11060234CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7565 ERIN WAY I CONTRACTOR: ASH ROOFING INC I PERMIT NO: 11060234 I
OWNER'S NAME: DAVID KEENAN I PO BOX 20040 I DATE ISSUED: 06/30/2011 1
OWNER'S PHONE: 4083742777
L LICENSED CONTRACTOR'S DECLARATION
License Class ( � Lic. # -�>6 -Z— ( 2
Contractor PtS4 1Q -00r -1110(A f NL Date (0.3C)
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.
SAN JOSE, CA 95160-0040
PHONE NO: (408) 927-9681
BUILDING PERMIT INFO: BLDG T- ELECT PLUMB
MECH f- RESIDENTIAL f- COMMERCIAL
JOB DESCRIPTION: RE -ROOF TEAR OFF EXISTING SHAKES, SHEATH WITH
OSB
RADIANT BARRIER, ROOF WITH LANDMARK 40YR
DIMENSIONAL WITH 30# UNDERLAYMENT NEW METAL
I hereby affirm under penalty of perjury one of the following two declarat' s:
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.
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
permit is issued. i Sq. Ft Floor Area:
APPLICANT CERTIFICATION
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,
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-poirit source regulations per the Cupertino Municipal Code, Section
9.18.
Signature L Date — I
r OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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
construct the project (Sec.7044, Business & Professions Code).
1 hereby affirm under penalty of perjury one of the following three
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.
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
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
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION
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,
cots, and expenses which may accrue against said City in consequence of the
ng of this permit. Additionally, the applicant understands and will comply
all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Signature Date
APN Number: 35920009.00
Valuation: $8380
Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued bye- Date: �1,�-
RE -ROOFS:
All roofs shall be inspected prim' to any roofing material being installed. If a roof is
installed without first ob ini an inspection, I agree to remove all new materials for
inspection. %
Signature of Applicant: Date:
i
ALL ROOF C�kERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
Date:
CONSTRUCTION LENDING AGENCY
I herby affirm that there is a construction lending agency for the performance of "ark's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
3 ITEMS OF 3
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 35920009.00
DATE ISSUED.......: 06/30/2011
RECEIPT #........-: BS000013940
REFERENCE ID # ...: 11060234
SITE ADDRESS .....: 7565 ERIN WAY
SUBDIVISION ......
CITY CUPERTINO
IMPACT AREA ......
OWNER ............: DAVID KEENAN
ADDRESS ..........: 7565 ERIN WAY
CITY/STATE/ZIP ...: CUPERTINO, CA 95014
RECEIVED FROM ....: LINDA ASH
CONTRACTOR .......: ASH, BOB LIC # 18553
COMPANY ..........: ASH ROOFING INC
ADDRESS ..........: PO BOX 20040
CITY/STATE/ZIP ...: SAN JOSE, CA 95160-0040
TELEPHONE ........: (408) 927-9681
OPERATOR: patg
COPY ## : 1
FEE ID UNIT
QUANTITY
AMOUNT
PD -TO -DT
THIS REC
NEW BAL
-----------------------
1BCBSC VALUATION
----------
8,380.00
----------
1.00
----------
0.00
----------
1.00
----------
0.00
1BSEISMICR VALUATION
8,380.00
0.84
0.00
0.84
0.00
1REROOFRES SQ FEET
26.00
338.00
0.00
338.00
0.00
TOTAL PERMIT
----------
339.84
----------
0.00
----------
339.84
----------
0.00
METHOD OF PAYMENT
-----------------
CREDIT CARD
TOTAL RECEIPT
AMOUNT
---------------
339.84
---------------
339.84
VOICE ID DESCRIPTION
-------- ----------------------------
309 EXTERIOR LATH
601 ROOF TEAR OFF
REFERENCE NUMBER
--------------------
MC
VOICE ID DESCRIPTION
-------- ----------------------------
311 SCRATCH COAT
602 ROOF PLYWOOD NAIL
604 ROOF IN -PROGRESS 605 FINAL REROOF
:UPERTINO
CONTRACTOR / SUBCONTRACTOR LIST
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
Fax: 408-777-3333
JOB ADDRESS: r( 02—IN WA
PERMIT # ZZ, 9Q 2
OWNER'S NAME: G7� N
PHONE # ';�-7 •- Z77 —j
GENERAL CONTRACTOR: (DOr-I � I N(—
BUSINESS LICENSE # j
ADDRESS: J(.0 „ 4s- zoo
CITY/ZIPCODE: 15AV11-'�
*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 S BCO TRACTO HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors andc1 mplete the following information:
Owner / Contractor Signature
Date
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
FEE ESTIMATOR - BUILDING DIVISION
FEE ID ROOF AREA
s.f.
