11090010 CITY OF CUP-ERTINO BUILDING PERMIT
BUILDING ADDRESS: 10510 RANDY LN CONTRACTOR:BECKS ROOFING PERMIT NO: 11090010
OWNER'S NAME: KAWAMOTO TOSHIKO TRUSTEE 6191 OCHO RIOS DR DATE ISSUED:09/02/2011
OWNER'S PHONE: 4082555695 SAN JOSE,CA 95123 PHONE NO:(408)365-8979
__A LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIALS
License Claso-'J Lic.# y1i RE-ROOF 30 SQUARES,TEAR OFF 30LB FETL#30 YR
COMP CLASS A
Contractor C,r /� Date °"
I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000)of Division 3 of the Business&Professions
Code and that my license is in full force and 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. Sq.Ft Floor Area: Valuation:$11000
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the worolpwhich this i APN Number:31602057.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAY M LAST CALLED INS PEC I N.
indemnify and keep harmless the City of Cupertino against liabilities,judgments, /
costs,and expenses which may accrue against said City in consequence of the Issued by: Date: �� f
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source regulation er the Cupertino Municipal Code,Section
9.18.
�� RE-ROOFS:
Signature Date �/ [ All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed without first obtaining an inspection,I agree to remove all new materials for
inspection. .�w �
OWNER-BUILDER DECLARATION 'L `
Signature of Applicant: Date:
1 hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I,as owner of the property,or my employees with wages as their sole compensation,
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 HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. I will
I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Secti ns 05,25!1,and 25534. ✓ ��
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date:_
permit is issued.
I 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 CONSTRUCTION LENDING AGENCY
Compensation laws of California. If,after making this certificate of exemption,I
become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANT CERTIFICATION Lender's Address
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 purposes.(We)agree to save ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
cts,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
ting of this permit.Additionally,the applicant understands and will comply
..a all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 31602057. 00
DATE ISSUED. . . . . . . : 09/02/2011
RECEIPT # . . . . . . . . . : BS000014655
REFERENCE ID # . . . : 11090010
SITE ADDRESS . . . . . : 10510 RANDY LN
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : KAWAMOTO TOSHIKO TRUSTEE
ADDRESS . . . . . . . . . . . 10510 RANDY LN
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2038
RECEIVED FROM . . . . : TERESA BECKS
CONTRACTOR . . . . . . . : BECKS, CARL LIC # 21908
COMPANY . . . . . . . . . . : BECKS ROOFING
ADDRESS . . . . . . . . . . : 6191 OCHO RIOS DR
CITY/STATE/ZIP . . . : SAN JOSE, CA 95123
TELEPHONE . . . . . . . . : (408) 365-8979
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 11, 000 . 00 1. 00 0 . 00 1 . 00 0. 00
1BSEISMICR VALUATION 11, 000 . 00 1. 10 0 . 00 1 . 10 0 . 00
1REROOFRES SQ FEET 30 . 00 420 . 00 0 . 00 420 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 422 . 10 0 . 00 422 . 10 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 422 . 10 visa
---------------
TOTAL RECEIPT 422 . 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
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(ftupertino.org
PROJECT ADDRESS 7., 7APN#
OWNERNAME �L.T PHONE 5 � E-MAIL
�// z
STREET ADDRESS 0 ZkCITY, STATE,ZIP FAX
CONTRACTOR NAME LICENSE NUMBE 3 LI J BUS.LIC.#
COMPANY NAME E-MAIL FAX
CITY,STATE,ZIP
STREET ADDRESS�6 ,
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 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, 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 rs are r ired to be installed in accordance with Sections R314 and R315 of
the 2010 California Residential Code.
Signature of Applicant/Agent: Date:
ReroofPo1icv_2011.doc revised 02/16/11
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: A9 10 PERMIT# U
OWNER'S NAME: PHONE #
GENERAL CONTRACTOR: BUSINESS LICENSE #
ADDRESS: 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.
I am not using any subcontractors: ,P2,
S1gnature 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
-A"L-�
Owner/Contractor Signature hate
REROOF PERMIT APPLICATION _--
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE• CUPERTINO, CA 95014-3255
CUPERTIN4
(408)777-3228• FAX(408)777-3333 • building(a)cupertino.om
PROTECT ADDRESS e x �# ??j Q 2
U l 4s
s
OWNER NAME 41, I 0: PHONE 1 E-MAIL
2,va 410 STREET ADDRESS `q 1 i CITY, STATE ZIP FAX
APPLICANT NAME ` PHONE E-MAIL
ADDRESS ,�/l - STATE,ZIP �- �+j FAX
❑ OwNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
)qk
COMRACTOR NAME LICENSE NUMB _ E BUS.LIC.#
COMPANY NAME G //� _ ] E-MAIL FAX
STREET ADDRESS ,q CITY,STATE ZIP P
v
ARCHITECT/ENGIINEER 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: f� VALUATION:
sTRucTURE: ❑ Commercial
EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES WPOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY)
REMOVE/REPLACE IF NO, PLYWOOD ❑ 'h" ❑ PLYWD PSB PITCH ROOF
❑No #LAYERS: TTHICKNESS: ❑ 5/8" TYPE: ❑ CDX :12 CLASS: A
ICC-ES REPORT#
PROPOSED ROOF TYPE: ❑B=-UP ROOF ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SINGLES ❑OTHER
DESCRIPTION OF WORK �� .�--� -ff
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 cows cti I autho representatives of Cupertino to enter the ab ve-identifie properr;for inspection purposes.
Signature of Applicant/Agentyr ��—�f Date: `
SUPPLEMENTAL INFORMATION REQUIRED _
_If building is associated with a Home Owner's Association,provide letter ° W _
.-.w'Yu mac""--sem
i
x
of approval from HOA. mtt �i '� st�vINN �w —
Provide Planningapproval to vert if there an restrictions. - - -
PP verify y = '° AT PLA�tvi � s '
Provide copy of Manufacturer's Installation Specifications. �m„ n� E
Ovide signed copy of Cupertino's Tear-Off Policy. OT �
ReroofApp_201 Ldoc revised 03/02/11