09010063 CITY OF CUP RTINO
BUILDING DIVISION PERMITTR # ►tAl' IEr:
PERMIT NO.
BUILDING ADDRESS:
901 S D
PERMIT ISSUE DATE
OWNER'S NAME:
PHO SA CONTROL NO.
BUILDING PERMIT INFO
ARCHITECT/ENGINEER:
BLDG ELECT PLUMB MECH
TEAR OFF SHAKE, INSTALL OSB
u p p LICENSED CONTRACTOR'S DECLARATION AND 40 YR COMP 30 PD Job Description
V I ion. affirm that I am licensed under provisions of Chapter 9(commencing
with Section 7000)of Division 3 of the Business and Professions Code,and my license is
y in full force and effect.
License s ft
Clas
F-p Date L Contractor
ARCH CCS DECLARATION—
I understand my plans shall be used as public records
�yU
y Licensed Pcufcssional
y 0 OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the
too O following mason.(Section 7031.5,Business and Professions Code:Any city or county
K m fl! 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 Valuation
< that he is licensed pursuant to the previsions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area
xF a (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
y R E 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).
❑I,u 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(See.7(X4.Business Required Inspections
and Professions Code:The Contractors License Law does not apply to 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.).
❑I,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.
❑1 am exempt under Sec. B tit P C for this mason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby afTtrm under.penalty of perjury one of the following declarations:
❑1 have and will maintain a Certificate of Consent to self-insure for Workers Compen-
sation,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 Compensation Insurance carrier and Policy number ate:
Carrier jj_� /-.-,,. d 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,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 Workes Compensation provisions of the Labor Code,you must
Z forthwith comply with such provisions or this permit shall be deemed mvokcd.
Z O CONSTRUCTION LENDING AGENCY
E~-c tom. I hereby affirm that there is a construction lending agency for the performance of
p; the work for which this permit is issued(Sec.3097,Civ.C.)
W Q Lender's Name
Z Landers Address
U p 1 certify that I have read this application and state that the above information is
LL hr correct.I 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
W above-mentioned property for inspection purposes.
a (We)agree to save,indemnify and keep harmless the City of Cupertino against
Hliabilities,judgments,costs and expenses which may in any way accrue against said City
U Z in consequence of the granting of this permit Date
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
SOURCE REGULATION.
Re-roofs
rgrtature HAZARDOUS MATERIALS DISCLOSURE T}�of Roof
—
Date
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 ❑No
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
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes ONO
1 have mad the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health tit Safety Cade,Sections 25505,25533 and 25534.1 understand duh if the building
does not currently have a tenant,cwt it is my responsibility to notify the occupant of the
rcquirem cats which must me 'or to issuance of a Ccrtificato of txcupancy. Signature Of Applicant Date
All roof coverings to be Class" "or better
er or rixed s Date
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN 35906004. 00
DATE ISSUED. . . . . . . : 01/14/2009
RECEIPT #. . . . . . . . . . BS000006974
REFERENCE ID # . . . : 09010063
SITE ADDRESS 901 SAGE CT
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER JOHN GAO & JENNIFER ZENG
ADDRESS 901 SAGE CT
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-4217
RECEIVED FROM DADDARIO ROOFING
CONTRACTOR EDGAR MONTOYA LIC # 26245
COMPANY DADDARIO ROOFING
ADDRESS 1734 WILLA WAY
CITY/STATE/ZIP . . . : SANTA CRUZ, CA 95062
TELEPHONE . . . . . . . . : (831) 476-9109
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- -
1BCBSC VALUATION 9, 850 . 00 1 . 00 0 . 00 1 . 00 0 . 00
1BSEISMICR VALUATION 9, 850 . 00 1 . 00 0 . 00 1 . 00 0 . 00
1REROOFRES SQ FEET 27 . 00 351 . 00 0 . 00 351 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 353 . 00 0 . 00 353 . 00 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- ------------------
CHECK 353 . 00 22306
---------------
TOTAL RECEIPT 353 . 00
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
APN # Date:
Building Ad ess:
wner's Name: Phone #:
66 Vzo
Contractor: Phone #:
LL_
Fax#: 233l
Cupertino Business License #: Contractor License M
D
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof o Built-Up roof
❑ Asphalt Shingles e/Asphalt Shingles
A_-Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other (Specify) ❑ Other (Specify)
Number of existing coverings j ❑ Provide I.C.B.O. Report#
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description: �' � p�� S a lc� ^� d 1 I D S ' T5
r p
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.
Valu tion: If -
r
I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
ignatur
Revised 01/07/09
CITY OF CUPERTINO Y {
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
1REROOFRES Re-roof Residential B 1SFDWLR00F
1 BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
I 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
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/ " 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: -s r-) M-e vi C)
Job Site Address: 901 5'6La •e c' —
Roofing Company Name: IJ a et 1rV ' gC2 F;yt
Applicant's Signature: _ Date:&I �9
Greg Casteel
Building Official
Revised 07/30/08
1P
. n oor Air ualrty an Finishes
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
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 0
e 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 Ayes 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 Available: 1 1401 1301 57
Total Points Project Received:11 01 01 0
G:data/progs/greenbuildngguidelines/remodelers/greenpointsfinal2.12.D4prolectedxls
Community Development
10300 Torre Avenue
.Y Cupertino CA 95014
`F Telephone(408)777-3228
CITY OF Fax(408)777-3333
.XPEkTINO
Buildin De artment
JOB ADDRESS: PERMIT #
OWNER'S NrAME: PHONE #77 — Sel c 5-
GENERAL
GENERAL CONTRACTOR. o- ,ra .,-, FAX#
I am not using any subcontractors: 0 ( l d g
'SignaWre 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
bing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
- 01--
Own /Co tractor Signature Date