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11030033 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 881 LILY AVE CONTRACTOR:NEIGHBORS ROOFING PERMIT NO: 11030033 AND GUTTERS OWNER'S NAME: RACHEL WEI 255 DONDERO WAY DATE ISSUED:03/07/2011 3R'S PHONE: 4082527070 SAN JOSE,CA 95119 PHONE NO:(408)629-7922 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r— ELECT r— PLUMB License Class Lic.# t MECH RESIDENTIAL COMMERCIAL Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:RE-ROOF INSTALL ALL NEW COMP SHIINGLES FOR (commencing with Section 7000)of Division 3 of the Business&Professions EXISTING SFDWL TEAR OFF 32SQ 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. I have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Floor Area: Valuation:$14500 Section 3700 of the Labor Code,for the performance of the work for w�c this permit is issued. 'I;' APN Number:35903023.00 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. ( Issued b�-� Dater Signature< e - I( Li OWNER-BUILDER DECLARATION RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for the following two reasons: inspection. 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, Signature of Applicant: Date- Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534. 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 Ow r or ut rrzed e / become subject to the Worker's Compensation provisions of the Labor Code,I must Date:=> ��©(c forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.) correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address inify and keep harmless the City of Cupertino against liabilities,judgments, and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. Licensed Professional Signature Date REROOF TEAR-OFF POLICY COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL CUPERTINO 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 (408)777-3228 • FAX(408)777-3333• building(d�cupertino.org PROJECT ADDRESS l I j au,/ APN# OWNER NAME ACJ )� DPHONE 7 7 E-MAIL STREET ADDRESS CITY, STATE,ZIP FAX )I ; C- v C-C, -y- CONTRACTOR CONTRACTOR NAME , / L LICENNU BER �G� LIC SE TYPE BUS.LIC.# COMPANY NAME n /ev E-MAIL FAX STREET ADDRESS(J` ell CITY,STATE,ZIP Q q5_722- PHONE p T/ J I Liz) 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. 3. 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. —o Signature of Applicant/Agent: Date: l� RerogJPolicy_2011.doc revised 02/16/11 CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 35903023 . 00 DATE ISSUED. . . . . . . : 03/07/2011 RECEIPT #. . . . . . . . . BS000012849 REFERENCE ID # . . . : 11030033 SITE ADDRESS . . . . . : 881 LILY AVE SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : RACHEL WEI ADDRESS . . . . . . . . . . : 881 LILY AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : NEIGHBORS ROOFING CONTRACTOR ROBERTO LOPEZ LIC # 27063 COMPANY . . . . . . . . . . : NEIGHBORS ROOFING AND GUTTERS ADDRESS . . . . . . . . . . : 255 DONDERO WAY CITY/STATE/ZIP . . . : SAN JOSE, CA 95119 TELEPHONE . . . . . . . . : (408) 629-7922 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 14, 500 . 00 1. 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 14, 500 . 00 1 .45 0 . 00 1.45 0. 00 1REROOFRES SQ FEET 32 . 00 416 . 00 0 . 00 416 . 00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 418 .45 0 . 00 418 .45 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 418 .45 #2360 --------------- TOTAL RECEIPT 418 .45 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 //v _3 0033 REROOF PERMIT APPLICATION LM COMMUNITY DEVELOPMENT DEPARTMENT •BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408)777-3228• FAX(408)777-3333•buildina(d)cupertino.org CUPERTINO PROJECT ADDRESS (r� 1l / v APN# L3 o j' © J OWNER NAME _ j- a PHONE L-4 D q ?7 2 J,`L 0 E-MAIL STREET ADDRESS CITY, STATE,ZIP FAX APPLICANT NAME PHONE E-MAIL STREET ADDRESS CITY,STATE, ZIP FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT MICONTRACTOR ❑CONTRACTOR AGENT Cl ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAMEC� Yea LICENSE NUMBER LICENSETYPEBUS.LIC.#(�-c)6 COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE ,r2-90 2( ARCHITECTIENGINEER NAME LICENSE NUMBER BUS.LIC.# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF BLDG: &,RESIDENTIAL ❑COMMERCIAL ROOF AREA: -> VALUATION: ,`r I f EXISTING ROOF TYPE: 1-1BUILT-UPROOF "_A PHALT SHINGLES 29400D SHAKES ❑WOOD SHINGLES 1 l�❑OTHER(SPECIFY) REMOVE/REPLACE 0-YES IF NO, PLYWOOD (&,w, ❑ PLYWD ROSB PITCH: ROOF 11NO #LAYERS: THICKNESS: 115/8" TYPE: ❑ CDX 12 CLASS: A PROPOSED ROOF TYPE: ❑BUILT-UP ROOF QASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD 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 correct. 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 todi222 onstruction. I autho a representatives of Cupertino to enter the above identified property for inspection purposes. Signature of Applicant/Agent: /t� Date: SUPPLEMENTAL INFORMATION REQUIRED 0"ICEUSEONLY _If building is associated with a Home Owner's Association,provide letter gt'►NdxEct�TYpE :xQUTINGsz of approval from HOA. pvEx-rltE eovrril Q stJu un+IC PI a�iwltxlEw _Provide Planning approval to verify if there any restrictions. � icexEss; pLANNBYCPLhN;I2E�I1'�' Provide copy of Manufacturer's Installation Specifications. 0 STANDAP 1wIR&DEP`1" 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: 881 lily ave. DATE: 03/07/2011 REVIEWED BY: bobs. APN: BP#: *VALUATION: 1$14,500 -1 PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof PRIMARY SFD or Duplex PENTAMATION 1 SFDWLROOF USE: PERMIT TYPE: WORK install new comp shingles for existing sfd tear off. SCOPE FEE ID ROOF AREA s.f. 1 REROOFFRES 3,200 F-T-L 1'�.I'm l'l 1-c'�_ Ip.�?>. F-1 I 014 r I'i?1 rlr IY,tiIL-1 Imp, 1,e iL f 't NOTE: Thesefees are based on the preliminaty in ormation available and are only an estimate. Contact the De t or addh 7 in o. FEE ITEMS (Fee Resolzution 09-051 Eff 7/1/10) FEE QTY/FEE MISC ITEMS Plan Check F ac° Str1>1?l. 1't'f' I _T phwlh 'V ,Tr. I lc c:P/rrl C`h<ck, Permit Fee: $416.00 T'lz�rr:h. ".tict il.'l'l�•�: (�r�afr f��=�°: C t?Tt.titf°1?t';ti)tl �t7;1 lf'otRWft:'rt Ict'7,ii>11- l'(`tz: Work Without Permit? 0 Yes E) No $0.00 Ylczrarrttt�> 7�'c'�is Ir avel 0ocmaclttatioll Fc<c.s: Strong Motion Fee: IBSEISMICR $1.45 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $418.45 $0.00 TOTAL FEE:" $418.45 Revised: 01/15/2011 Building Department City Of Cupertino LM 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 CUPERTINO Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: Yl ca PERMIT# _ OWNER'S NAME: )-i e ! ( PHONE# LJnK Z SZ -tom /U GENERAL CONTRACTOR: 41CI .F-)F,yl BUSINESS LICENSE# ADDRESS: ,. ,. `/2 CITY/ZIPCODE: *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 SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. // JJ /? 1 am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: 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