12070248 CITY OF CU13ERTINO BUILDING PERMIT
BUILDING AUUIt lCsS: IOlaS SWAN OAK LN CON'1'ItACI'O R:PI:f1iRSEN-DEAN INC FERMI"r NO: 12070248
O\VNI•.R'S NANW; NAh1 I1EE Llai 7980 EN'IT:RPRISE DR DATE ISSUED:07/3012012
O\PN'IiR'S 11II0N'Ei NEWARK,CA 94560 PIIONE NO:(510)494-4982
LICENSED CONTRAM OR's lwCLAliA.r1ON r r r
BUILDINSG I'II2AI ITINFO: BLDG ELECT PLUMB
License Class C 3 S Lic.H
/7 � Y68/I 7 A11701 r Resn3ENTIAL r COMMERCIAL r
Contractor (G' (`SeA��eQA) Date 7r30-1 Z
I hereby aft iron that I:un licensed under Ute pro,inion,of Chapter 9 .1011 DESCRIPTION:RIiMOVI:WOOD SHAKH AND INSTALL I I SQS
(comnrenciny,widn Section 7000)of Division 3 of the Business& Professions I'RESIDEN1'IAL
Code and that my license is in full force and effect. SHINGhIis OVI:R 1/2 RADIANT 1'I,Yl4'OOD 30H I'ECr
I lierchy affirm under pcnalry'or perjury one of the following 1w 4)dMara Bone:
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 lir 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.Et Floor Area: Valuation:$6357
permit is issued.
APPLICANT'CERTIFICATION APP'N'rrimber:34232136.00 Occupancy Type_
I cerlif) that I have read this application and state that the above information is
correct.I agree to comply With all city and county Ordinances and state laws relating
In building Construction.and Hereby authorize representatives of this city to enter
upon lire above mentioned property for inspection purposes. (mVe)agree to save t r n
indenmify and keep harmless the City of Cupertino against lixbilities.judgmnents. I ER1IMIT E\1 IRE$ IF NJORK IS NOT STARTED
costs,and expenses which may acerae against said City in consequence ofthe WITHIN 180 DAYS OF PI:RiMIT ISSUANCE OR
granting of this permit. Additionalh',the applicant understands mid will complyi i
with all non-point sou •regulations per lire Cupertino Municipal Code.Section
180 DAYS �RO�'1 LASTCALLED INSPECTION.
9.18.
Issued by' Dale)�
Signature
❑ OWN Ii R-IS Ii I LD ER D."CLARATION L_
RI;ROOFS:
1 herehy affirm that I:un e\empt Dont the Contractor's I.icense Law for one of All roofs shall be inspected prior to any rooting material being installed 11'a roof is
the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials f'or
I,as owner of the property,or illy employees Willi W:acs 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 Applicant: Date:
1,as owner of the property,am exclusively contracting With licensed contractors to
construct the project(Sec.7044,]Business&Professions Code). ,\LI,ItOOP CO\'FRINCS'I'O Til?CLASS".V'Olt RP;I"I'h;K
hereby affirm under penafiy Of perjury one of the followinC three
declal,tions:
I have and will maintain a Certificate of Consent to sell=insure f'nr Worker's HAZARDOUS MATERIALS DISCLOSURE
Compensation,as provided for by Section 3700 of the Labor Code,f'or lite I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the Work Ibr which this permit is issued California Health&Safely Code.Sections 2550,25533.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 I Iealth
Section 3700 of the Labor Code,for tine performance of the work for which this Safety Code.Section 25532(:)should I store or handle hazardous material.
Additionalh',short(] I use equipment or devices which emir hazardous air
permit is issued. contaminant,as defined by rhe Bit Area Air Qu:liip?Management District I will
I certify that in the performance of the work for which this pernmil is issued.I shall maintain compliance with the Cupnrinn Municipal Code.Chapter 9.R and rhe
not employ any person in any manner so as to become subject to the Workers Health&Safety Code,Sections 25505,25533,:in(]25534.
Compensation laws of California If,after malking this certificate of'esenmption,I
become subject to the Worker's Compensation provisions oflhe Labor Code,I muss Ow it, tun iz•A agent:
Date:forthwith comply ith such provisions or this permit shall be deemed revoked,wmev
CONSTRl1CI10N LENDING ACF NC1'
AI'I'LICANT Clild'I'IIICATION
I certify that I have read this application and state that the above information is I hereby ailirm that there is a consarction lending agency for the performance of work's
correct. I agree to comply With all city and county ordinances and sunt 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.(We)agree to save
indemnify and keep humorless the Cony of Cupenino against liabililies.judg i ems• Lendcr's Address
costs,and expenses which may accrue against said City in consequence of rhe
granting of this permit.Additionally,the applicant understands and will connpl}• ARCII1'11'CI"S DECLARATION
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. 1 understand any plans shall be used its public records.
Signature I7mc Licensed I'rofes,ian:l
CITY OF CUPERTINO
FEE ESTIMATOR— BUILDING DIVISION
ADDRESS: /b/YS fLcn co,{2 2,-) DATE: 07/30/2012 REVIEWED BY: bob s.
