12020020 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7762 ROBINDELL WAN' CONTRACTOR:TNT ROOFING CO PERMIT NO: t202002O
OWNER'S NAME: NIC DOWELL PETER E AND ANNE E 1610 BLOSSOM HILL RDSTE 6C DATE ISSUED:02/06/2012
OWNER'S PHONE: 4083710705 SAN JOSE,CA 95124 PHONE NO:(408)277-0800
0 LICENSED CONTRACTOR'S DECLARATION r—
F
BUILDING PERMIT INFO: BLDG ' ELECT PLUMB
License Class Lie.# FMECH RESIDENTIAL COMMERCIAL
Contra
Date JOB DESCRIPTION:TEAR OFF EXISTING,INSTALL COMP SHINGLES OVER
I hereby affirm that I alik licensed under the provisions of Chapter 9 30#
(commencing with Section 7000)of Division 3 of the Business&Professions FELT 20SQFT CLASS A
Code and that in);license is in full force arid 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
Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area: Valuation:$6745
permit is issue(].
APPLICANT CERTIFICATION APN Number:36223008.00 Occupancy Type:
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 put-poses. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED
indernniN and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this Permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulations per the Cupertino Municipal Code,Section
z. Issued by: 1/4Z
Signa Date:
Date
❑
OWNER-BUILDER DECLARATION
RE-ROOFS:
I hereby affirm that I am exempt from the Contractor'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 air inspection,I agree to remove all new materials for
1,,is owner of the property,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,
Business&Professions Code) Signature of Apllrcan�t �---�K—�.Date
[,,is owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I hereby affirm under penalty of perjury one of the following three
declarations: HAZARDOUS MATERIALS DISCLOSURE
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 I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for-which this permit is 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,Chapter 9.12 and the Health&
Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material.
Additionally,should I 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 pert6rinance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534.
Compensation laws of Calik)rnia. If,after making this certificate of exemption,I
become subject to(tie Worker's Compensation provisions of the Labor Code,I must Owner or authorized agent: Date:
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is I hereby affinn that there is a construction lending agency for the performance of work's
correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.)
to building construction,and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned property for inspection purposes.('Ale)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
costs.and expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
with all non-point source regulatit-wis per the Cupertino Municipal Code,Section
9.18. 1 understand my plans 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 36223008 . 00
DATE ISSUED. . . . . . . ; 02/06/2012
RECEIPT #. . . . . . . . . BS000015935
REFERENCE ID # . . . : 12020020
SITE ADDRESS 7762 ROBINDELL 14AY
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER MC DOWELL PETER E AND ANNE E
ADDRESS 10240 NE 12TH ST
CITY/STATE/ZIP . . . : BELLEVUE, WA 98004
RECEIVED FROM . . . . : MICHAEL D WILLIAMS
CONTRACTOR WILLIAM TYLER LIC # 22988
COMPANY TNT ROOFING CO
ADDRESS 1610 BLOSSOM HILL RD STE 6C
CITY/STATE/ZIP . . . : SAN JOSE, CA 95124
TELEPHONE (408) 277-0800
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- -
1BCBSC VALUATION 6, 745 .00 1.00 0 . 00 1 .00 0 .00
1BSEISMICR VALUATION 6,745 .00 0 .67 0 .00 0 .67 0 .00
1REROOFRES SQ FEET 20 .00 280 . 00 0 . 00 280 .00 0 .00
---------- ---------- ---------- ----------
TOTAL PERMIT 281.67 0 .00 281.67 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 281.67 VISA
---------------
TOTAL RECEIPT 281. 67
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
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE-CUPERTINO, CA 95014-3255
CUPERTINO
(408)777-3228- FAX(408)777-3333-building( cupertino.org
PROJECT ADDRESS � &I I / APN#
OWNER NAME �Q Q /,X &PHONE o/o
( / E-MAIL
STREET ADDRESS 2,/�0 `I(V CI STATE,ZIP-,j _ , ley
— FAX
CONTRACTOR NA -- �C/`' 2 * LICENSE NUMBER 5r`,l LICENSE,, P BUS.LIC.#
Cf
COMPANY NAME.�`.r-- r�..,, E-MAIL FAX
STREET ADDS
J" ;4:C4y C�� ` d �I4 CITY,STATE,ZIP ��'- `�. �S�r (J PHONEla-
I UNDERSTAND AND AGREE TO THE FOLLOWING:
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'/" 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: 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 monoxi etectors are required to be installed in accordance with Sections R314 and R315 of
the 2010 California Residenti ode
Signature of Applicant/Age '�s'� Date: ``
ReroofPolicy 2011.doc revised 02116111
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 7762 Robindell Way DATE: 02/06/2012 REVIEWED BY: A. Salvador
APN: BP#: VALUATION; 1$6,745
PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration /Repair
PRIMARY SFD or Duplex PENTAMATION 1 SFDWLROOF
USE: p PERMIT TYPE:
WORK Tear-off existing. Install comp shingles over 30#felt 20 SQ).
