subcontractors. " Signature
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR
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
BUSINESS N.
Owner / Contractor Signature
Date
Kai, V 3, �i a
Date