1 REROOFFRES 2,600
ivv«: i nese ees are vasea on the prennunary [n ormanon avauad[e ana are omy an estimate. contact the ue t or aaan
FEE ITEMS (Fee Resolution 09-051 Eff. ' . %0) FEE I QTY/FEE I MISC ITEMS
Select an Administrative Item
$0.001 TOTAL FEE: I $339.84 I
Revised: 04/29/2011
ADDRESS: 7565 erin way
DATE: 06/30/2011
REVIEWED BY: bobs.
APN:
BP#:
'EVALUATION: 1$8,380
PERMIT TYPE: Minor Building Permit
PLAN CHECK TYPE: Re -roof
PRIMARY SFD or Duplex
USE:
PENTAMATION 1 SFDWLROOF
PERMIT TYPE:
WORK
remove existing shake replace with radiant barrier and comp shingles.
SCOPE
FEE ID ROOF AREA
s.f.
1 REROOFFRES 2,600
ivv«: i nese ees are vasea on the prennunary [n ormanon avauad[e ana are omy an estimate. contact the ue t or aaan
FEE ITEMS (Fee Resolution 09-051 Eff. ' . %0) FEE I QTY/FEE I MISC ITEMS
Select an Administrative Item
$0.001 TOTAL FEE: I $339.84 I
Revised: 04/29/2011
CUPERTINO
1 t -0 2—
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building cupertino.om
PROTECT ADDRESS C j n 1 /� �Q
APN # -,2,7—C
OWNER NAME , /� j
PHONE L�
E-MAII-
STREET ADDRESS
CITY STATE, ZIP
APPLICANT NAME-1�o p" (v �
PHONE
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STREET ADDRESS ! (`QbO 40
,STATE, ZIP ��'
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❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGET CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TEN ANT
CONTRACTOR NAME, ` �
-
LICENSE NUtv��
LICENSE TYPE
BUS. LIC. # �5 3
COMPANY NAME / 7�
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ARCHITECT/ENGINEER
LICENSENUMBER
BUS. LIC. #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE of )kSFD or Duplex ❑ Multi -Family
ROOF AREA:
VALUATION:
4
STRUCTURE: ❑ Commercial
li
EXISTING ROOF TYPE::__,,(( ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER (SPECIFY)
REMOVE /REPLACE p�YES
IF NO, b
PLYWOOD W ❑ CS5
PLYWD )&OSB
PITCH:
ROOF
❑ NO
# LAYERS:
THICKNESS: ❑ 5/8"
TYPE: ❑ CDX
' 12
CLASS: A
-1
PROPOSED ROOF TYPE: 13BUILT-UPROOF XASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES
PROPOSED
ICC -ES REPORT #
DES ` ON OF WORK ^ , G i , �-' S �' Il ,�() I 1 �' 1 ll�j% 1�. 1 V I (\ ►vT �% 1' 1` �+�� WD 1"
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By my signature below, I certify to each f 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 ave p vided is correct. I ve read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relatin to bu' cons ction. uth rize.representatives of Cupertino to enter the above -identified propem; for inspection purposes.
Signature of Applicant/Agent: Date: 6,
SUPPLEMENTAL ORMATION REQUIRED_
If building is associated wi ome Owner's Association, provide letter
ilisE
RQuxc sig
THE.GOIINxER �II�iG
r
IAN Ri�R�
_
of approval from HOA.
Provide Planning approval to verify if there any restrictions.
Cf EiRR�ss': r T
❑ ELANNINGPLANRE\'IEW
Provide_copy of Manufactur'er's Installation Specifications.
❑juao❑
_
Cupertino's Tear Policy.
kt-�.
❑O&T1
rovide signed copy of -Off
ReroofApp_2011.doc revised 03/02/11