11110075 (2) -' CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22540 RICARDO RD CONTRACTOR:ROSSETTAS ROOFING PERMIT NO: 11110075
OWNER'SNAME: MICHIiI..IOIhINJ 401 LINCOLN AVE DATE ISSUED: 11/142011
OWNER'S 1.1ION B: 4082559990 SAN JOSE,CA 95126 PHONE NO:(408)294.4400
we /lLICEENSED CONTRACT ORAS DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
C.
License Class '3 r I c.4 WOO
{ISI Il MECH(- RESIDENTIAL r' COMMERCIAL r
Contractor a tin It a dflpq' Dale f �9
�—
hereby nflinn that I tun licensed under the prmJOB DESCRIPTION:RE-ROOF TEAR OFF WOOD SHAKE,INSTALL NEW
�isians of Chapter 9 '
(commencing with Section 7001)of Division 3 of the Business&Professions COMP&NEW
Code and that my license is in full force and effect. COX 1/2 PLYWOOD SHINGLES CLASS A 30SQ
hereby affirm under penally of perjury one of the following two declarations:
I have and will maintain a ccrtilicate of consent to sclf-insure for Worker's
Compensation,as provided Ibr by Section 3700 of the Labor Code,for the
performance of the work lix which this permit is issued.
I have and will mninmin Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,far the performance of the work forwhich this Sq.Ft Floor Area: Valuation:$21000
permit is issued.
APPLICAN"I'CFRI'I FICATION APN Number:35601007.00 Occupancy Type:
I certify that I have read this appliruion ad sink th:u 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 PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino ngainst liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
grantingot'dus permil. Additionally,theapplicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulations per the Cuperino Municipal Code,Section
9.18. 6/-Lr
✓ Issued by Dete: /'"
Signature Date
OWNER-BUILDER DECLARATION
RE-ROOFS:
ereby nl'Iirm Ilial I ❑m rwngnl from the Cuntrnctnr's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is
the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
I,as orncr of the properly,or my employees with wages as their sole compensation, inspection.
will do the work,and the structure is not intended or offered for sale(Sec.7044, nII It
Business&Professions Codc) Signature of Applicant: Date: 'tl
I,as owner of the property,ain exclusively con tilled%with licensed contractors to
construct the project(Sec.70,14,Business& I'ro1?ssioil s Code), ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1 hereby al7irm under penally of perjury our,o (he following three
declarations:
I have HAZARDOUS MATERIALS DISCLOSURE
have and will mninmin n Certificate of Coiucm to tt•Il=insure for Worker's
Compensation,as provided fur by Section 3700 afihc Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit k issued. California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter9.12 and the Health&
Section 3700 of the Labor Code,for the performance ollhe work for which this Safety Code,Section 25532(x)should I store or handle hazardous material.
Additionally,should 1 use equipment or devices which emit hazardous air
permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will
I certify that in the pertiinnmice of die work lint,yhich this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
not employ any pci mi in anv manner so as to becoine subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534.
Compensation lows of Culilixnia. II',a0cr nmking this certificate of exemption,I
become suhicct to the Worker's Compensation provisions of the Labor Code,I must Ow ne r u harized agent: t I I I
forthwith comply wish such provisions or This permit shall be deemed revoked. tr Date: /
\1'1'1.1(:,\:N \'ll(1N CONSTRUCTION LENDING AGENCY
'1'Claf"1'11
I certify that I have rend this application and state thnl the above information is I hereby affirm that there is a construction lending agency for the performance of work's
correct. I agree to comply with all city and coumc wdinances and state laws relating for which this permit is issued(See.3097,Civ C.)
to building COnSMICIIon,and hereby author i>c rep:rscntatives of this city to enter Lender's Name
upon the above mentioned property for inspection purposes.(We)agree to save
indemnil-y and keep hornless the City nl Cigs Iinu against liabilities,judgments, Lender's Address
Wo and expenses which nvoy accrue ne:fmat said Cby In consequence of the
og ol'dtis permit.Additionally,(lie'opplicmn understands and will comply - ARCHITECT'S DECLARATION
non-point source regulations per the Cupertino Municipal Code,Section
9.18. 1 understand my pions shall be used as public records.
