10070063 CITY OF CUPERTIr 0 BUILDING PERMIT
BUILDING ADDRESS: 821 STENDHAL LN CONTRACTOR:COSMOS ROOFING PERMIT NO: 10070063
OWNER'S NAME: LISA BRADRICK 1901 OLD MIDDLEFIELD WAY STE 22 DATE ISSUED:07/08/2010
JER'S PHONE: 6508882711 MOUNTAIN VIEW,CA 94043 PHONE NO:(650)969-7663
T LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG I— ELECT r— PLUMB
License Class C 3 Lic.# 7 5 4 U F r-
MECH" RESIDENTIAL COMMERCIAL
Contractor Date �
r the provisions of Chapter 9 JOB DESCRIPTION:RE-ROOF TEAR OFF EXISTING TAR&GRAVEL.NO
I hereby m li unde
RESHEET.INSTALL 4PLY TAR&GRAVEL CLASS A 25SQ
(Comm4, wit ction 7000)of Division 3 of the Business&Professions
Code d 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:$11745
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
APN Number:37542044.00 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 regu t' ns per the Cupertino Municipal Code,Section
9.18. Issued by• Date: - 6
Signature Date �6
RE-ROOFS:
V OWNER-BUILDER DECLARATION
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: 7/ /to
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
construct the project(Sec.7044,Business&Professions Code).
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. I 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, Additionally,should I use equipment or devices which emit hazardous air 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 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 Owne or auth d gent: _=�
become subject to the Worker's Compensation provisions of the Labor Code,I must Da I-Ii0
forthwith comply with such provisions or this permit shall be deemed revoked.
C STRUCTION LENDING AGENCY
APPLICANT CERTIFICATION I hereby affirm that there is a constriction 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 e
f
CITY OF CUPERTINO
FEE ESTIMATOR--BUILDING DIVISION
ADDRESS: DATE: REVIEWED BY:
APN: BP#: *VALUATION: $11,745
PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD or Duplex S TOTAL APPLICATION
USE: ROOF AF.EA: 2,500 f TYPE:
xW
as
C �
3 �
FIE ID
1 RERC)OFFRES
7EJ
NOTE: These fees are based on the preliminairTy in ormation available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS 0-'ee Resolution 09-05I Lk ?/U091 FE]41� QTY/FEE MISC ITEMS
1 f_
fit
Permit Fee: $325.00
7l ,
Work Without Permit? Q Yes (F) No 10.00
6
Strom Motion Fee: IBSEISMICR $1.17 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC 51.00
SUBTOTALS: $3':7.17 $0.00 TOTAL FEE: $327.17
Revised: 6/30/2010
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIP RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: B1K: Lot:
APN . . . . . . . . : 37542044 . 00
DATE ISSUED. . . . . . . : 07/08/2010
RECEIPT #. . . . . . . . . BS000010813
REFERENCE ID # . . . : 10070063
SITE ADDRESS 821 STENDHAL LN
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER LISA BRADRICK
ADDRESS 821 STENDHAL LN
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : JEFF RAINEY
CONTRACTOR CCSMOS, RICHARD LIC # 18844
COMPANY CCSMOS ROOFING
ADDRESS 1501 OLD MIDDLEFIELD WAY STE 2
CITY/STATE/ZIP . . . : MCUNTAIN VIEW, CA 94043
TELEPHONE (E50) 969-7663
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- - --------- ---------- ---------- ---------
1BCBSC VALUATION 11, 745. 00 1 .00 0 .00 1. 00 0 . 00
1BSEISMICR VALUATION 11, 745. 00 1 .20 0 . 00 1.20 0 . 00
1REROOFRES SQ FEET 25 . 00 325 .00 0 . 00 325 . 00 0 .00
- --------- ---------- ---------- ----------
TOTAL PERMIT 327 .20 0. 00 327 .20 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 327 .20 VISA
---------------
TOTAL RECEIPT 327 .20
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- --------------------------- ------ ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
I
(1)C3��
CITY OF
CITY OF CUPERTINO
its RE ROOF
CUPE TING PERMIT APPLICATION
APN# .-, Date: / /
to
Building Address:
821 STENDHAL LANE
Owner's Name: LISA BRADRICK Phone#:
650-888-2711
HOA: Yes ❑ No El If Yes, provide lei ter from HOA
Contractor: Phone#: 650-793-5012
COSMOS ROOFING
1901 OLD MIDDLEFIELD WY #22, MENLO PARK, CA 9:043 Fax#: 650-969-9905
Cupertino Business License #: Contractor License #:
785441
Type of Itoof Covering:
Existing: Proposed:
Built-Up Roof ® Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ 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: REROOF - TEAR OFF EXISTING TPR & GRAVEL. NO RESHEET. INSTALL 4PLY
TAR AND GRAVEL. CLASS A. 25 SQUARES.
