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09010130 CITY OF CUPERTINO � ZTI� fi; BUILDING DIVISION PERMIT PERMIT NO. BUILDING ADDRESS: ' PERMIT ISSUE DATE OWNER'S NAME: INC. 5 E) A CONTROL NO. "o n n 1) 4 0 g 4 8 2—0 3 7 BUILDING PERMIT INFO FARCHrrECTIENGIINIEER:INEER: B� 1 PLUMB MECHapCLICENSED CONTRACTOR'S DECLARATION Job DeSCnptlon firm that I am licensed under provisions of Chapter 9(commencing of Division3 of tits Business and Professions Codc,and my license isRE—RF PERMIT, PREVIOUS EXPD IN 2007 , #07100093 ffect License Class.Lic•S =-p Date Contractor 3 0 5 4 ARCHrTECTSDECLARATION "PERMIT FOR ROOF FINAL a < I understand my plans shall be used as public records �dU ILy Licensed Professional OWNER-BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the p O following reason.(Section 7031.5,Business and Professions Code:Any city or county � Pi which requires a permit to conswct alter,improve.dcmolLsh•or repair any swcture u�'^ prior to its issuance,also requires the applicant for such permit to file signed Chstaapter 9 S Ft.Floor Area Valuation that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 q' 0 YF G (commencing with Section 7000)of Division 3 of lite Business and Professions Code)or y that he is exempt therefrom and the basis for the alleged exemption.Any violation of APN Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than rive hundred dollars(M). 31630108 . 00 0 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 Required Inspections and Professions Code:The Contractor's License Law does not apply w an owner of property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for sale.If, however,the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). 61.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044.Business and Professions Code:)The Contractor's Li- cense Law does not apply to an owner of property who builds or improves thereon,and who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law. ,B&P C for this mason 0^� p undo Sec Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's Compen- -,ion,as provided for by Section 3700 of the Labor Code.for the performance of the work for which this permit is issued. 0 I have and will maintain Worker's Compensation Insurance.as required by Section 3700 of the Labor Codc•Cor the performance of the work for which this permit is issued. My Worker s Compensation Insurance carrier and Policy number are: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or less.) I certify that in the performance of the work for which this permit is issued,I shall not employ any n in ny manner to bceom subj to the Workers'Compensation Laws Of Cal'o Applicant NOTICE TO APP CANT:If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must ,J',Z forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I n I hereby affirm that there is a construction lending agency for the performance of �+ the work for which this permit is issued(Sec.3097,Civ.C.) W ALender's Name � Z Lender's Address I certify that 1 have read this application and state that the above information is LT'� cortecL 1 agree to comply with all city and county ordinances and state laws relating to construction.building consction.and hereby authorim representatives of this city to enter upon the C)U C) W above-mentioned property for inspection purposes nst liabilities,judgments,costs and expenses which may in any way accDate a (We)agree to save,indemnify and keep harmless the City of Cupertino agai rue against said City V Z in consequence of the granting of this permit. t--r A UNDERSTANDS AN�Cf3�1PLY WITH ALL NON-POINT Issued by: O EGULATION/. \(Vw -' ({1 I —( Re-roofs -� Signature of ApplicanUContractor Dare T Of Roof HAZARDOUS MATERIALS DISCLOSURE Type Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. 0Yes )p If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which it hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. strict? 0 Yes RNo I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building does n currcnlly ha ant,that it is my responsibility to notify the �Pant nr the Signature of Applicant Date req rem is hich ust mel priorp��ssuan f a Certificate 1 mac,�f1ry All roof coverings to be Class'A•"or better Dail Owner or authorized agent CITY OF CUPERTINO 3 ITEMS OF 5 PERMIT RECEIPT OPERATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 31630108 . 00 DATE ISSUED. . . . . . . : 01/30/2009 RECEIPT #. . . . . . . . . BS000007076 REFERENCE ID # 09010130 SITE ADDRESS . . . . . : 10564 N BLANEY AVE SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER JON CROCKETT ADDRESS . 10564 N BLANEY AVE CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2455 RECEIVED FROM JON CROCKETT CONTRACTOR LEON SHAVER LIC # 29509 COMPANY CUSTOM BUILDING & DESIGN INC. ADDRESS 2980 E CAPITOL EXPWY STE 50 40 CITY/STATE/ZIP SAN JOSE, CA 95148 TELEPHONE (408) 482-0376 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- 1BCBSC VALUATION 10, 000 .00 1 . 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 10, 000 . 00 1 . 00 0 . 00 1 . 00 0 . 00 1REROOFRES SQ FEET 30 . 00 390 . 00 0 .00 390 . 00 ---- 0 . 00 - ---------- ---------- ---------- TOTAL PERMIT 392 . 00 0 . 00 392 . 00 0 .00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- --------------------------- __ _ -- ---------- _ 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 604 ROOF IN-PROGRESS 605 FINAL REROOF 0 � � C>150 CITY OF CUPERTINO REROOF CUPEIZ INO PERMIT APPLICATION APN # Date: i 3 Building Address: Owner's Name: Phone #: 26 ('� 0 YD CIO � -7 :S i Contractor: Phone #: SWJ3_1� Fax#: Cupertino Business License #: Contractor License #: CM5 Type of Roof 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.B.O. Report# ❑ To be Removed ❑ Provide Mfgr. Installation Specs. Job Description:f(p fu N-A C-7 0, �0r Yao oa ! 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: - I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy: Signature Revised 01/07/09 CITY OF CUPERTINO REROOF CUPEf�TiNO FEE SCHEDULE Number of Fee ID Fee Description Fee Permit Type Squares Group 1REROOFCOM Re-roof Commercial B 1COMMLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICO Seismic Commercial B 1RER00FRES Re-roof Residential B 1SFDWLROOF �d 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee / 1BSEISMICRE Seismic Residential B 1REROOFMRES Re-roof Multi-Family B 1MFDWLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICRE Seismic Residential B 1BUSLIC Business License B INPUT ResDurces Energy •• . n oor rr ualrty and Finis es 1.Use Low/No-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 LowMo 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 0 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 0 10.Install Whole House Vacuum System 3 IAQ/Health pts y=yes D i 1 1 N.Flooring 1.Select FSC Certified Wood Flooring 8 Resource pts y=yes 0 2.Use Rapidly Renewable Flooring Materials 4 Resource pts y=yes 0 3.Use Recycled Content Ceramic Tiles 4 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 1 1 1 Total Points Avai a le: 1 1401 1301 57 Total Points Project Received: 01 0 0 acia G:data/progs/greenbuildingguidelines/remodelers/greenpointsfinal2.12.04protected.xls Community Development - 10300 Torre Avenue ' �I Cupertino CA 95014 J;. Telephone(408)777-3228 Fax(408)777-3333 CITY OF �.UPEkTINO BuiUlm V e artment JOB ADDRESS: PERMIT # IU�co N f�,�r�+�� c, . � k YStitt © '1 ooO G 3 OWNER'S NAME: Qyn) ( PHONE # (n - -75-) - 3 GENERAL CONTRACTOR: e Ski c,v e ✓ FAX # 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 Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Ll- Roofing °I 12 Septic Tank Sheet Metal Sheet Rock Tile I - - C Owner/Contractor Signature Date