SCOPE
NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc.). These ees are based on the grelinina in ornuation available,and are o!! an estimate. Contact the De t or addn 7 info.
FEE ITEMS s:..'+' 1 t3 3!' 1'1 r`9 FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 12,000 1 s.f. Re-roof
Suppl.PC Fee: Q Reg. 0 OT 0.0 hrs $0.00 $280.00 IREROOFRES
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee-0 Reg. Q OT Lij hrs $0.00
PNIE Unit Fee: $0.00
PME Permit Fee: $0.00
0
Work Without Permit? 0 Yes No $0.00 0
$0.00 Select a Non-Residential Q
_._......... ....................._......._......___._..._._..._n..._..
Building or Structure 0
Strong_ Fe,-,: 1BSEISAIICR $0.67 Select an Administrative Item
Con-Inds'i€n Fee: IBCBSC $1.00
SUBTOTALS: $1.671 $280.00 TOTAL FEE: 1 $281.67
Revised: 1/19/2012
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
C U P E RT I N O Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: �7 PERMIT# �==
OWNER'S NAME: A PHONE#
GENERAL CONTRACTOR: BUSINESS LICENSE#
ADDRESS:IZ3 CITY/ZIPCODE: .Jrll
*Our municipal code requires all businesses orking 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.
I am not using any subcontractors: dw � "'
Signature Date
Please check applicable subcontractors and complete the following information:
V 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
` Z -) 2 � �` �
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERT{NC} (408)777-3228• FAX(408)777-3333 • buildingecupertino.org
PROJECT ADDRESS 7(77
OWNER NAME PH911 _/ /�� E-MAIL
STREET ADDRESS Crr�Ir T ick C FAX
APPLICANT NAMEvvrf PHONE / y r6 E-MAII j C
STREET ADDRESS& 454Crry,STATE,7,IP wlcC „ �" / FAX
C1 OWNER ❑ OWNER-BUILDER 13 OWNER AGENT' ONTRACrOR 13CONTRACTOR AGENT 1:3 ARCHITECT 13ENGWEER ElDEVELOPER 13TENANT
CONTRACTOR NAME LICENSE NUIvIDER /O LICENSn BUS.LIC.#
COMPANY NAME
E-MAIL FAX
�(
STREET ADDRESS CITY,STATS14_ / (� PHONE 77
OD
Z C' �/�S (G (1. S C7 t 1
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC.#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑ SFD or Duplex ❑ Multi-Family ROOF AREA: VALUATTON: f
STRUCTURE: ❑ Commercial
EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY)
REMOVE/REPLACE ❑YES IF NO- PLYWOOD ❑ W, ❑ PLYWD ❑ OSB PITCH. ROOF
EI No I #LAYERS: THICKNESS: ❑ 5/8" TYPE: ElCDX 12 CLASS: A
PROPOSED ROOF TYPE: ❑BUILT-UP ROOFICC-ES REPORT#
e�PHALT SHINGLES 13 WOOD SHAKES El WOOD SHINGLES ❑OTHER
DESCRIPTION OF WORK
By my signature below,I certify to 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 and state laws relating ng c nstruction. I authoriz represe fives of Cupertino to enter the above-identifie)/ prepe/rt;for inspection purposes.
Signature ofApplicant/A Date: Z_
SUPPLEMEN15AL INFORMATION REQUIRED —'�
Ifbuilding is associated with a Home Owner's Association,provide letter NO,
of approval from HOA. uSp Btzrz�ln�`II tG c"`
Provide Planningapproval to veri If there an restrictions.
PP fY Y — JAtG=PriEvl�v 3
Provide copy of Manufacturer's Installation Specifications. ,run �`E -Q =
_Provide signed copy of Cupertino's Tear-Off Policy. - � � — i *
� -�=� �•—�._
ReroofApp_2011.doe revised 03/02/11