10080131CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10430 PLUM TREE LN
Cr- NER'S NAME: DONNA LEE
MER' S..PHONE: 4082343864
❑/ LICENSED CONTRACTOR'S DECLARATION
.�
Lice ass Lic. # 2 '7
contractor Date 0
I hereby a irm that I am licensed un 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
gran f this permit. Additionally, the applicant understands and will comply
will► all non- int se1egulations per the Cupertino M i al Code , Section
8.
a
c:,.....�,.-�A-t_" � Date
CO TIN :ACTOR: R E ROOFING & PERMIT NO: 10080131
CONSTRUCTION INC
15230 CLYDELLE AVE I DATE ISSUED: 08/19/2010
SAN J(ISE, CA 95032 I PHONE NO: (408)626-9320
BUILDING PERMIT INFO: BLDG ELECT r PLUMB
MECH r RESIDENTIAL r COMMERCIAL r
❑ OWNER -BUILDER DEULAKA I rvi`�
I hereby affirm that I am exempt from the Contractor's) License Law for one of
the following two reasons:
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,
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 th�ect
mit is issued, I shall\
not employ any person in any manner so as to become suto the Worker's
Compensation laws of California. If, after making this c,ate of exemption(T
become subject to the Worker's Compensation provisions @f the Labor Code, I "lu�
forthwith comply with such provisions or this permit shall be deemed revoked.., ^,
JOB I IESCRIPTION: RE -ROOF REMOVE EXISTING 2 LAYERS OF COMP
INSTA ,L
NEW 3)# FELT & LIFETIME COMP CLASS A 25SQ
Sq. Ft Floor Area: I Valuation: $12000
APN Number: 31633116.00 I 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
i the above mentioned property for inspection purposes. (We) agree to save
nify and keep harmless the City of Cupertino against liabilities, judgments,
cues, 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 regulations per the Cupertino Municipal Code, Section
9.18.
PERMIT EXPIRES IF WORK IS NOT STARTED
`'VITHIN 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
instar led without first obtaining an inspection, I agree to remove all new materials for
inspe ction.
Sign, iture of Applicant: Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I ha.,e 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 &
Safi ty Code, Section 25532(a) should I store or handle hazardous material.
Adc itionally, should I use equipment or devices which emit hazardous air
con aminants as defined by the Bay Area Air Quality Management District I will
maintain compliancuMth the Cupertino Municipal Code, Chapter 9.12 and the
es tW afeWCode, Sec ' ns 25505, 25533, an 25534.
a ized ag`"en`t : l l l V
Date:
-- CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Le ider's
ARCHITECT'S DECLARATION
I u iderstand my plans shall be used as public records.
Signature Date —Lu
Li sensed Professional
3 ITEMS OF 3
CITY OF CUPEF TINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Loi;:
APN ........: 3163311,).00
DATE ISSUED ....... : 08000011222
8/19/2)10
RECEIPT #••" '..10080131
REFERENCE ID # •••
SITE ADDRESS .....: 10430 PLUM TREE LN
SUBDIVISION ••....:CUPERTINO
CITY ............
IMPACT AREA .......
OWNER DONNA IEE
ADDRESS ..........: 10430 PLUM TREE LN
CITY/STATE/ZIP ...: CUPERT=:NO, CA 95014
OPERATOR: patg
COPY # : 1
RECEIVED FROM R E ROOFING & CONST
CONTRACTOR .......: PROCTOR, PAUL LIC # 20615
COMPANY.......... R E ROOFING & CONSTRUCTION INC
ADDRESS 15230 �LYDELLE AVE
CITY/STATE/ZIP S 08033, 20 9CA 5032
TELEPHONE .......
