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09010050 CITY OF CUPERTINO BUILDING DIVISION PERMIT BUILDING ADDRESS: PERMIT NO. 22139 RAE T,N TBD - OWNER'S NAME: PERMIT ISSUE DATE ..,) SA CONTROL NO. ARCHITECT/ENGTNEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH RE-ROOF REMOVE 35 SQ WOODad Z 0 O D D u00 LICENSED CONTRACTOR'S DECLARATION SHAKE, SHEATH WITH Job Description U i hcroby affirm that I am licensed under provisions of Chaptcr 9(commencing Z with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect .f 1`��6'(_� DIRA License Class L 3 T le•M—` n-a Date I—�L—T Contractor r'M t+ ARCHITECTS DECLARATI 3 1 understand my plans shall be used as public records �yU 4 O y Licensed Professional y OWNER-BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the in G following reason.(Section 703 1.5,Business and Professions Code:Any city or county ,t,$Pi which requires a permit to construct.alter,improve,demolish,or repair any structure y Zprior to its issuance,also requires the applicant for such permit to file a signed statement _< that he is licensed pursuant to the provisions of tike Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation yF $ (commencing with Section 7000)of Division 3 of the Business and Professions Cade)or y .. that he is exempt therefrom and the basis for the alleged exemption.Any violation of 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($500). ❑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 does not apply to an owner of (1 P 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 u. 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 Ucenae Law. [31 am exempt under Sec B&P C for this reason OwnerDate WORKER'S COMPENSATION DE DiRAT10N I hereby affirm under penalty of perjury one of the following declarations: 1 have and will maintain a Certificate of Consent to self-insure for Workers Compen- .don,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 required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Workers Com nes° a Insurance carrier and Policy number are: Cartip -C Tt 0 LL C1 Poliry Nc.f00 a ef-S yIt CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section treed not be completed if the permit is for one hundred dollars($100) ar less) I certify that in the performance of the work for which this permit is issued,l shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California Dae 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 ,J Z forthwith comply with such provisions or this permit shall be deemed revoked. 0 Z"'' CONSTRUCTION LENDING AGENCY (~i 1 hereby a(Tirm that there is a construction lending agency for the performance of �t the work for which this permit is issued(Sec.3097,Civ.C.) W A Lenders Name Z Lenders Address U 0 1 certify that I have read this application and state that the above information is LL�" correct I agree to comply with all city and county ordinances and state laws relating to 0 V building construction,and hereby authorize representatives of this city to enter upon the W above-mentioned property for inspection purposes LL (We)agree to save,indemnify and keep harmless the City of Cupertino against liabilities,judgments,touts and expenses which may in any way accrue against said City V Z in consequence of the granting of this permit Date l "� ►- APPL ANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOUR GULATIO Re-roofs G7 Sig of Appl t/Contractor Dale Type of Roof HAZARDOUS MATERIALS DISCLOSURE 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. ❑Yes IINo Will If a roof is installed without first obtaining an inspection,I agree to remove ll tike applicant or future building occupant asst equipment or devices which it hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. ,trice? ❑Yes 1;06 ` 1 have read the hazardous materials requirements under Chapter 6.95 of to Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building 1 doesnot currently have a tenant that it is my responsibility to notify the occupant of the requino hch must be me 'or to issuance of a Certificate of Occupancy. S Ignatd leant Date —�gate All roof coverings to be Class" or better Owner o orized cot Date' CITY OF CUPERTINO 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . . 35607069 . 00 DATE ISSUED. . . . . . . : 01/13/2009 RECEIPT #. . . . . . . . . . BS000006955 REFERENCE ID # . . . : 09010050 SITE ADDRESS . . . . . : 22139 RAE LN SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER SYKORA RONALD F AND MAUREEN A ADDRESS 22139 RAE LN CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4032 RECEIVED FROM . . . . : KING BEE ROOFING CONTRACTOR TBD - TO BE DETERMINED LIC # 00096 COMPANY TBD - TO BE DETERMINED ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : TELEPHONE . . . . . . . . . FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 12, 000 . 00 1. 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 12, 000 . 00 1 .20 0 . 00 1. 20 0 . 00 1BUSLIC FLAT RATE 1 . 00 114 . 00 0 . 00 114 . 00 0 . 00 1REROOFRES SQ FEET 35 . 00 455 . 00 0 . 00 455 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 571 .20 0 . 00 571 .20 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 571.20 0 --------------- TOTAL RECEIPT 571 .20 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 604 ROOF IN-PROGRESS 605 FINAL REROOF CITY OF CUPERTINO REROOF CUPEI�TINO PERMIT APPLICATION o90 10o-S-0 APN #0_� 07 OLP 9.00 Building Address: R R 9 Owner'`s' Name: Phone #: tel® 53 440 /209 Contractor: Phone#: qj& _3 q o _o q j Fax#: Cupertino Business License#: Contractor License #: 171q, ro '-/ S Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles Asphalt Shingles u- 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 o- Provide Mfgr. Installation Specs. Job Description: �,.-t-a�! .,ems , l� ���! �' -f ©a,rd -E-�'aAe_ G©u4 . 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: R I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy: Signatur Revised 01/07/09 CITY OF CUPERTINO ` OCF REROOF CUPEkTINO 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 �~ 1 REROOFRES Re-roof Residential B 1 SFDWLROOF 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 1 BSEISMICRE Seismic Residential B I 1 BUSLIC Business License B 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: Y;�e N �Y L O r0 Job Site Address: 3�/ I�a'� L .L _ Roofing Company Name: K wi ���rra--�� u e . Applicant's Signature: Date: Greg Casteel Building Official Revised 07/30/08 INPUT Rescurus Energy .D . n oor Airuairty an Flmshes 1.Use Low/No-VOC Paint 1 IAO/Health pts y=yes p 2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes p 3.Use Low/No VOC Adhesives 3 IAQ/Health pts y=yes p 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 p 6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes p 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 p 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 p 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 o 6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes 0 1 1 1 Total Points Available: 1 01 130 57 Total Points Project Received: 0 -OL 0 G:data/progs/greenbuildingguidelines/remodelers/greenpointsfinal2.12.D4protected.xls Community Development 10300 Torre Avenue I,jj� m; Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 ,UPEkTINO Building Department JOB ADDRESS: r 3 � Ra� PERMIT # OWNER'S NAME: v` S c o tr g PHONE # GENERAL CONTRACTOR: !- FAX# I am not using any subcontractors: — 2— 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