10090109 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 1554 PRIMROSE WAY CONTRACTOR:SIMON SAYS ROOFING PERMIT NO: 10090109
OWNER'S NAME: GERSHON PERELMAN a012 BECKLEY DR DATE ISSUED:09/15/2010
4ER'S PHONE: 4085044728 iAN JOSE,CA 95135 PHONE NO:(408)531-9700
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT r PLUMB r
License Class_ Lia:75f�y — m
ME r RESIDENTIAL r COMMERCIAL r
Contrnctor Date — .r 2 O l V
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:RE-ROOF TEAR OFF ENTIRE ROOF
IN
1/2 OSB&30
LB OSB&FELT 40 YR COMPOSITION CLASSS A ROOFING
(commencing with Section 7000)of Division 3 of the Business&Professions 24 1/2 SQ
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 WorkerIthis
Compensation,as provided for by Section 3700 of the Labor Code,for th
performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,as provided
Section 3700 of the Labor Code,for the performance of the work for whiSq.Ft Floor Area: Valuation:$8900
permit is issued.
APPLICANT CERTIFICATION APN Number:36615013.00 Occupancy Type:
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 constriction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED
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
granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. r Issued by/' ~-� Date:
Signature Date 5' 01 lJ
Li OWNER-BUILDER DECLARATION RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is
the following two reasons: installed without first obtaining an inspection, ree to remove all new materials for
I,as owner of the property,or my employees with wages as their sole compensation, inspection. R
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code) Si aturrApplicant: Date:
1,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
declarations: HAZARDOUS MATERIALS DISCLOSURE
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 I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
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
permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will
I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's Health&Safety Code Sections 25505,25533,and 25534.
Compensation laws of California. If,after making this certificate of exemption,I Ow horiz agent:
become subject to the Worker's Compensation provisions of the Labor Code,I must Date:_/S 2 6J Z)
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's
correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.)
to building construction,and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned property for inspection purposes.(We)agree to save
•mify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
,and expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
with all non-point source regulations per the Cupertino Municipal Code,Section
I understand my plans shall be used as public records.
9.18.
Signature Date Licensed Professional
CITY OF C'UPERTINO
FEE ESTIMATOR— BUILDING DIVISION
ADDRESS: DATE: REVIEWED BY:
APN: BP#: *VALUATION: $8,900
*PER MIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY T(17:-3/ PENTAMATION 1SFDWLR00F
USE: SFD or Duplex r_��«h� �j;r �i. PERMIT TYPE:
WORK
SCOPE
FEE ID ROOF AREA
s.r.
1 REROOFFRES 2,5 00
c'"
F
1, r;i �jCi"ra:r t J`e't':
r�r
/"'c Pw"T h. b)'p, j 'c,_ ;-lo,lovl 1'co.
NOTE: Theset or addn7 in-fees are based on the relimina in ormation a vailable and are onl an estimate. Contact the De o.
FEE ITEMS(Fee Resolution 09-051 Eff 7/7;70) FEE QTY/FEE MISC ITEMS
P/on Chec:h Fc"
Supp/. PC Fc c
F/rrrrzh.: :1c�c Ir. L�Cc�c Plan Clack:
Permit Fee: $325.00
Sullpl. Ill.sl F'e e
Plurnh./11ct lt.
7'1'1('(~ 1..-I it FCC:
P/truth.;11"(11. Pc l-ruit FCc.
(,'onsiruciion 1'a
,I'oatasliCe'd Rcviciv 1-Fee.
