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11060005 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 11731 SOUTHSHORE CT CONTRACTOR:CASTILLO'S ROOFING PERMIT NO: 11060005 OWNER'S NAME: LIOU THOMAS PAUCHIN 1703 CATHAY DR DATE ISSUED:06/01/2011 OWNER'S PHONE: 4082533989 SAN JOSE,CA 95122 PHONE NO:(408)251-3565 L. LICENSED CONTRACTOR'S DECLARATIONr— ) ! �`� BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# U MECH RESIDENTIAL COMMERCIAL Contract Date I I hereby affirm t at I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:RE-ROOF EXISTING SOLID SHEATHING REMAINS,TEAR (commencing with Section 7000)of Division 3 of the Business&Professions OFF WOOD SHAKE,INSTALL 30LB FELT,&GAF GRAND CANYON Code and that my license is in full force and effect. COMP CLASS A 16SQ I hereby affirm under penalty of perjury one of the following two declaratiovs. I have and will maintain a certificate of consent to self-insure for Worker's J` 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. Sq.Ft Floor Area: Valuation:$7500 APPLICANT CERTIFICATION 1 certify that I have read this application and state that the above information is APN Number:36653008.00 Occupancy Type: 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, PERMIT EXPIRES IF WORK IS NOT STARTED costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non-point source regulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION. 9.18. Signature Date Issued by: Date: OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS: the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is I,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I agree to remove all new materials for will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection. Business&Professions Code) _ 1,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: Date: construct the project(Sec.7044,Business&Professions Code). 46— /— i /" J 1 hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE 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 read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain Section 3700 of the Labor Code,for the performance of the work for which this compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Safety Code,Section 25532(a)should I store or handle hazardous material. permit is issued. Additionally,should I use equipment or devices which emit hazardous air I certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District I will not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Compensation laws of California. If,after making this certificate of exemption,I Health&Safety Code,Sections 25505,25533,and 25534. 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. 0a r,w autvorized a ent: Date: ` APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY 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 I hereby affirm that there is a construction lending agency for the performance of work's to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.) upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name indemnify and keep harmless the City of Cupertino against liabilities,judgments, c-z,and expenses which may accrue against said City in consequence of the Lender's Address ng of this permit.Additionally,the applicant understands and will comply N....,,all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION 9.18. I understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36653008. 00 DATE ISSUED. . . . . . . : 06/01/2011 RECEIPT #. . . . . . . . . : BS000013622 REFERENCE ID # . . . : 11060005 SITE ADDRESS . . . . . : 11731 SOUTHSHORE CT SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : LIOU THOMAS PAUCHIN ADDRESS . . . . . . . . . . : 11731 SOUTHSHORE CT CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : CASTILLO'S ROOFING CONTRACTOR . . . . . . . : JOSE CASTILLO LIC # 25850 COMPANY . . . . . . . . . . : CASTILLO'S ROOFING ADDRESS . . . . . . . . . . : 1703 CATHAY DR CITY/STATE/ZIP . . . : SAN JOSE, CA 95122 TELEPHONE . . . . . . . . : (408) 251-3565 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 7, 500 . 00 1. 00 0. 00 1. 00 0. 00 1BSEISMICR VALUATION 7, 500 . 00 0. 75 0. 00 0.75 0. 00 1REROOFRES SQ FEET 16 . 00 208. 00 0. 00 208 . 00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 209.75 0. 00 209.75 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 209. 75 #17111 --------------- TOTAL RECEIPT 209.75 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: 11731 southshore ct. DATE: 06/01/2011 REVIEWED BY: bob s. APN: BP#: 'VALUATION: 1$7,500 °PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof PRIMARY SFD or Duplex PENTAMATION 1 SFDWLROOF USE: PERMIT TYPE: WORK existing sheathing remains tear off wood shake install 301b felt comp shingles. SCOPE FEE ID ROOF AREA s.f. 1REROOFFRES 1,600 Li NOTE: Thesefees are based on the prelindnary information available and are only an estimate. Contact the De t or addn'1 info, FEE ITEMS (Fee Resolution 09-05.1 1ff. 7-1.-10) FEE QTY/FEE MISC ITEMS Permit Fee: $208.00 Work Without Permit? 0 Yes E) No $0.00 Stronjz Motion Fee: IBSEISMICR $0.75 Select an Administrative Item Bldg,Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: 1 $209.75 $0.00 TOTAL FEE $209.75 Revised: 04/29/2011 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: 3 l L PERMIT# OWNER'S NAME: �'�CiVv�A Li dPHONE# 1"55&5' GENERAL CON' � lC S BUSINESS LICENSE# ADDRESS: G_ CITY/ZIPCODE ,�' yjTC,SC ` Q 15-1 eL "Our municipal code requires all busin sses 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 SUB -ONT ACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. / I am not using any subcontractors: Signature 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 Owner/Contractor Signature Date REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 CUPERTlNO (408)777-3228• FAX(408)777-3333•building(cDcupertino.org PROJECT ADDRESS I , 13 1APN# /tle OWNER NAME 7LOWU I C)u` PHONE E-MAIL STREET ADDRESS `� ITV, ST ZIP FAX J q APPLICANT NAME N4- PHON.E2,571 �3S-( E-MAIL STREET ADDRESS CITY,STATE, Z • L I.S e /� FAX t �S ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME - e LICENSE NUMBER+yq%, LICENSE TYPFC BUS.LIC.# COMPANY NAME �_� ^� E-MAIL FAX STREET ADDRESS l CITY,STATE ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC.# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF �SFD or Duplex E] Multi-Family ROOF AREA: VALUATION: �] STRUCTURE: ❑ Commercial tl/ I •�� EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY) REMOVE/REPLACE YES IF NO, PLYWOOD ❑ 'h" ❑ PLYWD El PITCH: ROOF 11 NO #LAYERS: THICKNESS: 1-] 5/8" TYPE: 11CDX 5—:12 CLASS: A PROPOSED ROOF TYPE: ❑BUILT-UP ROOF /ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT# f DESCRIPTION OF WORK: •. \ C c DR U�004 1�;; kAk_e 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 acc rate. I agree to comply with all applicable local ordinances and state laws relati g to b ding co ction. I authorize representatives of Cupertino tc enter thea ve-identifie prope fo inspection purposes. Signature of Applicanth Date: SUPPLEMENTAL ORMATION REQUIRED +. oI ICEts QIVLy ;. _ LAN If building is associated with a Home Owner's Association,provide letter PT P9 ROTITING SLIP of approval from HOA. DYER THE coIJLVTR ❑ BUII DING PLAN REVIEW Provide Planning approval to verify if there any restrictions. ❑,EXPREss ❑ PLANNING PLAN REVIEW ; _Provide copy of Manufacturer's Installation Specifications. ❑'ST;�L�mA>n ❑ FZR�DEPT rovide signed copy of Cupertino's Tear-Off Policy. ❑ 'OTHER . ReroofApp_2011.doc revised 03/02/11