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10040103I CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 10334 ALPINE DR I CONTRACTOR: TIP -TOP ROOFING I PERMIT NO: 10040103 OWNER'S NAME: SHIRLEY P. LIN ,WNER'S PHONE: 4082531472 ❑ LICENSED CONTRACTOR'S DECLARATION License Class C'1 3'r Lie. # /'9(6 6 O Contractor Date e qrZK Ile, I hereby affirm//that I am licensed under the provisions of Ch Ater 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 regulations per the Cupertino Municipal Code, Section 9.18. Signature //a Date 0 ❑ OWNER- BUILDER DECLARATION 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) 1, 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 —on the above mentioned property for inspection purposes. (We) agree to save emnify and keep harmless the City of Cupertino against liabilities, judgments, .osts, 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. Signature / "(f'n �C C7 Date �r 1/a 1160 NADINE DR I DATE ISSUED: 04/16/2010 CAMPBELL, CA 95008 1 PHONE NO: (408)370 -6425 JOB DESCRIPTION: RESIDENTIAL u COMMERCIAL RE -ROOF TEAR OFF SHAKE INSTALL OSB, 30LB CLASS A 38 SQUARES Sq. Ft Floor Area: I Valuation: $16500 APN Number: 32615073.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued br 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. �� Signature of Applicant: A ;J M'L �` �%�% W-4 Date: RINGS 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 225505, 25533, and 255534. Owner or authorized agent: Wit/ / /dt '! Date: 6'' 11V IM 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 Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional .�I 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 C U P E RT I N O (408) 777 -3228 - FAX (408) 777 -3333 - buildingCc_DcuPg n9 ;.2 XPN PROJECT ADDRESS �� 3 3 Cl A,` j! j�(/� /Z • 3 (�' / l (� /T / - / PHONE E -MAIL OWNER NAME ��+ �� L //V S3 l � ? Z CITY, STATE, ZIP FAX STREET ADDRESS - ' LICENSE NUMBER LICENSE TYPE BUS. LIC. q Z 2 Q Z CONTRACTOR NAME AV" �L �- ' E -MAIL �J�, C �' ti FAX COMPANY NAME ��/o .+ N�7A L�� P &,r CITY, STATE, ZIP ^A�y� /2 L� G A �S° PHONE / e STREET ADDRESS �iNr �� ]' �''v / �J Y I UNDERSTAND AND AGREE TO THE FOLLOWING: 1. The re -roof project shall comply with all applicable provisions of the 2007 California Building Code. 2. An inspection request shall be scheduled the day before the inspection date. Please call (408)777- 3228 between 7:30 - 3:30pm (Mon -Fri) to schedule the next day inspection. 3. After the roof is torn off and the nails /fasteners have been removed and all the dry -rotted wood has been replaced, you must call for a roof inspection. A building inspector will be available with one hour. There are special hours for the service: 7:30 — 10:30am and 1:00 — 2:30 anpm (Mon — Thurs); n 7:30 — 10:30am P 4. If plywood is installed, a plywood nailing inspection is required. 5. 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. 6. 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 item will be verified: a. Flat roofs shall have a minimum of I/" per foot of slope and demonstrate there is no ponding. b. A listing from an approved testing agency shall be available on -site to review at the time of the inspection. _ c. Proper spark arrestor installation. 7. NOTE: If you call for a plywood nailing inspection and the job is not ready, you will be charged to a re- inspection fee of $126.00. The re- inspection fee shall be paid before another inspection can be scheduled. "NY my signature below, I certify to each of the following: I am the property owner or authorized agent to act on ...,e property owner's behalf. I understand and agree to comply with the re -roof policy stated above 6 l�ZC�_ Date: d Signature of Applicant/Agent: a ReroofPolicy_201 0. doe revised 04 /l4 /l0 CITY OF CITY OF CUPERTINO Imi REROOF CUPERTINO PERMIT APPLICATION 1616410103 APN # Date: Building Address: 1� 3 3�1- Owner's Name: Sfj��r%`, Phone #: �-eB 2.53 - /0'a 2- HOA: Yes ❑ No EA —'If " es, provide letter from HOA Contractor: P _ oP f.H Phone Fax #: C/o a 3 Cupertino Business License #: Z '/"2 O 2- Contractor License #: Type of Roof Covering: Existing: Proposed: • Built -Up Roof ❑ Built -Up roof • Asphalt Shingles � Asphalt Shingles e4 Wood Shakes �❑ Wood Shakes o 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: Z` ,5-e f�e eq e-r-f Residential 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: fC,` � S ` a� o ,o I Have Read, Understand and Will Comply with Cupertino's Tear -Off Policy: Si Revised 02/05/09 CITY OF [a CITY OF CUPERTINO REROOF CUPERTINO FEE SCHEDULE Fee ID Fee Description 1REROOFCOM Re -roof Commercial 1BCBSC Cal Bldg Standards Commission Fee 1BSEISMICO Seismic Commercial 1REROOFRES Re -roof Residential 1BCBSC Cal Bldg Standards Commission Fee 1BSEISMICRE Seismic Residential 1REROOFMRES Re -roof Multi - Family 1BCBSC Cal Bldg Standards Commission Fee 1BSEISMICRE Seismic Residential 1BUSLIC Business License =Group Type Number of Squares B 1COMMLROOF B ALL PERMIT TYPES B B 1SFDWLROOF B ALL PERMIT TYPES B B TALL 1MFDWLROOF B PERMIT TYPES B B 3 ITEMS OF 3 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 32615073.00 DATE ISSUED.......: 04/16/2010 RECEIPT # ......... BS000010203 REFERENCE ID # ...: 10040103 SITE ADDRESS 10334 ALPINE DR SUBDIVISION ...... CITY CUPERTINO IMPACT AREA ...... OPERATOR: SylviaM COPY # : 1 OWNER SHIRLEY P. LIN ADDRESS ..........: 7157 BRISBANE COURT CITY /STATE /ZIP ...: SAN JOSE, CA 95129 -4648 RECEIVED FROM CONTRACTOR ... COMPANY ...... ADDRESS ...... CITY /STATE /ZIP TELEPHONE .... NIJAZ KADICH NIJAZ KADICH LIC # 24202 TIP -TOP ROOFING 1160 NADINE DR CAMPBELL, CA 95008 (408)370 -6425 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT - - - - -- THIS REC - NEW BAL ---- - - - - -- ------- - - - - -- 1BCBSC VALUATION ---- - - - - -- 16,500.00 ---- - - - - -- 1.00 ---- 0.00 1.00 0.00 1BSEISMICR VALUATION 16,500.00 1.70 0.00 1.70 0.00 1REROOFRES SQ FEET 38.00 494.00 0.00 ---- - - - - -- 494.00 ---- - - - - -- 0.00 ---- - - - - -- TOTAL PERMIT ---- - - - - -- 496.70 0.00 496.70 0.00 METHOD OF PAYMENT --------------- -- CREDIT CARD TOTAL RECEIPT : AMOUNT --------------- 496.70 --------------- 496.70 VOICE ID DESCRIPTION -- - - - - -- ---------------------- - - - - -- 601 ROOF TEAR OFF REFERENCE NUMBER --------------- - - - -- visa VOICE ID DESCRIPTION -- - - - - -- ---------------------- - - - - -- 602 ROOF PLYWOOD NAIL 604 ROOF IN- PROGRESS 605 FINAL REROOF