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11030117CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10240 DUBON AVE OWNER'S NAME: JANET GEIGER ' 4ER'S PHONE: 4082527174 ❑ LICENSED CONTRACTOR'S DECLARATION License Class 9 Lic. # ?27 Z Contractor �r (25�" Date lT ZF !1 I hereby affirm that lam 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. 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. 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 -point source regulatpris per the Cupertino Municipal Code, Section 9.18. \,�L [4/ Signature Date �iNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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 construct the project (Sec.7044, Business & Professions Code). I 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, and expenses which may accrue against said City in consequence of the _mg of this permit. Additionally, the applicant understands and will comply w„'i all non -point source regulations per the Cupertino Municipal Code, Section 9.1s. CONTRACTOR: QUALITY FIRST HOME PERMIT NO: 11030117 IMPROVEMENTS 6545 SUNRISE BLVD STE 202 DATE ISSUED: 03/28/2011 CITRUS HEIGHTS, CA 95610 PHONE NO: (916) 788-2921 BUILDING PERMIT INFO: BLDG F ELECT PLUMB MECH F RESIDENTIAL F COMMERCIAL JOB DESCRIPTION: RE -ROOF REMOVE EXISTING ROOF(SHAKES) & INSTALL DECK ARMOR UNDERLAYMENT & 30YR COMP SHINGLES(DECK ARMOR IS EQUIVALENT TO 30LB FELT; CLASS A 29SQ Sq. Ft Floor Area: I Valuation: $14964 APN Number: 34214049.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Date: RE -ROOFS: 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. Signat of plicant: Date: 2fl ALL ROO COVERINGS 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. Owne auth � ed agent: 2 Date:3 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of vwrk's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Signature Date ' Licensed Professional 3 ITEMS OF 3 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 34214049.00 DATE ISSUED.......: 03/28/2011 RECEIPT #......... BS000013003 REFERENCE ID # ...: 11030117 SITE ADDRESS 10240 DUBON AVE SUBDIVISION ...... CITY CUPERTINO IMPACT AREA ...... OWNER JANET GEIGER ADDRESS 10240 DUBON AVE CITY/STATE/ZIP ...: CUPERTINO, CA 95014 OPERATOR: patg COPY # : 1 RECEIVED FROM ....: QUALITY FIRST HOME CONTRACTOR .......: GC ANDERSON LIC # 30398 COMPANY ..........: QUALITY FIRST HOME IMPROVEMENT ADDRESS ..........: 6545 SUNRISE BLVD STE 202 CITY/STATE/ZIP ...: CITRUS HEIGHTS, CA 95610 TELEPHONE ........: (916) 788-2921 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC ---------- NEW BAL --------- ----------------------- 1BCBSC VALUATION ---------- 14,964.00 ---------- 1.00 ---------- 0.00 1.00 0.00 1BSEISMICR VALUATION 14,964.00 1.50 0.00 1.50 0.00 1REROOFRES SQ FEET 29.00 377.00 0.00 377.00 ---------- 0.00 ---------- TOTAL PERMIT ---------- 379.50 ---------- 0.00 379.50 0.00 METHOD OF PAYMENT ----------------- CHECK TOTAL RECEIPT : AMOUNT --------------- 379.50 --------------- 379.50 VOICE ID DESCRIPTION -------- ---------------------------- 309 EXTERIOR LATH 601 ROOF TEAR OFF REFERENCE NUMBER -------------------- #2342 VOICE ID DESCRIPTION -------- ---------------------------- 311 SCRATCH COAT 602 ROOF PLYWOOD NAIL 604 ROOF IN -PROGRESS 605 FINAL REROOF CUPERTINO -7 REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildingCa1cupertino.orq PROTECT ADDRESS ,9 ^ ' / � , APN # OWNER NAME 6 iV Q PH �{ V ! 