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09010067 CITY OF CUPERTINO ' BUILDING DIVISION PERMIT ' � : BUILDING ADDRESS: PERMIT NO. 10671 HALE PL SHELTON ROOFING 09010067 OWNER'S NAME: PERMIT ISSUE DATE INE: paj Sip S A�ttCONTROL NO. (650) 961-7699 ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 a a0p LICENSED CONTRACTOR'S DECLARATION Job Description U I hereby affirm that I am licensed under provisions of Chapter 9(commencing p U with Section 70110)tr Division 3 of the Business and Professions Code,and my license is y in full force and a �. zG INSTL NEW TAR&GRVL ROOF r 2 SQ ZLicense Class 3l Lic.N n t-G Date I)/—i S-ca S contrador ARCHITECTS DECLARATION 1 understand my plans shall be used as public records ' o. ,0(4 Licensed Professional y 1 OWNER-BUILDER DECLARATION i<2 1 hereby affirm that I am exempt from the Contractors License Law for the L Q O following reason.(Section 7031.5,Business and Professions Code:Any city or county R Pi which requires a pennit to construct,alter,improve,demolish,or repair any structure y Z y prior to its issuance,also requires the applicant for such permit to file a signed statement _`e that he is licensed pursuant to the provisions of the Contractor's Liccrw Law(Chapter 9 Sq.Ft.Floor Area Valuation Y t— (commencing with Section 7000)of Division 3 of the Business and Professions Code)or y that he is exempt therefrom and the basis for the alleged exemption.Any violation of $1250 Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy not more than five hundred dollars(S500). 32640010. 71 p y Type 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 and Professions Code:The Contractors License Law does not apply to an owner of Required Inspections 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.U. 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.). 0 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractors 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 Contractors License Law. 0 I am exempt under See. B dt P C for this mason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I hive and will maintain a Certificate of Consent to self-insure for Worker's Compen- .,ation,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 Cook:,for the performance of the work for which this permit is issued My Workers Comp[�r�_aau/onn Insurance carrier and Policy number are: Cartier. �3 al'f� 71C�Li Pol'ncyNo.: S'171/0k6i 9S CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section reed not be completed if the permit is for oac 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 person in any manner so as to become subject to the Workers'Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Workers Compensation provisions of the Labor Code,you must Oforthwith comply with such provisions or this permit shall be deemed revoked. Z C4 CONSTRUCTION LENDING AGENCY 11441 hereby affirm that there is a construction lending agency for the performance of 0 � the work for which this permit is issued(Sec.3097,Civ.C.) WCL A Lenders Name Z Lenders Address V Q I certify that 1 have read this application and state that the above information is (y correct.1 agree to comply with all city and county ordinances and state laws relating to 0 U building construction,and hereby authorize representatives of this city to enter upon the a above-mentioned property for inspection purposes (We)agree to save,indemnify and keep harmless the City of Cupertino against In liabilities,judgments,costs and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit. / APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOU CE ZEGULATTONS. `,:_ �___.._.._ . n/-/S'-0J Re-roofs / Sig(fatuMl ApplicandContractor Date — HAZARDOUS MATERIALS DISCLOSURE Type of Roof 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 nor to an roofing material being installed.0Yes Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove L ha'rardous air contaminants as defined by the Bay Arm Air Quality Management all new materials for inspection. .strict? 0vm 4E})vu 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Hmlth&Safety Cedc,Sections 25505.25533 and 25534.1 understand that if the building does not currently have a tenant,that it' my responsibility to notify the occupant of the �.