Work Without Permit? 0 Yes E) No $C.00
1'lcrrtrtrfr,�r 1"c'�:'.s:
Tr�r��c�l/)octrftrt�rttcrtiort l��c�e. :
Strong Motion Fee: 1BSEISMICR $C.89 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00
SUBTOTALS: $326.89 $0.00 TOTAL FEE: $326.89
Revised: 9/14/2010
CITY OF CUPERTINO
PERMIT RECEIPT OPERATOR: patg
3 ITEMS OF 7 COPY # : 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36615013 .00
DATE ISSUED. . . . . . . 09/15/2010
RECEIPT #. . . . . . . . . :
REFERENCE ID # . . . : 10090109
SITE ADDRESS . . . . . : 15E4 PRIMROSE WAY
SUBDIVISION . • • ' . . : CU1'ERTINO
CITY . . . . . . . . . . . .
IMPACT AREA . . . . . . .
OWNER GERSHON PERELMAN
ADDRESS . 1554 PRIMROSE WAY
CITY/STATE/ZIP CUPERTINO, CA 95014
RECEIVED FROM . . . . : SI14ON SAYS ROOFING
CONTRACTOR DA:2RYL SIMON LIC # 23053
COMPANY SIAON SAYS ROOFING
ADDRESS 3012 BECKLEY DR
CITY/STATE/ZIP SA9 JOSE
531,9700 95135
TELEPHONE
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC --NEW-BAL-
---------
---------- 0 .00
---------- ---------- 0 .00 1. 00
8, 900 .00 1.00 0 .00
1BCBSC VALUATION 0 .00 0 .90
1BSEISMICR VALUATION 8, 900 . 00 0 '90 0.00 325 .00 0 .00
1REROOFRES SQ FEET 25.00 325.00 _ --------
- --------- ----------
---------
TOTAL PERMIT
326 .90 0.00 326 .90 0 .00
VOICE ID DESCRIPTION
VOICE ID DESCRIPTION ----
__------ --------------
-------------
602 ROOF PLYWOOD NAIL
601 ROOF TEAR OFF
604 ROOF IN-PROGRESS
605 FINAL REROOF
MMnMoor Quality and Finishes
1.Use Low1No-VOGG Pa:M 1 IAO/Health pts y=yes
2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts yeses
3.Use LvwMo TOC Adhesives 31AQ/Health pts y--yes
4.Use Salvaged Materials for Interior Finishes 3 Resource pts y--yes 0
01
5.Use Engineered Sheet Goods with no added Urea
Formaldehyde 61AQ/Health pts y=yes
DI
6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y--yes 0
7.Sao]ajqd�,Qr MDF 4IAQ/Healft pts y--yes D
B.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes 0
9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y=yes 0
10.Install Whole House Vacuum System 3 IAQ/Health pts y=yes
' 1 1 1
N.Flooring
1.Select FSC Certified Wood Flooring B Resource pts y=yes 0
2.Use Rapidly nenewahle Flooring ly>lafados 4 Resource pts y=yes D
3.Use Recycled Content Ceramic Tiles 4 Resource pts Y--yes
4.Install Natural Linoleum in Place of Vinyl 5 IAQ/Health pts Y--yes 0
5.Use Exposed Concrete as Finished Floor 4 Resource pts Y--yes 0
6.Install Recycled Content Carpet with Low VOCs 4 Resource pts Y--yes 0
Total Points Available; 140 130 57
Total Points Pro'ect Received: 0 0 0
1
G:datalpmo]reenbulirringguidelines/remodelers(greenpointsfinal212MproteDledxls
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
CUPERTINO
(408)777-3228•FAX(408)777-3333•building(d)cupertino.org
PROJECT ADDRESS APN#
OW &WE � �PeJ^ A PHO-: E-MAIL
S A�WtEES .„A r- Li C v pE�f )" V
ZI
TO
f .� FAX
CONTRACR .`AME I v` LICENSE NUMBEI. LICENSE TYPE BUS.LIC#
COMPA Y A1�E, ,/ E-MAIL FAX
S aT JRF13 CIT STA 1E ZIP PHONE
(� I UNDERSTAND AND AGREE TO THE FOLLOWING:
1. The re-roof project shall comply with all applicat le provisions of the 2007 California Building Code.
2. You must schedule all needed inspections a minimum of one day before the requested inspection date.
Please schedule inspections online or call (408)7"7-3228 between 7:30-3:30 (Mon-Fri).