Residential 0 Commercial ❑
Green Building: Please complete relevant portion of the Confirmed with 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:
$11, 745
1 Have Read, Understand and Will Comply wit.i Cupertino's Tear-Off Policy:
Signa e
Revised 02/05/09
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPAR'-MENT•BUILDING DIVISION
ALBERT SALVADOR, P.E.,C.B.O., BUI-DING OFFICIAL
10300 TORRE AVENUE•CUPERTINO CA 95014-3255
CUPERTINO
(408)777-3228•FAX(408)777-3333•i>uildinq(aDcupertino.orq
PROJECT ADDRESS I 7,1PN#
OWNER NAME PH 1IE E-MAIL
STREET ADDRESS -J ' H� I�- CITY, -IZ'/,Jv CA v/ FAX
CONTRACTOR NAME GTE,ZIP
- LICENSE NUMB[ LICENCSE�TYP BUS.LIC.#
I _H SSCOMPANY NAME 711
FAX
STREET ADDRESS -TE,ZIPInd o�.D ►v►ifll�1� lrl� I - viL-0 e 0 969
I UNDERSTAND AND A 3REE TO THE FOLLOWING:
1. The re-roof project shall comply with all applica)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)777-3228 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 a id 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 first 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 from the building inspector when the re-roofing is
complete. To receive a final sign-off, the follo A ing items will be verified:
a. Flat roofs shall have a minimum of 1/4"per i oot 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 inspectic n.
c. Proper spark arrestor installation.
8. NOTE: If you call for a tear-off or plywood na ling inspection and the work is not complete, you will
be charged a re-inspection fee of$126.00. The -e-inspection fee shall be paid before another
inspection can be scheduled.
By my signing below, I certify each of the following i:;true: I am the property owner or authorized agent to act
on the property owner's behal . I understand and agre.- to comply with the re-roof policy stat d above.
Signature of Applicant/Agent: Date: Lh
ReroofPolicy_2010.doc revised 05/17/10
M.1ndODr Air Quality and Finishes
1.Use Low/NQ-VOC Paint 1 IAQ/Health pts y--yes 0
2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes 0
3.Use Low/No VOC Adhesives 3 IAQ/Health pts y--yes 0
4.Use Salvaged Materials for Interior Finishes 3 Resource pts y--yes 0
5.Use Engineered Sheet Goods with no added Urea
Formaldehyde 61AQ/Health pts y=yes D
6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 0
7.Seal all Exposed Particleboard or MDF 4 IAQ/Health. pts y=yes 0
8.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 1 0
10.Install Whole House Vacuum System 3 IAQ/Health pts y=yes 0
i ism
N.Flooring
1.Select FSC Certified Wood Flooring 3 Resource pts y=yes 0
2.Use Rapidly Renewable Flooring Materials t Resource pts y=yes 0
3.Use Recycled Content Ceramic Tiles 1 Resource pts y=yes 0
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: 1 1401 1301 57
Total Points Project Received: 0 01 0
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