09010019 CITY OF CUPERTINO
BUILDING DIVISION PERMIT � � � '
1
BUILDING ADDRESS: PERMIT NO.
10450 I
OW NER's NAME: IMPROVEMENTS PERMIT ISSUE DATE
'F'ON A '�889 CONTROL NO.
916) 788-2921
ARCHiTECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
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0 o p LICENSED CONTRACTOR'S DECLARATION
m I hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description
Z with Section 70()0)of Division 3 of the Business and,fof .ons Code,and my license is
'may in full forceanc�Lic x 7�7s77y RE-RF T/0 SHKS OSB 1STFLR ONLY, INSTL COMP ON
j n Z License Class —
C-a Dale Contractor t tri— 1ST&2ND FLR RF, CLS A 37SQ
ARCHITECTS DECLARATION
006< 1 understand my plans shall be used as public records
�yU
U.yLicensed Professional
A
0,
OWNER-BUILDER DECLARATION
I hereby affirm that I 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
K m which requires a permit 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 License Law(Chapter 9 Sq.Ft.Floor Area Valuation
X
F- (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 $27206
Section 7031.5 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).
❑1,as owner of the property,or my employees with wages as their sole compensation, 32635044 . 0 0
will do the work and the structure is not intended or offered for sale(Sec.7044,Business
and Professions Code:The Contractor's 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.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.).
❑1,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.
❑1 am exempt under Sec. B&P C for this reason
OwnerDate
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-
_ron,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
tI have and will maintain Worker's Compensation Insurance,as required by Section
3 of the Labor Code,for the performance of the work for which this permit is issued.
My Worke C mpensa'o surance rticr and Policy number are:
Cartier. 0 1 Policy No.:342,70 3
CERTIFICATE OF CEM ON FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars(S I00)
or less.)
1 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 of 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
Oforthwith comply with such provisions or this permit shall be deemed revoked.
z)"i CONSTRUCTION LENDING AGENCY
[--r
N.]► 1 hereby affirm that there is a construction lending agency for the performance of
Ix 5 the work for which this permit is issued(Sec.3097,Civ.C.)
WCI.Q Lender's Name
]0 Lender's Address
V 0 1 certify that I have read this application and state that the above information is
4L►" correct 1 agree to comply with all city and county ordinances and state laws relating to
O U building construction,and hereby authoria representatives of this city to enter upon the
W above-mentioned property for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
� liabilities,judgments,toss and expenses which may in any way accrue against said City
fJ z in conseque cc of th Ing�ulcrm�APPLI UNDE TAPLY WITH ALL N -P INT Issued by: Date
SOU E R TIO D
_ _ Re-roofs
S' um of Appli HUAZARDO ATERIALS DISCLOSURE D 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 prior to any roofing material being installed.
C]Yes ,p•No
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
'it hazardous air contaminants as defined by the Bay Area Air Quality Management all new ma rials fo 'nspeeti
strict?
❑Yes ..Ej Jo
I have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&S%ctyCode 255()5.25533 and 25534.1 understand that if the building
docs mol oily have tenJaF7ccrtfficatc
' ibility to notify the occupant of the U
regmire en wni mull of Occup cy. Si nature of pplicant to
O ncrorauthorizedagenl ate All roof coverings to be Class's'or better
CITY OF CUPERTINO
2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN 32635044 . 00
DATE ISSUED. . . . . . . : 01/06/2009
RECEIPT #. . . . . . . . . . BS000006912
REFERENCE ID # . . . : 09010019
SITE ADDRESS . . . . . : 10450 PHAR LAP DR
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER WEN KU
ADDRESS . . . . . . . . . . : 10450 PHAR LAP DR
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-1152
RECEIVED FROM . . . . : QUALITY FIRST HOME
CONTRACTOR . . . . . . . : GC ANDERSON LIC # 30398
COMPANY . . . . . . . . . . : QUALITY FIRST HOME IMPROVEMENT
ADDRESS . . . . . . . . . . : 660 COMMERCE DR STE E
CITY/STATE/ZIP . . . : ROSEVILLE, CA 95678
TELEPHONE (916) 788-2921
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 27, 206 . 00 2 . 80 0 . 00 2 . 80 0 . 00
1REROOFRES SQ FEET 37 . 00 481. 00 0 . 00 481. 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 483 . 80 0 . 00 483 . 80 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 483 . 80 #9593
---------------
TOTAL RECEIPT 483 . 80
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
CITY OF CUPERTINO r-)q of 00
REROOF
CUPER �TINO PERMIT APPLICATION
APN # Date:
,/
Building AddrLia"
/Oqs-v Pe
Owner's Name: Phone #:
O
e,oe14 �qo?) Sb 7- S1.3�
Contractor: Phone #: 9(6) Zg u
4,ta�t Fax 78a- 2-9y z
Cupertino Business License #: Contractor License #:
27S-772-
Type
7s-?7zType of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles X Asphalt Shingles
*C 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:7,�� d 6� sit , S 05 3 /S t FL06,2 6i1.17 //tet S 0/1
&wp ok, /5t � 244 -.i �oo���� G/Qs s . 14 37�
Residential Commercial E]
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 ea ders a ill Comply with Cupertino's Tear-Off Policy:
S' ature
Revised 6/16/08
CITY OF CUPERTINO
i REROOF
CUPERTINO FEE SCHEDULE
Number of Fee ID Fee Description ::G0uPjee Permit Type
Squares
1REROOFCOM Re-roof Commercial B 1COMMLROOF
1BSEISMICO Seismic Commercial B
1REROOFRES Re-roof Residential B 1SFDWLROOF
1BSEISMICRE Seismic Residential B
F-7
1REROOFMRES Re-roof Multi-Family :BT1MF_DW_:LR:0:0F
1B MISMICRE Seismic Residential B
1BUSLIC Business License B
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/ "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: " �u
Job Site Address: Id u S_D 7,1,
s /- ,
Roofing Company Name: lI q
Applicant's Signature: Date: /
Greg Casteel
Building Official
Revised 07/30/08
IM—
. n oor rr ualrty and i i es INPUT Resources EnLrgy 1A011-lealthm
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
0
6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes
7.Seal all Exposed Particleboard or MDF 4 IAQ/Health. pts y=yes 0
S.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes D
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 0
1 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 t
Total Points Avai a le: 1 1401 130 57
Total Points Project Recelved:1 01 01 0
G:data/progs/greenbuildingguidelines/remodelers/greenpointsfinal2.12.04protected.xls
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
CUPEkTINO
Building Department
JOB ADDRESS: PERMIT # 09 U ( u kD I
/6 I/S� Ao✓Id /Z
OWNER'S NAME: ,La PHONE # 7-
GENERAL
GENERAL CONTRACTOR:
I am not using any subcontractors: 4
Signa a Datel
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