� w n w must met issuance of a Certificate of Occupancy. lean "i�'' _ Sigilafire ofofAppri t Date req� pri' -- � g All roof coverings to be Class 'or better authorized agent Date' CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 32640010 .71 DATE ISSUED. . . . . . . : 01/15/2009 RECEIPT # . . . . . . . . . . BS000006977 REFERENCE ID # . . . : 09010067 SITE ADDRESS . . . . . : 10671 HALE PL SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER CATI MYER ADDRESS 10671 HALE PL CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : SHELTON ROOFING CO CONTRACTOR . . . . . . . : WRAY, RICHARD LIC # 20755 COMPANY . . . . . . . . . . : SHELTON ROOFING ADDRESS . . . . . . . . . . : 1988 LEGHORN ST CITY/STATE/ZIP . . . : MOUNTAIN VIEW, CA 94043 TELEPHONE (650) 961-7699 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 1, 250 . 00 1 . 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 1, 250 . 00 0 . 50 0 . 00 0 . 50 0 . 00 1REROOFRES SQ FEET 2 .00 26 . 00 0 . 00 26 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 27 . 50 0 . 00 27 . 50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 27 . 50 #18155 --------------- TOTAL RECEIPT 27 . 50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ----------------------- 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 604 ROOF IN-PROGRESS 605 FINAL REROOF Community Development ; ,. 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 WEkTINO Building Department JOB ADDRESS: PERMIT # /0671 f I/ - 6%) ,potiv0C� OWNER'S NAME: 9,,, PHONE # GENERAL CONTRACTOR < R ,C1j,, , 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 Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date CITY OF CUPERTINO 0q01 00(4�7 ` REROOF C TyCUPEI�TINO PERMIT APPLICATION APN # Date: _ 2,2 b Ll 00/0, -7/ Building Address: 106 ';71 �/a l Al � //o� ��, r s �/11 c� u o i3 e�.L 7,Z yl Owner's Name: Phone #: Contractor: Phone #:G so) �G i/o Fax #: (;SCS-- �6/-�D6 Cupertino Business License #: Contractor License #: 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) `tea✓ o,,.4 (),-a Lle f ❑ Other (Specify) Number of existing coverings Zoo F1 - ❑ Provide I.C.B.O. Report# ❑ To be Removed ❑ Provide Mfgr. Installation Specs. z Y� �u 7"�✓ a�i c� G r� .c J ✓ OF - h/ ie c,,r- Z l f Job Description: _71 j a!f die w 7'✓ c.ccv C- A - Residential F1 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: _ ;t/,)—5-0 . C9 0 I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy: Sign to e Revised 01/07/09 Community Development Department Building Division City of Cupertino 10300 Torre Avenue Telephone: (408)777-3228 Fax: (408)777-3333 Building Department Subject: Re-roofing policy for the City of Cupertino 1. Prior to permit issuance,you must agree to comply with 2007 IBC Standards and manufacturers specifications on re-roofing.All roofs are Class "A"per Cupertino municipal code 16.04.080. 2. New roof coverings shall not be applied without first obtaining all inspection and written approval from the building inspector. A final inspection and approval shall be obtained from the building inspector when the re-roofing is completed. 3. All roofs shall be inspected prior to any roofing installation. 4. To receive a final sign off from the City,the following steps are required: 1) Pre-inspection and/or tear off approval. 2) In-progress inspection approval. 3) Final inspection approval. a) Spark arrester installation. 5. If plywood is installed,a plywood nail inspection is required. 6. Any roofing which is applied without first obtaining an inspection, will require the removal of all new material down to the sheathing, so a proper City inspection can be performed. 7. NOTE: If you call for a plywood nail inspection and the job is not ready, you will be charged a re-inspection fee of$176.18. The re-inspection fee must be paid before another inspection can be scheduled. IMPORTANT: 1. Flat roofs must have a minimum of 1/ "per foot slope and demonstrate that there is no ponding. 2. An I.C.B.O.report is required to be on the job site at the time on inspection. I understand and will comply with the above stated policy on re-roofing. Homeowner's Name: On ee X, Job Site Address: 106 '71 l sL P/ 3/l 6 Roofing Company Name: �2Ls Applicant's Signature: _ Date: of— Greg Casteel Building Official Revised 07/30/08 M. n oor Air ualfty an Fmtshes 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 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 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 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 0 1 1 1 N.Flooring 1.Select FSC Certified Wood Flooring 6 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 ELM ! Total Points Available 1 1401 130 57 Total Points Project Received: 01 01 0 G:date/rogr buil rngguidelines/remodelers/greenpointsfina1212.04protectedxls