3. Tear-off roof inspection is required. Please call for tear-off inspection after the roof is torn off and all
the nails/fasteners have been removed. Any and all dry-rotted wood shall be replaced prior to this
inspection. A building inspector will be available within one hour.
There are special hours for this service: 7:30 — 10:30am and 1:00—3:30pm (Mon—Thurs);
7:30 — 10:30am and 1:00—2:30pm (Friday).
4. If plywood is installed, a plywood nailing inspection is required.
5. In-Progress roof inspection is required. Call for an in-progress roof inspection to verify building is
weather tight after installation of approximately 25% of the roofing material.
6. New roof coverings shall not be applied without irst obtaining all inspections and written approvals
from the building inspector. Any roofing which s applied without first obtaining an approved inspection
will require the removal of all new material dowit to the sheathing so a proper inspection can be
performed.
7. A final inspection and approval shall be obtained from the building inspector when the re-roofing is
complete. To receive a final sign-off, the following items will be verified:
a. Flat roofs shall have a minimum of 1/4"per foot of slope and must demonstrate there is no ponding.
b. Listings from approved testing agencies for:ill pre-manufactured products used shall be available
on-site to review at the time of the inspection.
c. Proper spark arrestor installation.
8. NOTE: If you call for a tear-off or plywood nai ing inspection and the work is not complete, you will
be charged a re-inspection fee of$126.00. The r:-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 underst d and agree to comply with the re-roof policy
stated above.
Signature of Applicant/Agent: Date: / `" IJ 2016
ReroofPolicy_2010.doc revised 05117/10
Simon Says Roofing
3012 Beckley Dr
San Jose, Ca 95135
Tele: 408-531-9700 Fax: 408-531-1815
Bonded &Insurad License#784948
September 15,2010
To Whom It May Concern:
1,Darryl Simon, owner of Simon Says Roofing,am requesting that Allen Simon, be
authorized to pull permits on behalf of the company. If you have any questions,
please feel free to contact me at anytime. 'Chank you in advance for your time.
Regards,
DARRYL SIMON
OWNER
Simon Says Roofing
simonsaysroofinff@,aol.com
3012 Beckley Dr. San Jose, Ca 95135
408.531.9700 direct
408.531.1815 fax
i -d Xdd 13Cd3Sd1 dH WdLE = 1 010a SI daS
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
CUPERTINO Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: k S,S`� c •^cz,vse� PERMIT# J ��
OWNER'S NAME: PHONE#
GENERAL CONTRACTOR: BUSINESS LICENSE# $ `�$
ADDRESS: O'3o �` Qri,,a CITY/ZIPCODE:
*Our municipal code requires all businesses working'n 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. ��—
I 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
CITY OF )^I
CITY OF <"UPERTINO
;jj
RE]ZOOF
CUPERTINO PERMIT APPLICATION
NN
Date:
ing Ad ress:
} )
4w�er's Rame: Phone #:
HOA: Yes ❑ No provide letter from HOA
If es,
Contractor: Phone #: �
sl!at►�01`� 5/�' KUd��,'�i Fax#: b
v�
Cupertino Business License #: Contractor License #:
Type of Poof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
9,,-,Wood Shingles u--Wood Shingles
❑ Other (Specify) ❑ Other (Specify)
Number of existing coverings ❑ Provide I.C.C.E.S. Report#
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description: -r4- ,4 Y' O C r) 2
l��
TO �� L L �p re �� �fi '
esiden ial - - Commercial
Green Building: Please complete relevant portion of the Confirmed nzith Planning Dept. if
Green Building Checklist & attach it to the application or if there are any restrictions:
applicable, include in plan set & the sheet index.
Valuation: ,/ qo �
I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
Signature
Revised 02/05/09