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11100144 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10320 CALVERT DR CONTRACTOR:COSMOS ROOFING PERMIT NO: 11100144 OWNER'S NAME: MARION,PATRICK 1901 OLD MIDDLEFIELD WAY STE 22 DATE ISSUED: 10/19/2011 OWNER'S PHONE: 6504650700 MOUNTAIN VIEW,CA 94043 PHONE NO:(650)969-7663 A LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIAL License Class C 3 Lic.# '"79 6 q 41 RE-ROOF 18.5 SQ-TEAR OFF EXISTING CAPSHEET, INSTALL 4 PLY CAPSHEET CLASS A Contractor �r7N'�© ' tom/ Date lb 3 f I hereby affirm that I am licensed underAe 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:$8700 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 APN Number:37518014.00 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 1 0 D YS 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 LAST CALLED INSPEC 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 (J Issued by: Date: granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. tl /J ' 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. ' O E DER DECLARATION Signature of Applicant: Date: I 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. 1 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,Sections 25505,25533,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 Compensation laws of California. If,after making this certificate of exemption,I CONST ENDING AGENCY 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 pen-nit 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 indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION -sts,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. ming of this permit.Additionally,the applicant understands and will comply ..ith all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date 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 CW-cupertino.org PROJECT ADDRESS /0• 2-O e- - /0?� APN# OWNER NAME PH9NE�O O 700 E-MAIL STREET ADDRESS /© 2� /• M / T D) C�,�ATE.ZZ?I�O G/�• 95O/ FAX CONTRACTOR NAME Gam„L�V 1 LICENSE NUMBERI LICENSE T BUS.LIC. 7� # COMPANY NAME � �.,�r / E-MAIL STREET ADDRESS CITY,STATE,ZIP ONE e� wa2-U � /o c� G • 69 . 7JG 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 reauired 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 monoxide detectors are required to be installed in cnrdance with Sections R314 and R315 of the 2010 California Residential Code. Signature of Applicant/Agent: Date: /0/170 ReroofPolicv 2011.doc revised 02/16111 CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 37518014 . 00 DATE ISSUED. . . . . . . : 10/19/2011 RECEIPT #. . . . . . . . . BS000015089 REFERENCE ID # . . . : 11100144 SITE ADDRESS . . . . . : 10320 CALVERT DR SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER MARION, PATRICK ADDRESS 10320 CALVERT DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : PERMIT SERVICES CONTRACTOR . . . . . . . : COSMOS, RICHARD LIC # 18844 COMPANY COSMOS ROOFING ADDRESS 1901 OLD MIDDLEFIELD WAY STE 2 CITY/STATE/ZIP . . . : MOUNTAIN VIEW, CA 94043 TELEPHONE . . . . . . . . : (650) 969-7663 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 8, 700 .00 1.00 0 . 00 1.00 0. 00 1BSEISMICR VALUATION 8, 700 .00 0.87 0. 00 0 .87 0. 00 1REROOFRES SQ FEET 18 .50 266. 00 0. 00 266 .00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 267.87 0 . 00 267 .87 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 267. 87 3104 --------------- TOTAL RECEIPT 267.87 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: 10320 Calvert Dr. DATE: 10/19/2011 REVIEWED BY: jsg APN: BP#: "VALUATION: 1$8,700 ';PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof PRIMARY SFD or Duplex PENTAMATION 1 SFDWLROOF USE: P PERMIT TYPE: WORK Tear off existing tar and gravel and replace with new tar and gravel SCOPE FEE ID ROOF AREA s.f. 1 REROOFFRES 1,850 Ll NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . Thesefees are based on the prelindina information available and are only an estimate. Contact the De t or addn 7 info, FEE ITEMS (Fee Resolution 11-053 Elf. 1,-112 FEE QTY/FEE MISC ITEMS Permit Fee: $266.00 Work Without Permit? 0 Yes No $0.00 Strom,,Motion Fete: 1BSEISAffCR $0.87 Select an Administrative Item B1dgStds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $267.87 $0.00 TOTAL FEE: $267.87 Revised: 10/01/2011 REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228•FAX(408)777-3333•building@cupertino.org CUPERTINO � � ' W lqq PROJECT ADDRESS' /O 7� �® � J CZ-T APN# V OWNER NAME �`f 21C.K �1/,JL�,J PHON� U )OG E-MAIL STREETADDRESS I O. ZO / ,�l . 1 -y T (1 CIZT E�PT'J/� C ®/ 4 FAX CONTACT NAME C/ � PHONE V E-MAIL STREET ADDRESS CITY,STATE,ZIP FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER7q, ( LICENSL.TYPE BUS LIC.# COMPANY NAME O I( `� t E-MAIL /�xO Z S REET ADDRESS J1 C,7(j�- CITY,STATE,ZIP (PO ONE q9 9 Cool Of�t A 5� � �o J! ,nus .�7o cam' �' � 3� s o 9 766 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: VALUATION: STRUCTURE ❑ lg5v 9 SCO Commercial EXISTING ROOF TYPE. y� BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY) REMOVE/REPLACE OYES IF NO, PLYWOOD ❑ %" ❑ PLYWD �OD �PIT�CHZ:CROOF ❑ NO #LAYERS: THICKNESS: ❑ 5/8" TYPE: '12 CLASS: A PROPOSED ROOF TYPE: BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT# DESCRIPTION OF WORK: e5-r-f- C7I -71 Jr C A 94-4 �,` jz Pt 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 constr authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: fO SUPPLEMENTAL INFORMAIT6NREQUIRED OFFICE USE ONLY If building is associated with a Home Owner's Association,provide letter PLAN CHECK TYPE ROUTING SLIP of approval from HOA. ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW Provide Planning approval to verify if there any restrictions. ❑ EXPRESS ❑ PLANNING PLAN REVIEW Provide copy of Manufacturer's Installation Specifications. ❑ STANDARD ❑ FIRE DEPT Provide signed copy of Cupertino's Tear-Off Policy. ❑ OTHER: ReroofApp_201 1.doc revised 03/16/11