Signature Date Licensed Professional
• CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35601007. 00
DATE ISSUED. . . . . . . : 11/14/2011
RECEIPT #. . . . . . . . . : BS000015306
REFERENCE ID # . . . : 11110075
SITE ADDRESS . . . . . : 22540 RICARDO RD
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : MICHEL JOHN J
ADDRESS . . . . . . . . . . : 22540 RICARDO RD
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : ROSSETTA' S ENTERPRI
CONTRACTOR . . . . . . . : ROSSETTA, DAN LIC # 20781
COMPANY . . . . . . . . . . : ROSSETTAS ROOFING
ADDRESS . . . . . . . . . . : 401 LINCOLN AVE
CITY/STATE/ZIP . . . : SAN JOSE, CA 95126
TELEPHONE . . . . . . . . : (408) 294-4400
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- -------—-
1BCBSC VALUATION 21, 000.00 1. 00 0. 00 1. 00 0. 00
1BSEISMICR VALUATION 21, 000.00 2 . 10 0 . 00 2 .10 0. 00
1REROOFRES SQ FEET 30.00 420. 00 0. 00 420 .00 0.00
---------- ---------- ---------- ----------
TOTAL PERMIT 423 . 10 0 . 00 423 .10 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 423 . 10 #15974
---------------
TOTAL RECEIPT 423 .10
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
•
CITY OF CUPERTINO
FEE ESTIMATOR —BUILDING DIVISION
• ADDRESS: 22540 ricardo rd. DATE: 11/14/2011 REVIEWED BY: bobs.
APN: BP#: "VALUATION: $21,000
°PERMITTYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD or Duplex PENTAMATION 1SFDWLR00F
USE: PERMIT TYPE:
WORK I tear off wood shake install new comp shingles.
SCOPE,
FEE ID ROOFAREA
(S.C.)
1REROOFFRES 3,000
,41nrh. Plan Ck ock Plumb, Plnn Check Elec.Pfau Checlr
;bleah. Perwa Vee. Plun;h. Pernm tree.' vlec. Pernuz Fee:
Urher Heck nap. 06ter pluu;h Li.:P. rather F7ra. lisp.
;17 etz.Inge }gee: Plumh. Lsp.Fee: Mee.lnvr Fee.:
NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc. . Thesefees are based on the prellmina information available and are aan estimate. Contact the De t or addn 7 Info.
FEE ITEMS (Fee Resolution 11-053 E1X 711111) FEE QTY/FEE MISC ITEMS
Plan Che>cr, fee:
.Suppl, PC ee
Tltun/i.Glrkrch.;lila,
Permit Fee: $420.00
SnppL 111sp Vee
F'krrnb.iddech.:'Itiluc
1'lrrnt!?.'Hlech.%Fier.Permit Fee:
Con"muctior nix
Adndnistrative Fee.
Work Without Permit? () Yes (F) No $0.00
.4411ance:d Planning pees:
'A,wel Documentation Fnus
Sirone Motion Fee: 1BSEISAECR $2.10 Select an Administrative Item
Blde Stds Commission Fee: IBCBSC $1.00
SUBTOTALS:, $423.10 $0.00 TOTAL FEE: $423.10
Revised: 10/01/2011
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
• CUPERTINO (408)777-3228 • FAX(408)777.3333 • buildingecupertino.orD
PROJECT ADDRESS /yQ (fir AFN Y C)
OWNERNAME S 1 PHONE . W -2d C 0 EMAM �l
STREET ADDRESS 72^,D 1 a CFIT. STATE,ZIP ) / PAX
APPLICANT NAME ) `� rd(,l a PHO v�` /yt- ' �r l E-MAIL
STREET ADDRESS V- L,VCnI !JIIC- ,,// 9J 1 MC4
!Y' ?9Y- �l .
