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11070032 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19821 MERRITT DR CONTRACTOR:R E ROOFING & PERMIT NO: 11070032 CONSTRUCTION INC [OWNER'S NAME: TRUDEAU HOWARD D JR AND SUZANN 15230 CLYDELLE AVE DATE ISSUED:07/06/2011 NER'S PHONE: 4082576703 SAN JOSE, CA 95032 PHONE NO:(408)626-9320 LICENSED CONTRACTOR'S DECLARATION r F_ r- BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# t I 1 j� MECH RESIDENTIAL COMMERCIAL Contractor R� ��U�I'�`� �� t Date �Zj6 f JOB DESCRIPTION: RE-ROOF 28 SQUARES,TEAR OFF WOOD SHAKE, 1 hereby affirm that I am licensed under the provisions of Chapter 9 REPLACE (commencing with Section 7000)of Division 3 of the Business&Professions WITH COMP SHINGLES CLASS A 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:$15000 1 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:31630033.00 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 WITHI 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 DA M LA CALLED INSPE �TJIN. indemnify and keep harmless the City of Cupertino against liabilities,judgments, fl costs,.and expenses which may accrue against said City in consequence of the grant permit. Additionally,the applicant understands and will comply Issued by: Date: with I non-po sourc ions e Cupertino Municipal Code,Section _ RE-ROOFS: Signature Date All roofs shall be inspected prior to any roofing material being installed. If a roof is installed irst obtaining aajnsection,I agree to remove all new materials for inspe ion. - L1 OWNER-BUILDER DECLARATION __ I!/ Signa ire of Appli Date: I hereby affirm that I am exempt from the Contractor's License Law for one of t the following two reasons: ALL ROOF COVERINGS TO BE CLAS "A"OR BETTER 1,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 1 use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the tabor Code,for the air contaminanlus defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will in i tarn comp�T4 e Cupertino Municipal Code,Chapter 9.12 and 1 have and will maintain Worker's Compensation Insurance,as provided for by the ealth&Safettio 533,and 25534. Section 3700 of the Labor Code,for the performance of the wok for which this (p / permit is issued. Ow er or authorided - Date: 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 CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,1 must 1 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 1 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 -non the above mentioned property for inspection purposes.(We)agree to save :mnify 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. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 CU PERTI NO Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: � , t-yu'u PERMIT# CO 3 -3' OWNER'S NAME: YV `)Lui 0't>41 PHONE # �V`�— 62 �� ✓ GENERAL CONTRACTOR:. 'F,0U)` 'Itv' BUSINESS LICENSE# ADDRESS: 2-'30 (vk,14 ( ,`1. ` CITY/ZIPCODE: 5,j C� *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 ND L SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontra rs: �__ 'Mature Date Please check applicable subcontractors and complete the following information: j/ 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 CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 31630033 . 00 DATE ISSUED. . . . . . . : 07/06/2011 RECEIPT # . . . . . . . . . BS000013975 REFERENCE ID # . . . : 11070032 SITE ADDRESS . . . . . : 19821 MERRITT DR SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : TRUDEAU HOWARD D JR AND SUZANN ADDRESS . . . . . . . . . . : 19821 MERRITT DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-2441 RECEIVED FROM . . . . : R E ROOFING CONTRACTOR . . . . . . . : PROCTOR, PAUL LIC # 20615 COMPANY . . . . . . . . . . : R E ROOFING & CONSTRUCTION INC ADDRESS . . . . . . . . . . : 15230 CLYDELLE AVE CITY/STATE/ZIP . . . : SAN JOSE, CA 95032 TELEPHONE . . . . . . . . : (408) 626-9320 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 15, 000 . 00 1 . 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 15, 000 . 00 1 . 50 0 . 00 1 . 50 0 . 00 1REROOFRES SQ FEET 28 . 00 392 . 00 0 . 00 392 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 394 . 50 0 . 00 394 . 50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 394 . 50 3581 --------------- TOTAL RECEIPT 394 . 50 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 PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333 • building cDcupertino.ong Z. PROJECT ADDRESSAPN M r ,l M # I (-0 (D / ?, OWNER NAME {, ` ' D.�M PHONE p 1U rl 1j E-MAIL STREET ADDRESSj� ( n CITY, STATE,ZIP (), Ju n 00 �/' f,` FAX APPLICANT NAME l {I L Nt _Jam' PHONE V E-MAIL V 1 STREET ADDRESS CITY,STATE,ZIP FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR N e /n/ (� C� LICENSE NUMBER "]�1 � LICENSE TYPP,i 1)j BUS.LIC.# COMPANY NAME `l xl 4 N NC. E-MAIL ( 3 t FAX I I'MU STREET ADDRESS 1�� f �/ CITY.STATE,ZIP C' ` [� /_ n PHONE4(k �C�� ARCHITECT/ENGINEER NAME L LICENSE NUMBER 1 i of L BUS.LIC.#fib I L COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF fASID r Duplex ❑ Multi-Family ROOF AREA: f VALUATION: sTRvcTURE: ommercial �� EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES oOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY) REMOVE/REPLAC YES I IF NO, PLYWOOD ❑ '/:" ❑ PLYWD ❑ OSB PITCH: ROOF 13NO #LAYERS: THICKNESS: 5/B" TYPE: DX '12 CLASS: A PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT# DESCRIPTION OF WORK: opts 1 By my signature below,1 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 inf io ve 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 stat aws relating to ildina construction. I authorizer resentatives of Cupertino tc enter the above-identified property for inspection purposes. Signature of ApplicAgent: i ! Date: SUPPLEl t1 ,IN2 s sx�OMCE FORMATION REQUIRED QS Via. .3,, - _If building is associated with a Home Owner's Association,provide letter E =tou1Tly, sLtP of approval from HOA. pvER t$E COIINR �IvG PLAN REVIEW w - ,- _Provide Planning approval to verify if there any restrictions. Ck EJss ❑ PLANNINGPLATIREVIEWl A1 _ _Provide copy of Manufacturer's Installation Specifications. ❑ sTANnaxD `gni PT � T/ovide signed copy of Cupertino's Tear-Off Policy. - ❑-or�R ReroofApp_2011.d6c revised 03/02/11