7/ 7 E-MAIL STREET ADDRESS la �lJ �d PU"�G / f C ST ZQ FAX APPLICANT NAME uaw les PHONE E-MAII STREET ADDRESS / SSS ah21JB',7vvd Jt CT� S�� s(O ld FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT W CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRAC AME44 // C -f LIC�JNr1 IER7 2 dd 77E LICENSF,jYPE �✓ BUS. LIC. # COMPANY NAME -MAIL,, FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC. # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE / USE OF I3C SFD or Duplex ❑ Multi -Family STRUCTURE: ❑ Commercial ROOF AREA VALUATION: 9 ,, BUILT-UP ROOF ❑ ASPHALT SHINGLES I.'R��O+OD SHAKES ❑ WOOD SHINGLES ❑ OTHER (SPECIFY) EXISTING ROOF TYPE: 11f� REMOVE /REPLACE R<S El NO IF NO, / # LAYERS: PLYWOOD L"l%:" ❑ THICKNESS: 1-15/8" PLYWD Ii?6SB TYPE: ❑ CDX PITCH: I Z ROOF CLASS: A PROPOSED ROOF TYPE: 11BUILT-UPROOF PSPHALT SHINGLES 13WOOD SHAKES 11WOOD SHINGLES ❑ OTHER ICC -ES REPORT # DESCRIPTION OF WORK: 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 correc 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 buil g cons n. I authorize representatives of Cupertino to enter the above- i ntified p perry for inspection purposes. Signature of Applicant/Agent: Date: Zy SUPPLEMENTA FORMATION REQUIRED _ If building is associated with a Home Owner's Association, provide letter of approval from HOA. Provide Planning approval to verify if there any restrictions. Provide copy of Manufacturer's Installation Specifications. Provide signed copy of Cupertino's Tear -Off Policy. ocEiisEorrLY " PLAN CHECK TYPE ROUTING stip - ❑ OVER-THE-COUNTER ❑ EXPRESS ❑ STANDARD 7 BUTLI)ING'PLAN, REVIEW ❑` PLANNING PLAN REVIEW ❑ FIREbi PT ❑ OTHER:.., ReroofApp_2011.doc revised 03/02/11 CUPERTI!NO 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 (408) 777-3228 • FAX (408) 777-3333 - buildinq(cDcupertino.orq PROJECT ADDRESS to c bwi APN # OWNER NAME PH ��7( E-MAIL STREET ADDRESS `a T G 4 L CITY TATE ZIP ` FAX CONTRACTOR NAME LICE E LICENSE BUS. LIC. # COMPANY A E-MAIL FAX STRFjET $ ��GCP. if �Z CITCS*f/!� ffI !!!�2 4;� C-+ I St(( PHONE 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 shall be scheduled 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. On the day of the inspection, a building inspector will be available within one hour for either a Tear -Off Inspection or Nailing Inspection if you call again on that day between the hours specified. The following inspections are required: a. 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. b. If plywood is installed, a plywood Nailing Inspection is required. c. Progress Inspection is required when approximately 50% of roof covering is installed. 4. New roof coverings shall not be applied without first obtaining all 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. 5. 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 I/4" 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. 6. 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 accordance with Sections R314 and R315 of the 2010 California Residential Code. Signature of Applicant/Agent: iy- Date: ,2011. doc revised 02/16/11 CUPERTINO 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: (D Z yU Z)`,loh hhe PERMIT # / L1 % -7 OWNER'S NAME:` �',tt ee. PHONE # GENERAL CONTRACTOR: CVV,44e F(/1ST BUSINESS LICENSE # 9l7 S 7 7 Z ADDRESS: (IPPYJ S1,AO& SO- A91wd At toe CITY/ZIPCODE:079VS "E A&3 X(e lb "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 SUBCONTRAC ORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. /P�4' 9- 9a 1 am not using any subcontractors: � Signature Date Please check applicable subcontractora complete the following information: Owner / Contractor Signature 3' k !! If 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 3' k !! If Date