METHOD OF PAYMENT
-----------------
CHECK
TOTAL RECEIPT
AMOUNT
---------------
327.20
---------------
327.20
VOICE ID DESCRIPTION
601 ROOF TEAR OFF
604 ROOF IN -PROGRESS
REFERENCE NUMBER
---------------------
##:? 618
VOICE ID DESCRIPTION
602 ROOF PLYWOOD NAIL
605 FINAL REROOF
QUANTITY
AMOUNT
PD -TO -DT
THIS REC
FEE ID UNIT
----------
--NEW-BAL-
____----------
1BCBSC VALUATION
----------
12,000.00
----------
1.00
0.00
0.00
1.00
1.20
0.00
0.00
1BSEISMICR VALUATION
12,000.00
1.20
_25.00
0.00
325.00
0.00
1REROOFRES SQ FEET
25.00
----------
----------
----------
_27.20
0.00
327.20
0.00
TOTAL PERMIT
METHOD OF PAYMENT
-----------------
CHECK
TOTAL RECEIPT
AMOUNT
---------------
327.20
---------------
327.20
VOICE ID DESCRIPTION
601 ROOF TEAR OFF
604 ROOF IN -PROGRESS
REFERENCE NUMBER
---------------------
##:? 618
VOICE ID DESCRIPTION
602 ROOF PLYWOOD NAIL
605 FINAL REROOF
CITY OF BUI (DING DIVISION
FEE ESTIMATOR DATE: REVIEWED BY:
;Dj ADDRESS: VALUATION:
A
BP#:
PN:
PLAN CHEC K TYPE: Re-ro
*PERMIT TYPE: Minor Building Permit
pENTAMATION
PERMIT TYPE:
PRIMARY RFD or Duplex
USE:
WORK
p O(M •tRl',I----
12,000
1 SFDWLROOF
No ,-
NOTE These ees are based on the preliminary it,
FEE ITEMS (Fee Resolution, 09-051 Eff i� 1 1O)
t't�att C7re��k cc:
StrJ 1 7 PC 1 ' e'
l'/orr 010:k.
Permit Fee:
f'Itrntla %.11c it.:�l:r'c r t =77o ir'e��"
Work Without Permit? Yes NO
1�1cltlttltl� 1`�'�',i:
7ru� ��1 (fit>c�triilc'r"t�ca�I�in 1"CVS:
StrongMotion Fee: 1BSEISMICR
IBCBSC
Bld Stds Commission Fee:
SUBTOTALS::'
-ion availa 51e and are o,
FEE QTY/FEE
$325.00
$0.00
an estimate Contact the Dept j
MISC ITEMS
Select an Administrative Item
%0.001 TOTAL FEE: $327.20
Revised: 8/17/2010
�f
CITY OF
CUPEkTINO
CITY OF CU'ERTINO
REROOF
PERMIT APPLICATION
APN #
1 r'
Building Address:
Owner's Name. N �L
HOA: Yes E] No ei
If
r
Contractor /� p, U
f\ I I
letter from HOA
CM^Nv, (0)vt Imo.
Cupertino Business License #: EU 3 K
Type of Roof Covering:
Existing:
❑ Built -Up Roof
Asphalt Shingles
❑ Wood Shakes
❑ Wood Shingles
❑ Other (Specify)
Number of existing coverings
To be Removed
Job
Job Description:
l i� PCZ L ,� Vlni �.0
Residential
Proposed:
❑ Built -Up roof
,Asphalt Shingles
❑ Wood Shakes
❑ Wood Shingles
❑ Other (Specify)
❑ Provide I.C.C.E.S. Report #
t
❑ Provide Mfgr. Installation Specs.
r-&
L,-IOLS Uy-
Commerciai
Green Building: Please complete relevant portic,n of the
Green Building Checklist & attach it to the Iication or if
applicable, include in plan set & the sheet index.
