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12020026
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20245 STEVENS CREEK BLVD CONTRACTOR:LEGACY ROOFING& PERMIT NO: 12020026 WATERPROOFING OWNER'S NAME: TERSINI KENNETH S TRUSTEE&ET AL 1698 ROGERS AVE STE tO DATE ISSUED:02/07/2012 OWNER'S PHONE: 4082S72103 SAN JOSE,CA 95112 PHONE NO:(408)467-4150 0 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class(b J C—-'b� Lic.4 C6' Q Z ko'S k.-:, MECH ' RESIDENTIAL COMMERCIAL ContractorUeoca Date '1-_.,./ 11 [hereby affirm that I am licensed unJOB DESCRIPTION:ENTIRE BLDG-REMOVE EXISTING ROOF,ADD L`4�dr the provisions of Chapter 9 DENSE (commencing with Section 7000)of Division 3 of the Business&Professions GLASS DECK SUBSTRATE AND ADD TPO ROOFING MEMBRANE Code and that my license is in full force and effect. 37SQFT CLASS A I hereby affirm tinder penalty of perjury one of the following two declarations- [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-$3)5004--' permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is APN Number:31625043.00 Occupancy Type: 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, PERMIT EXPIRES IF WORK IS NOT STARTED costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non-point source regulaticiis per the Cupertino Municipal Code,Section 180 DJ 'S FRO T CALLED INSPECTION. 9.1 b. Signature Date- Issued by: Z Date: 0 OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS: tile following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is [,as owner of the property,or my employees with wages as their sole compensation, installed without first obtainin tion,1 move all new materials for will do the work,and the structure is not intended or offered ti--)r sale(Sec.7044, inspection. Business&Professions Code) [,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: Date: construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm tinder penalty of perjury one of the following three declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE 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. CaliforniaI have and will maintain Worker's Compensation Insurance,as provided for by CHealth&Safety Code,Sections 25505,25533,and 25534. 1 will maintain Section 3,700 of(fie Labor Code,for the performance of the work for which this compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Safety Code,Section 25532(a)should I store or handle hazardous material. Permit is Issued. Additionally,should I use equipment or devices which emit hazardous air I certify that In the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District I will not employ any person in any manner so as to becorne subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and tile Corn Pell sation laws of California. If,atter making this certificate of exemption,I Health&Safety Code,Sections 25505,25533,and 25534. become subject to the Worker's Compensation provisions of the Labor Code,I tnust h * d gent: 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 correct.1 1 agree to comply with all city and county ordinances and state laws relating I hereby affirm that there is a construction lending agency for the performance of Nwirk's to building construction,I and hereby authorize representatives of this city to enter for which this permit is issued(See.3097,Civ C.) upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name indemnify and keep harmless the City of Cupertino against liabilities,judgment-,, 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 with all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION 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 # Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 31625043 .00 DATE ISSUED. . . . . . . : 02/07/2012 RECEIPT #. . . . . . . . . : BS000015945 REFERENCE ID # : 12020026 SITE ADDRESS . . . . . : 20245 STEVENS CREEK BLVD SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : TERSINI KENNETH S TRUSTEE & ET ADDRESS. . . . . . . . . . . : 21710 STEVENS CREEK BLVD CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : LEGACY ROOFING & WA CONTRACTOR . . . . . . . : ROBERT LAUBACH LIC # 24091 COMPANY . . . . . . . . . . : LEGACY ROOFING & WATERPROOFING ADDRESS . . . . . . . . . . : 1698 ROGERS AVE STE 10 CITY/STATE/ZIP . . . : SAN JOSE, CA 95112 TELEPHONE . . . . . . . . : (408) 467-0150 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 35, 000 -00 2 .00 0 .00 2 .00 0.00 lBSEISMICO VALUATION 35, 000 .00 7 .35 0. 