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11030054 r CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10650 S DE ANZA BLVD CONTRACTOR:LEGACY ROOFING& PERMIT NO: 11030054 WATERPROOFING OWNER'S NAME: BYER PROPERTIES 1698 ROGERS AVE STE 10 DATE ISSUED:03/11/2011 ( ;R'S PHONE: 4157168708 SAN JOSE,CA 95112 PHONE NO:(408)467-0150 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r— License Class C 32 6 Lic.# 60 Lbs u �"" r(� A.I. MECH 1 RESIDENTIAL COMMERCIAL Contractor It��X�- �V S"�r1 fr � - a' I31ate .� �I(I( I hereby affirm that I am lice ed under the provisions of Chapter 9 JOB DESCRIPTION:RE-ROOF REMOVE THE EXISTING BUILD-UP ROOF, (commencing with Section 7000)of Division 3 of the Business&Professions INSTALL Code and that my license is in full force and effect. DENS ANDA 60 MIL MEMBRANE ROOF MECHANICALLY Y ATTACHED;CLASS A SOSQ 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. 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:$29510 APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is APN Number:36937027.00 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. a Signature Date '� ( ( Issued b `�� `"' t y: � Date: �;_lK_lt T i L 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) / I,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: �^--1.� Date:V n 11� construct the project(Sec.7044,Business&Professions Code). I 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. I 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. O er or/Rut i ed ge t: l l++) l Date: 3� I 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 it' -nify and keep harmless the City of Cupertino against liabilities,judgments, and expenses which may accrue against said City in consequence of the Lender's Address gr, ang of this permit.Additionally,the applicant understands and will comply with 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 REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408)777-3228- FAX(408)777-3333- building aaDcupertino.org CUPERTINO PROJECT ADDRESS ` �C' O e �� APN 0 ,,7 0 OWNER NAME �� PHONE��`� k/7 (Top,r/ E-MAIL STREET ADDRESS ° CITY, STATE,ZIP / G FAX b b Pt,"tfe C� .S•�_ APPLICANT NAME _ Aki v PHONE E-MAIL STREET ADDRESS CITY,STATE, ZIP FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC.# COMPANY NAME E-MAIL FAX tftl ice:C, ��'`�C ►r�e+�; . 11C ��_'� ��'(—�t�i STREET ADDRESSi CITY,STATE,ZIP S� L PHONE Stn ".T�s-�. yc��. b ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC.# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF BLDG: ❑RESIDENTIALCOMMERCIAL ROOF AREA: 50 of VALUATION: Liv_ i EXISTING ROOF TYPE: BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY) REMOVE/REPLACE AYES IF NO, PLYWOOD ''/i' ❑ PLYWD ❑ OSB PITCH: ROOF ❑ NO #LAYERS: THICKNESS: ❑ 5/8" TYPE: CDX --j-1-:12 CLASS: `� PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES OTHER SPD��mhr ICC-ES REPORT# ]� DESCRIPTION OF WORK: I y I L M :r.b r e- C- MZ 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 itis accurate. I agree to comply with all applicable local ordinances and state laws relating to b ing constructs a th ize ntatives of Cupertino to enter the above-ide ified property for inspection purposes. Signature of Applicant/Agent: .�-�— Date: i1il SUPPLEMENTAL INFORMATION Q IREDOk*CE VWONLY _If building is associated with a Home Owner's Association,provide letter =P N ,CHECI i'x>'7[ ,.s. Ror�rnvGs> of approval from HOA. QUER-=-eaUN >R BUELDING_`PLA l H, _Provide Planning approval to verify if there any restrictions. 6WREss='' �.,2'LANNINGrr Ne> vi Provide copy of Manufacturer's Installation Specifications. sTArmaitn 07,"" RE tiErr Provide signed copy of Cupertino's Tear-Off Policy. ❑ OTHER: ReroofApp_2011.doc revised 03/02/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10650 de anza blvd. DATE: 03/11/2011 REVIEWED BY: bobs. APN: BP#: "VALUATION: 1$29,510 *PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof PRIMARY SFD or Duplex PENTAMATION 1 SFDWLROOF USE: PERMIT TYPE: WORK remove existing built-up roof, install 1/4" densdeck and a 60 mil membrane roof mechanical) SCOPE attached. FEE ID ROOF AREA s.f. 1 REROOFFRES 5,000 ...... Lj NOTE. Thesefees are based on the preliminary in ormadon available and are only an estimate. Contact the De t or addn 7 info, FEE ITEMS (Fee Resolution 09-051 Ifff '-l.-%0� FEE QTY/FEE MISC ITEMS Permit Fee: $650.00 Work Without Permit? 0 Yes E) No $0.00 Strom; Motion Fee: IBSEISMICR $2.95 Select an Administrative Item Bldg:Stds Commission Fee: 1BCBSC $2.00 SUBTO___TALS7 $654.95 $0.00 TOTAL FEE:' $6,94-9651 Revised: 01/15/2011 i-'