The URL can be used to link to this page

09010027 CITY OF CUPERTINO BUILDING DIVISION PERMIT GTr BUILDING ADDRESS: PERMIT NO. 10128LBANON DR RESPONSIBLE FQQZLUG_1XC__ 0901 0027 OWNER'S NAME: PERMIT ISSUE DATE 9MONEAROT= ELLIOTT SXNrfA CONTROL NO. (650) 969-6151 ABUILDING PERMIT INFO RCHITECT/ENGiNEER: BLDG ELECT PLUMB MECH 0 0 o a 00 LICENSED CONTRACTOR'S DECLARATION Job Description V p I hereby affirm that I am licensed under provisions of Chapter 9(commencing V with Section 7000)of Division 3 of the Business and Professions Code,and my license is Ln in full force and efl C '3 RE-RF T/0 &DI POSE EXTNG RF APPLY NEW TAR GRVL RF License Class •ff F o Dae Contractor CLS A 2 6 S Q ARCHITECTS DECLARATION I understand my plans shall be used as public records yU Gy Licensed Professional 0 3OWNER-BUILDER DECLARATION j< 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 Cole:Any city or county m V which requires a permit to construct.alter,improve,demolish,or repair any structure !ZIn prior to its issuance,also requires the applicant for such permit to file a signed statement _C that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation F $ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or 9 9 6 0 that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 70315 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type not more than five hundred dollars(5500). 34214023 . 00 0 1,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 dors not apply to an owner of q P property who builds or improves thereon,and who does such work himself or through his own employces,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.). 0 I,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- ccnse 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 Contrsctoes License Law. 0 1 am exempt under Sec. B&P C for this mason Owe 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 Workces Compen- an,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 Code,for the performance of the work for which this permit is issued. My Worker's Compensation Insurance cirricr and Policy number +am. Carrier. S �� 11r PolicyNo.: /% 5 y 70 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,1 shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws o[California Date Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must D O forthwith comply with such provisions or this permit shall be deemed revoked. 4 0 4 CONSTRUCTION LENDING AGENCY N 1 hereby affirm that there is p construction lending agency for the performance of . Y > the work for which this permit is issued(Sec.3097,Civ.C.) it Q Lender's Name =z Lender's Address J 0 l certify that 1 have read this application and state that the above information is LL r� correct.I agree to comply with all city and county ordinances and state laws relating to .J Vbuilding construction,and hereby authorim representatives of this city to enter upon the w above-mentioned property for inspection purposes L>w (We)agree to save,indemnify and keep harmless the City of Cupertino against F"co) liabilities,judgments,costs and expenses w ch may in any way accrue against said City in consequent: of the rsnti o[this t. V Z APPLICA UNDER;, DS A ILL MPLY WITH ALL NON-POINT Issued by: Date /-0C--o1_11 SOUR R GULATTO Re-roofs Sign ore of Applicant/Con for Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Win 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. 0 Yes ((No Will If a roof is installed without first obtaining an inspection,I agree to remove ll the applicant or future building occupant use equipment or devices which nil hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. urict? 0 Yes No 1 have read the li=rdous materials ro iromcnis under Chapter 6.95 of the Califor- nia Health do Safety Code,Sections 25505.25 3 and 25534.1 understand that if the building docs nacurrendy�havcgient.War it is y repo 'bility to notify the occupant of the requireI prior _ug a c fiae mrOcea ancy. Signature of Applicant Date _7 711-V ` D All roof coverings to be Class" `'or better 01 Date CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot: APN 34214023 . 00 DATE ISSUED. . . . . . . : 01/08/2009 RECEIPT # . . . . . . . . . . BS000006923 REFERENCE ID # . . . : 09010027 SITE ADDRESS . . . . . : 10128 LEBANON DR SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER CAROL ELLIOTT ADDRESS . . . . . . . . . . : 10128 LEBANON DR CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2646 RECEIVED FROM . . . . : RESPONSIBLE ROOFING CONTRACTOR . . . . . . . : ELMORE, PAUL M. LIC # 105 COMPANY . . . . . . . . . . : RESPONSIBLE ROOFING INC ADDRESS 2882 SPRING ST CITY/STATE/ZIP . . . : REDWOOD CITY, CA 94063 TELEPHONE . . . . . . . . : (650) 969-6151 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 9, 960 . 00 1 . 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 9, 960 . 00 1. 00 0 . 00 1 . 00 0 . 00 1REROOFRES SQ FEET 26 . 00 338 . 00 0 . 00 338 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 340 . 00 0 . 00 340 . 00 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 340. 00 #12198 --------------- TOTAL RECEIPT : 340 . 00 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 7UPEkTINO Building Department JOB ADDRESS: PERMIT# i r r ro OWNER'SNAME: (lc, 4 PHONE # ya GENERAL CONTRACTOR: "e5 Pons'Ug o l nc FAX # I am not using any subcontractors: Signature Date Please check ap licable 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 REROOF OF CUPEkTINO PERMIT APPLICATION APN #3q(q, jq, a3 . c)o Date: , Building Addr ss: i � r n �� Owner's Name: Phone #: C_ ( 4c-��<� Qn Contractor: Phone #: , Fax#. I `� Cupertino Business License M S Contractor License #: Type of Roof Covering: Existing: Proposed: b Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles ❑ Asphalt Shingles ❑ Wood Shakes o Wood Shakes ❑ Wood Shingles ❑ Wood Shingles _ ❑ Other(Specify) a Other(Specify) j ,r q CC, ,e Number of existing coverings ( o Provide I.C.B.O. Report # 30 To be Removed ❑ Provide Mfgr. Installation Specs. Job Description: —re ,F Q c� 0� �i 5�o<e �x� rc� 00 I, I A/Zw TG X �S�vet 9-00r 2 C 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: � 0<) I Have Read, Understand d Will Comply with Cupertino's Tear-Off Policy: Signature Revised 6/16/08 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 1/4 "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: ( ;G( C 10 Job Site Address: Q Roofing Company Name: Applicant's Signature: �� PP � � Date: 09 Greg Casteel Building Official Revised 07/30/08 INPUT Resources • AD/Health M. n oor it ua rty and Finis es 1.Use LowMo-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 mid 1 1 N.Flooring 1.Select FSC Certified Wood Flooring B 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 f 1 1 Total Points Avai a le: 1 1401 1301 57 Total Points Project Received: 01 0 0 G:datalprogslgreenbuildngguidelinestremodelerslgreenpointsfinal2.12.04proteoted.xis