00 7.35 0 .00 1REROOFCOM SQUARES 37 .00 359.00 0 .00 359 .00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 368 .35 0.00 368 .35 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 368.35 #90405 --------------- TOTAL RECEIPT 368 .35 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 CUPERTINO 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408)777-3228- FAX(408)777-3333-buildinQ(a)-cugertino.org PROJECT ADDRESS APN# _Z1 1cli L_ OWNER NAME qN�E6 ^Z� 2 E-MAIL / STREP AD�1S�, CITY, STATE,ZIP FAX AMC.., CONTRACTOR NAME LICgNSSENUMBBERJ LICENSE PE BUS.LIC.# � � � � \ � E'S ` � COMPANY NAME E-MAIL FAX STREET AD KESS CI STATE,ZIP PHONE �e Ckwo 8 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 I/" 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 monoxide detect uired to be installed in accordance with Sections R314 and R315 of the 2010 California Residential Code. Signature of Applicant/Agent. Date.. ( Z� ReroofPolicv_2011.doc revised 02/16/11 CITY OF CUPERTINO 1 FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 20245 stevens creek DATE: 02/07/2012 REVIEWED BY: larry s APN: BP#: "VALUATION: 1$35,000 PERMIT TYPE: Building Permit TPLAN CHECK TYPE: Alteration /Repair PRIMARY SFD Or Duplex PENTAMATION 1 SFD OOF USE: PERMIT TYPE: WORK remove existing roof, add 1/4 dense glass deck substrate and add t o roofing membrane... SCOPE NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public FVorks,Fire,Sanitary Sewer District,Sc ho District,etc.). Thesefees are based on the relimina in ormation available and are onlyan estimate. Contact the D or dn'1 FEE ITEMS f'={ '�, za: k °� {` t; t FEE QTY/FEE MISC IT 4/ Plan Check Fee: $0.00 ID2Es.f. Re-roof 1 Suppl.PC Fee: Reg. 0 OT hrs $0.00 $51 . ® 1REROOFRES E PME Plan Check: $0.00 Permit Fee: $0.00 r Suppl. Insp. Feer Reg. 0 OT LEI hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Work Without Permit? j Yes No $0.00 0.00 Select allon-Resrtientral , :Building or Structure ® I BSEISAIICR $ .50 � i w3: `r; m Select an Administrative Item ._.g._f_'_`_` ory.._ ,-, '- IBCBSC $2.00 SUBTOTALS: $5.50 $518.00 TOTAL FEE: $ 3.50 Revised: 1/19/2012 REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT- BUILDING DIVISION 10300 TORRE AVENUE-CUPERTINO, CA 95014-3255 CUPERT[NO (408)777-3228• FAX(408)777-3333 -buildinQa-cupertino.orm PROTECT ADDRESS „Z AP�L� C) O -L. OWNER NAMEPHONE Z5-7,z/03 E-MAIL of 1w ADDRESS CITY ZIP FAX � ,zo 3 1 APPLIC ANT NAJv1E PHONE 7- f S E-MAIL m�(`�iB ~",•A RESS --� CITY,STATE,ZIPS j' � FAX sv ` �Ll f ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT I�OR NAME o LI � �CENS�'I'�F� BUS.LIC.# " &T 7 COMPANY NAME NJ Q E-MAIL h'1.1�C�rl3 @ �f7�Cy/u^' STREET ADDRESS CISTATE,ZIP PHO P�c)-Z- �.,r-��- ids- ©1-• � --�c. ARCHITECT/ENGINEER NAME LICENSE NUMBER �� BUS.LIC.# G COMPANY NAME w^ E-MAIL ��/ F FAX STREET ADDRESS _r ,/l CITY,STATE,ZIP /• PHONE USE of ❑ SFD or Duplex ❑ Multi-Family ROOF AREA: VALUATION: p STRUCTURE: �R-Commercial / EXISTING ROOF TYPE: BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY) REMOVE/REPLACE YES IF NO. PLYWOOD PLYWD ❑ OSB PITCH: ROOF ❑ NO #LAYERS: THICKNESS: ❑ 5/8" TYPE: �'CDX 2- :12 ASS: A T O ICC-ES REPORT# PROPOSED ROOF TYPE: ElBUILT-UPROOF ❑ASPHALT SHINGLES [71WOOIS SO SHIIJGLES '�OTHER W DESCRIPTION OF WORK _ n Y'a�t h=MSL= OIS� -�R� 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 to building con ctlo a representatives of Cupertino tc enter the above-identified prorert;for inspection purposes. Signature of Applicant/Agent: Date: aZ—� SUPPLEMENTAL INFORMATION REQUIRED OWNER- I Q... If building is associated with a Home Owner's Association,provide letter of approval from HOA. wxx=TI �R� --B1�tG �.rT xEv> Provide Planningapproval to verify if there an restrictions. T `G- _ PP fY Yj P>;An�Tc�lra�rxE�� Provide copy of Manufacturer's Installation Specifications. Provide signed copy of Cupertino's Tear-Off Policy. ''�• -�.-•mac-�-_� ._..�.� 3�� --w�s.,_ „�-. �= g' _.. ReroofApp_2011.doc revised 03/02/11