0 OWNER ❑ OWNER-BUILDER ❑ OWNERAOENT a CONTRACTOR ❑CONTRAC'IVR AOPNr ❑ ARCHRECr ❑E19GP1EEl ❑ DEVELOPER ❑TENAM
CONTRACTOR NAME BUS.LIC.Y
Y�Lf a .SPL �'—
COMEANYNAME IZU4
/./ dI-V E-MAB. FCx`(
STREET ADDRESS 4uU Krill cTl �TP.�ZIl' 11 �I Z� PHOIDE O 79y- L 00
ARCHTJECT/ENG@IEFOR NAME LICENSE NUM®ER cksQ- BUS..LIO.Y
COWANY NAME E-MAJL FAX
STREET ADDRESS CTTY,STATE,ZIP PHONE
USE OF Ef'SFD or Duplex ❑ Multi-Family ROOF AREA. �-2
ALUATION:
STRUCTURE: [3 Commercial 1,Oro
EXISTING ROOF TYPE: ❑BUB.T-UP ROOF ❑ASPHALT SHINGLES WOOD SHAY= ❑WOOD SHINGLES ❑OTHER(SPECIFY)
REMOVE/REPLACE &YES 1FNO, PLYWOOD H" ❑ PLYWD ❑ OnxOSB PfICH AOOP
EI No THICKNESS 11 518- TYPE
CLASS
PROPOSED ROOF TYPE: ❑BUMT-UP ROOF M<IPHALTSHINGLES 0 WOOD SHARPS ❑WOOD SHNGLES ❑OTHER ICC-ES REPORT Y
DESCRIPTION OF WORK _ II 11 � '1
1 C1r YU. 1'00 1 kr2N Lul 40 tlt� 1 KLW &h4 rut
By my signature below,I certify to each of the following: I am the property owner or authorised agent to act on the property owners behalf. I have read this
application and the information I have provided is comet I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to bull nstruction. I authorim representatives of Cupertino;c enter the above end ted property for inspection purposes.
S ignarza ofApplicant/Agent b.'tA@� Date: (t IY rl
SUPPLEMENTAL INFORMATION REQUIRED
_If building is associated with a Home Owner's Association,provide letter i --'✓s° '�tPJ -�',,,, , �putTN.pr§t�a„`
of approval from HOA. r7r` Sr•M`
W1Z'JawDnv:
_Provide Planning approval to verify if there any restrictions. ,mut�BS tt W is cflnvz;T. „
_Provide copy of MaDufacttaer's Installation Specifications.
rovide signed copy of Cupertino's Tear-Off Policy.AOL
- �cLJ •"d�-�. '
ReroofApp_2011.doc revised 03/02111
REROOF TEAR-OFF POLICY
2 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•buildinaCdcupertino.Ora
PROJECT ADDRESS +y11
Lb I lr� APN0
OWNER NAME ( tC PHONE E-MAIL
STREET ADDRESSK� r CITY, STATE, �Wp a'/ FAX
Gd S
CONTRACTORNAME i I1 LIC S NU Jt� LIC E'IV�E BUS.LIC.0
S a d v 6 SI
COMPANY NAME E-MAIL nn FAX
„ s F j cvvw ,,),' 9Y Y4
STREET ADDRESS Ol r SIM /��— CITY AE.ZI�\P\ t A,( qm PHONE Lx? 2qY-YY00
l (' ` I UNDERSTAND AND AGREE TO(TTHE-1FOLLOWING:
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 Inspection 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 Y4" 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, I certify each of the following is true: 1 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 Code.
Signature of Applicant/Agent: Date: ( ft
RerooJPolicv_201 l.doc revised 02116111
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone:408-777-3229
U P E RTI N O Fax: 408-777-3333
CONTRACTOR / SUBCONTRACTOR LIST
JOBADDRESS: 22fYO sar u PER MIT# D S
OWNER'S NAME: 4PHONE# 24 - 896
GENERAL CONTRACTOR: g BUSINESS LICENSE#
ADDRESS: W 'Sj' 5- CITY/ZIPCODE: 5 � 9 2
*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. d_
I am not using any subcontractors:
Signature Date
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
lip Tile
Owner/Contractor Signature Date