27APN: BP#: �a10 'JQ� 'VALUATION: $6,357
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY SFD Or Duplex PENTAMATION
USE: pPERMIT TYPE: 1SFDWLROOF
WORK tear off wood shake and install comp shingles.
SCOPE
C - -
S/ech. Plan Check Phunb. Plc,"Cheek Flee Plan Check
blech.Permit Fee: Plumb.Permit Fee: F.lev. Permit Fee:
Othcr,ilech. Insp. Other Plumb Insp. Li I Other Elve.hup, Ll I
Mech.bsp. Fee: Plumb. hap. Fee: Elcr.Imp.Frac:
NOTE: This estimate does not include fees due to other Departments(i.e. Planning, Public Btorks, Fire,Sanitary Sewer District,School
District.etc). There fees are based on the prelindnat3 information available and are onh,at estimate. Contact the Det for adda7 into.
FEE ITEMS (Fee Resohtlion 11-053L--E7/111U IFEEQTY/FEE MISC ITEMS
Plan Check Fee: 1,100 s.f. Re-roof
Suppl. PC Fee: Q Reg. Q OT 00 hrs $165.00 IREROOFRESPME Plan Check:
Permit Fee: $0.00
Suppl. Insp. Fee@ Reg. Q OT O,Q hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Consnvtction Tax:
Administrative Fee: Q
Work Without Permit? O Yes Q) No $0.00
Advanced Planning Fee: $0.00 Select a Non-Residential
Trm el Documentation Fees: Building or Structure 0
A
Strong Motion Fee: IBSEISMICR $0.64 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
UBTOTALS:
,S $1.64 $165.00 TOTAL $166.64
Revised: 07/01/2012
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 rx
CUPERTINO (408)777-3228 • FAX (408)777-3333 • buildino0cuoertino.oro
PROJECT ADDRES/O/ 5- �` �QI APN# t �a /3
OWNER NAME• ^ 1� /Il PHONEI� E-MAIL
U
STREET ADDRESS,v7 CS y�I I�S I FAX
CONTACT NAME JIF�7 J� _ Aj PVNS _ 2/18 r E/-MAIL
STREET ADDRESS 7n
5 c (� Cl /Y�.SPATE, Z P JC-A ^e"�I FAX
❑OWNER ❑ OWNER-aUIIDER ❑ OWNERAGERr ErCONTkACTOR ❑CONTRACTORAGENT ❑ ARCHITECT 11 ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACT Ae C�1i.LleQ� Rao ti
LICENSE LICENSE LICENSCHT')E BIS..LIC.a
COMPANY NAME / JJ FAX V•-J l/
'STREET ADDRESS TATE ZIP PHON
7 9'0L-1der Isc O(- liar, < 1: `/56G �S�D
ARCHITECTIENGINEER NAME LICENSE NUMBER BIS.LIC.tl
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY.STATE.ZIP PHONE -
USE OF ❑ SFD Or Duplex JZ(Multi-Family ROOF AREA: VALUATION: 2 D
STRUCTURE: ❑ Commercial 10,,,7( 6 35 /7 r
EXISTING ROOF TYPE: 11 BUILT-UP ROOF ❑ASPHALTSHINGLFS ; WOODSHAXES ❑WOODSHINGLES ❑OTHER(SPECI FY)
REMOVE/REPLACE IFNO. PLYWOOD AO A- 11PLYWD P' OSB PITCH: ROOF
A
❑NO tl IA'ERS THICXNESS la' TYPIE: ❑CDCell :12 MSS:
PROPOSED ROOF TYPE: ❑BUILT-UPROOF .ASPHALT SHINGLES 11 WOOD SHARES ❑WOOD SHINGLES ❑OTHER
ICC-ES
3?qREPORT
DESCRIPTION OF WORK: �V�•IVV� / '1 I �r G K Iti S� 1 l `SI��A 1 14 I ��^IIJ I l�
Fe
By my signature blow.I certify to each of the follmving: I am the property oHner or authorized agent to act on the property owner's behalf. I have read this
application and the information I have pmved is correct. I have read the Description of Work and verify it is accurate. 1 agree to comply with all applicable local
ordinances and stale laws relating to b I i' cfo�nn(ss�trucuou. authorize representatives of Cupertino to enter the above-idcntifie4Aroperty for inspection purposes.
Signature of Applicant/Anent: "'-' Date: f2—
SUPPLEMENTAL INFORMATION REQUIRED OFFICF.USEONLV- - -
_If building is associated with a Home Owner's Association,provide letter P"N CHECRTVPE;'' •°I' ROUTING SLIP .
ofapproval from HOA. n-VtL�iE-COUNTER.-:. ., �Q BUILDING PLAN REVIEW
. .
_Provide Planning approval to verify if there any restrictions. 1:1EXPRE-I I. ! - ElPLANNING`PLAN FIEVIEW
Provide copy ofManufacturer's Installation Specifications. ❑'STANDARD'- '❑ FIREDEPT ,
P�vide signed copy of Cupertino's Tear-Off Policy. ❑ OTHER:
ReroojApp_2011.doc revised 03ll6//I