Valuation: Ulf
Contirmea wiun r1a,11--r, „0�.._
there are any restrictions:
I Hwd, Understand and Will Comply with C upertino's Tear -Off Policy:
Signatures '
Revised 02/05/09
2. Use Low VOC, Water -Based Wood Fnishes
4. Use Salvaged Materials for Interior Finishes
5. Use Engineered Sheet Goods with no added Urea
Formaldehyde
6. Use Exterior Grade Plywood.for Interior Uses
B. Use FSC Certified Materials for Interior Finish
9. Use Finger -Jointed or Recycled -Content Trim
10. Install Whole House Vacuum System
N. Flooring
1. Select FSC Certified Wood Flooring - -
3. Use Recycled Content Ceramic Tiles
4. Install Natural Linoleum in Place of Vinyl
5. Use Exposed Concrete as Finished Foor
6. Install Recycled Content Carpet with Low VOCs
1 fA /Health pts
y --yes
21A)/Health pts
y=yes,
31AD/Health pts
y --yes
3 R :source pts
y=yes
61AQ/Health pts
y=yes
1 lAOMealth pts
y --yes
4IAQMBalth. pts
y --yes
4 R esouroe pts
y=yes
1 R 3sDurce pts
y --yes
3 l,kQ/Health pts
y --yes
B Resource pts
y --yes
-
4 ReSDurce pts
y --yes
4 Resource pts
y --yes
5 IA )/Health pts
y --yes
4 Resource pts
y --yes
4 Re source pts
y --yes
Total Points Available:
Total Points Project Received:
1401 1301 57
I 5I 0 0
G:datalprngs/greenbuil Ingodelines/remodelerslgreenpointsfina121204protectedxis
t __
CUPERTINO
REROOF TEAR -OFF POLI(;Y
COMMUNITY DEVELOPMENT DEPARTMI_NT - BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE • CUPERTINO, C<, 95014-3255
(408) 777-3228 • FAX (408) 777-3333 - buiHing(a)cupertino.org
PROJECT ADDRESS '1 f� /1 I p L/1j�
vV_t
,_
APN #
OWNERNAME. /l./(i '1/
P_HOINi G�34_ 3"^
E-MAIL
STREET ADDRESS
U 4 � o T I l � O /�
l� ", (LICENSE
`f�U
tr'. STATE, ZIP �f �'7i J'1.� fl ►� Jd
l•
FAX
CONTRACTOR NAME' 1 i / �) ► J
ll v �V
NUMBER —1 .27G'(;tV�
LI NSFyTIE �
BUS. LIC. # -2- /
COMPANY NAME A L
C/
E-MAIL 1 \ 1 o d �� 4 LA 0, kol.c1�
FAX
STREET ADDRESS l 2 „ ��i Yli1 ,1 I ; i
CITY, STATE, !IP \
PHONE4 of _ /_4_ 9 3
2
I UNDERSTAND AND AGR EE TO THE FOLLOWING:
1. The re -roof project shall comply with all applicable provisions of the 2007 California Building Code.
2. You must schedule all needed inspections a minims m of one day before the requested inspection date.
Please schedule inspections online or call (408)777.3228 between 7:30-3:30 (Mon -Fri).
3. Tear -off roof inspection is required. Please call fir tear -off inspection after the roof is torn off and all
the nails/fasteners have been removed. Any and ill 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 inspecti.)n is required.
5. In -Progress roof inspection is required. Call for in in -progress roof inspection to verify building is
weather tight after installation of approximately 25`/o of the roofing material.
6. New roof coverings shall not be applied without fir;t obtaining all inspections 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.
7. A final inspection and approval shall be obtained frim the building inspector when the re -roofing is
complete. To receive a final sign -off, the followin€ items will be verified:
a. Flat roofs shall have a minimum of 1/4" per fool of slope and must 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.
8. NOTE: If you call for a tear -off or plywood nailin; inspection and the work is not complete, you will
be charged a re -inspection fee of $126.00. The re -1 ispection fee shall be paid before another
inspection can be scheduled.
By my sigria�g below, rtify each of the following is tn.e: I am the property owner or authorized agent to act
on the pr,6perty owner's be lf. understand and agree to comply with the re -roof policy stated ab ve.
Signature f Applicant/Agent: Date: J _
._..... _-
ReroofPolicy_2010.doc revised 05/17/10