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11110122 (2) CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10421 PHAR LAP DR CONTRACTOR:LOS GATOS ROOFING PERMIT NO: 11110122 OWNER'S NAME: FYALL WILLIAM L AND BRIGITTE M P O BOX 1726 DATE ISSUED: 11/22/2011 O NER'S PHONE: 4082557675 LOS GATOS,CA 95031 PHONE NO:(408)298.9399 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r, PLUMB r License Class (J.IE.�IRa V?d 1 (- r� MECH RESIDENTIAL COMMERCIAL r Contractor Car I Daty- 't L 1 hereby affirm that I am licensed and the provisions of Chapter 9 JOB DESCRIPTION: RE-ROOF ( toes. (commencing with Section 7000)of Division 3 orthe Business&Professions C-�"-1P 5h' n9(e9 CQo-S7 -A 4z-Sq Code and that my license is In full force and effect. 1 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:$12600 1 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. APN Number:32639036.00 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 PERMIT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION. 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 er the Cupertino Municipal Code,Section Issued b Date: 9.18. Signature Date • ROOFS: OWNER-BUILDER DECLARATION All roofs shall be inspected prior m anyy roofing material berg installed.If a roof is installed without first obtaining an inspection,I agree to remove all new materials for I hereby affirm that 1 am exempt from the Contractor's License Law for one of inspection. the following two reasons: 1,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date:`� 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 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 read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& performance of the work for which this permit is issued. Safety Code,Section 25532(x)should I store or handle hazardous material. 1 have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I 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 Health&Safety Code,Sections 25.50.5,25533,and 25534. 1 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 Owner or authorized age Compensation laws of California. If,after making this certificate of exemption,1 Date: rl 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. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.) I certify that I have read this application and state that the above information is Lender's Name 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 Lender's Address upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, 9thts,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION 'ting of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records. all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Licensed Professional Signature Date • CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 32639036. 00 DATE ISSUED. . . . . . . : 11/22/2011 RECEIPT #. . . . . . . . . : BS000015376 REFERENCE ID # . . . : 11110122 SITE ADDRESS . . . . . : 10421 PHAR LAP DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : FYALL WILLIAM L AND BRIGITTE M ADDRESS . . . . . . . . . . : 10421 PHAR LAP DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-1118 RECEIVED FROM . . . . : GARY C RADNICH CONTRACTOR . . . . . . . : RANDY BROWN LIC # 23481 COMPANY . . . . . . . . . . : LOS GATOS ROOFING ADDRESS . . . . . . . . . . : P 0 BOX 1726 CITY/STATE/ZIP . . . : LOS GATOS, CA 95031 TELEPHONE . . . . . . . . : (408) 298-9399 • FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 12, 600 .00 1. 00 0.00 1.00 0 . 00 1BSEISMICR VALUATION 12,600 .00 1.26 0.00 1.26 0. 00 1REROOFRES SQ FEET 40 .00 560.00 0.00 560.00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 562.26 0. 00 562 .26 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 562.26 VISA --------------- TOTAL RECEIPT 562.26 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 • 2- DLO REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 • CUPERTINO (408)777-3228 • FAX(408)777-3333 • buildinglD.cupertino.orG PROXECr ADDRESS /D / SIJ kFN OWNERNALffi ryry. r PHONE O I W! E-MAL STREET ADDRESS441 CITY. STATE ZIP Pro/Y FAX 97 APPLICANT NAME PHONE E-MAIL STREET ADDRESS ` CRY STATE, ZIP IA FAX . ❑OWNER ❑ OWNER-BUILDER ❑ OWNERAOENr ❑ CONTMCrOR ❑CONTRACTOR ADEM ❑ ARCHRBCT ❑ENCENEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME `/®0 ME UCENRE NUER&A 70 -7 LICENSE TYPE Q BUS.LIC.Y COMPANY NAME /A^ 0 ^ N B-MkIL AWL C•1d FAX STREET ADDRESSCJ 1W CITY,STATE,ZIP S^ PHONE �J ARCHITECMENG@!gRNAME LICENSE NUNWER BUS.LIC Y COMPANY NAME E-MAIL FAX STREET ADDRESS CRY,STATE,ZIP PHONE USE OF SFD or Duplex ❑ Multi-Family ROOF AREA::STRUCTURE: VALUATION: p STRUcnE: ❑ Commercial gt00q /Z EXISTING ROOF TYPE: ❑BUILT-UP ROOOOF ❑ASPHALT SHINGLES0o8'� O$HARES ❑WOOD sHNmm ❑OTHER(Bpticnrr REMOVE/REPLACE y❑ E1 IF NO, OAO' ROOF a- x W 00- PW �:12CLASS A PROPOSED ROOF TYPE: ❑BUTLT-UP ROOF ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT x DESCRIPTION OF W7& i By my signature below,I certify m 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 information I have provided is correct I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances Rod state laws MIRtin buildiauthorize representatives of Cupertino to enter the above-identified property for inspection purposes. an Signature ofApplicanNAgent ,y3 .Wi Date: ��// SUPPLEMENTAL INFORMATION REQUIRED ms`s _a �CaPtt�7SrcNC +a- ;,-,�i; k _If building is associated with a Home Owner's Association,provide letter I �"n'LA"��_��5+�k�`✓—s"PJ.„�,�zt+.��RoutUi.¢!sl7r �t1 of approval from HOA. FY p ,tia 'D .tia, 1 yL'"Js ` t_ _Provide Planning approval to verify if there any restrictions. Provide copy of Manufacturer's Installation Specifications. / �x � a ✓lsrovide signed copy of Cupertino's Tear-Off Policy. ReroofApp_2011.doc revised 03/02/11 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION • ADDRESS: 10421 pharlap dr. DATE: 11/22/2011 REVIEWED BY: APN: BP#: "VALUATION: $12,600 *PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof PRIMARY SFD or Duplex PENTAMATION 1SFDWLR00F USE: PERMIT TYPE: WORK re lace wood shake with comp shingles. SCOPE FEEID ROOFAREA s.f. 1REROOFFRES 4,000 th"t, Phw Plumb. Phan Check Ele..Plan ChecA- Lre(A Perurit hire; Plund+. Perrin Fee: fila.. Pet nih Fee: <'1lha-I terh.Irsp, 011jer Piuurh Insp. Orher Elre. prop. Ej ,lire ch.6Np. bee: 1'luulb. hsrp./-'er: Efei Imp.Fee: NOTE: This estimate does not include fees due to other Departments(ie.Planning,Public Works,Fire,Sanhary Sewer District,School District,etc. . These fees are based on the prelinina in ormatlon available and are only an estimate. Contact the Dept foraddn7 in o. FEE ITEMS (!ee Resohdirnr /1-053 E(j 7,i1/1I/ FEE QTY/FEE MISC ITEMS Plan Check-Fee: Suppl. P<:C.Fee Plr un b.;a�ech..2li<: Permit Fee: $560.00 Suppl. Insp Fee Plump./?Llech.%lifer. I'hmrh.:'_Vli�ch.�l lec I'ermit.F eec Crntciruclion Adminis7ratiiv Fee: Work Without Permit? O Yes (E) No $0.00 Advanecd Pfannin�F%'ees: lrervel Docennentation Fer; Strom Motion Fee: IBSEISMICR $1.26 Select an Administrative Item • Bldg Stds Commission Fee: iBCBSC $1.00 SUBTOTALS: $562.261 $0.001 TOTAL FEE: $562.26 Revised: 10/01/2011 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-buildinc(a),cupertino.ora PROJECT ADDRESS /(9 APNN OWNERNAME .�\�` m �' PHONE � e E-MAIL STREETADDRESS SCITY, STATE,ZIP FAX CONTRACTOR NAME ``��II 6%11 LICENSE NUM ER 70 LICENSE IYP€`je BUS.LIC.p COMPANY NAME E-MAIL C' 7 FAX STREET ADDRESS C CITY,STATE,ZIP Pr PHON4EO .j I UNDERSTAND AND AGREETOTHE FOLLOWING: G� J 1. The re-roof project shall comply with all applicable provisions of the 2010 California Codes. 2. An inspection request can be scheduled up to 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. For Tear-Off and Nailing Inspections, you must also call on the day of the inspection only after that phase of the work is completed. The building inspector will be available within one hour. Progress and Final Inspections will be given a two hour window. 3. 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. 4. If plywood is installed, a plywood Nailing Inspection is required. 5. Roofing shall not be applied without first obtaining all prior 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. Progress Insnection is required when approximately 50% of roof covering is installed. 7. 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 1/<" 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, vents painted, gutter/downspouts installed, debris removed. 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. By my signing below, 1 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. I also understand that smoke detectors and carbon monoxide detectors are required to be installed in accordance with Sections R314 and R315 of the 2010 California Residential C Signature of Applicant/Agent: Date: _Z Z l� RerooJPolicv_1011.doc revised 01/16/1/ Building Department City Of Cupertino 10300 Tone Avenue Cupertino, CA 95014-3255 U P E RT I N O Telephone:408-777-3228 Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: /On/ I PERMIT# OWNER'SNAME: ' JPHONE# GENERAL CONTRACTOR: G BUSINESS LICENSE# ADDRESS: //Z 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 OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. �1 I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: t/ 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