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090100319Op % y, f SOWh CITY OF CUPERTINO BUILDING�DIVISION PERMIT * BUILDING ADDRESS: PERMIT NO. OWNER'S NAME: PERMIT ISSUE DATE 1 ; S A CONTROL NO. 408)241-1334 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description I hereby 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 � �lr�a�and effect L� p �-t� l+�_�uv RE -RF INSTL PLYWD 30 LB FLT, 50YR RF CLS A 32 SQ; _ Datc l - 8 M Contractor) a 6n N en iw ��i aK� r � �— ��' j /� , o 5' 7 / �. , 7 ARCHITECTS DECLARATION i1 I understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the following reason. (Section 70315, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or mpair any structure prior to is issuance, also requires the applicant for such permit to rale a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 Sq. Ft. Floor Area Valuation (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 0 that he is exempt therefrom and the basis for the alleged exemption. Any violation of APN Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500). 35704058 . 0 0 ❑ 1, as owner of the property, or my employees with wages as their sole compensation, Required fired Ins ectionS 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 q 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 louden 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. ❑ I am exempt under See . B k P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION 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- 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 tris permit is issued My Worker'sCom anon Insurance carrier and Policy number are: Grtie.+-e P 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 Worker's Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.) Lenders Namc Lender's Address I certify that I have read this application and state that the above information is correct. l agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in any way accrue against said City in consequence of the granting of this permit. APP C PLY WITH ALL NON -POINT Issued bA!PPy: Date �DERSTANDSA�pWILL Re -roofs Type of Roof Signature of li ontractor Date HAZARDOUS MATERIALS DISCLOSURE Will tha4pplicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety Cede, Section 25532(x)? All roofs shall be inspected prior to any roofing material being installed. [:1 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 .it hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. JIStrICI? ❑Yes C3 No I have mad the hazardous materials requiremcnrs under Chapter 6.95 of the Califor- nia Healthdo SafctyCodc, Sections 25505.25533 and 25534.1 understand chat if the building does not currently'tenant. that it is my risibility to notify tbe occupant of the require w h must be m to issu of certificate of occupancy. Signature of App ' nt Date All roof coverings to be Class "A" or better G r ria authnrizad ri Date 4 ITEMS OF 4 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ......... 35704058.00 DATE ISSUED.......: 01/08/2009 RECEIPT #.......... BS000006929 REFERENCE ID # ...: 09010031 SITE ADDRESS .....: 22361 SANTA PAULA AVE SUBDIVISION ....... CITY .............. CUPERTINO IMPACT AREA ....... OWNER ............: JAUHER ZAIDI ADDRESS ..........: 22361 SANTA PAULA DR CITY/STATE/ZIP ...: CUPERTINO, CA 95014 OPERATOR: patg COPY # : 1 RECEIVED FROM ....: JOHN HENRY ROOFING CONTRACTOR .......: JEROD M OLEKI LIC # 25872 COMPANY ..........: JOHN HENRY ROOFING ADDRESS ..........: 12780 CLAYTON RD CITY/STATE/ZIP ...: SAN JOSE, CA 95127 TELEPHONE ........: (408)241-1334 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 32.00 416.00 0.00 416.00 0.00 TOTAL PERMIT ---------- 532.20 ---------- 0.00 ---------- 532.20 ---------- 0.00 METHOD OF PAYMENT ----------------- CREDIT CARD TOTAL RECEIPT : AMOUNT --------------- 532.20 --------------- 532.20 VOICE ID DESCRIPTION -------- ---------------------------- 601 ROOF TEAR OFF REFERENCE NUMBER -------------------- VISA VOICE ID DESCRIPTION -------- ---------------------------- 602 ROOF PLYWOOD NAIL 604 ROOF IN -PROGRESS 605 FINAL REROOF CITY OF CUPERTINO () l o C O C),:� REROOF CUPERTINO PERMIT APPLICATION APN # Date: Building Address: 'a3 (o 'S' Wv1 0,�a \ c Owner's Name: Phone #: 3 a u e c -A . i L\ 0, k - 5 LA 3 Contractor: Phone #: y o% CiJLC) - A) ",� cl C C:) G Fax #: (; c, nr-� E�_ Cupertino Business License #: Contractor License #: l a 1 Type of Roof Covering: Existing: Proposed: ❑ Built -Up Roof ❑,Built -Up roof ❑ Asphalt Shingles d Asphalt Shingles r/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: - Z 3" �r) Ctl�� U� � lb, ePCi Ll r, r0d,� I�f1 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: FA I Have Read, Understand and Will Comply with Cupertino's Tear -Off Policy: Q212 Signature Revised 6/16/08 CITY OF CUPERTINO REROOF FEE SCHEDULE Number of Squares Fee ID Fee Description Fee Group Permit Type 1RER00FC0M Re -roof Commercial B 1COMMLROOF 1BSEISMICO Seismic Commercial B 2 1REROOFRES Re -roof Residential B 1SFDWLR00F 1BSEISMICRE Seismic Residential B 1 REROOFMRES Re -roof Multi -Family B 1MFDWLROOF 1BSEISMICRE Seismic Residential B 1 BUSLIC 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 co mply with the above stated policy on re -roofing. Homeowner's Name: h eC' �-cXkA,1 Job Site Address: 3 Roofing Company Name: J Applicant's Signa Greg Casteel Building Official Revised 07/30/08 L Date: 1. Use LowMo-VOC Paint 1 IAQ/Health pts y=yes 2. Use Low VOC, Water -Based Wood Finishes 2 IAQ/Health pts y=yes 3. Use LowMo VOC Adhesives 3 IAQ/Health pts y=yes 4. Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes 5. Use Engineered Sheet Goods with no added Urea 4 Resource pts y=yes Formaldehyde 61AQ/Health pts y=yes 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 8. Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes 9. Use Finger -Jointed or Recycled -Content Trim 1 Resource pts y=yes 10. Install Whole House Vacuum System 3 IAQ/Health pts y=yes N. Flooring 1. Select FSC Certified Wood Flooring 8 Resource pts y=yes 2. Use Rapidly Renewable Flooring Materials 4 Resource pts y=yes 3. Use Recycled Content Ceramic Tiles 4 Resource pts y=yes 4. Install Natural Linoleum in Place of Vinyl . 5 IAQ/Health pts y=yes 5. Use Exposed Concrete as Finished Floor 4 Resource pts y=yes 6. Install Recycled Content Carpet with Low VOCs 4 Resource pts y --yes Total Points Available: Total Points Project Received: 1401 130 57 0 1 0 r- C,�G:data/progstgreenbuildngguidelines/remodelerslgreenpointsfina12.12.D4protected.xls ` CITY OF flff TINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS: ?off a� PERMIT # (/ a U -7/ OWNER'S NAME:'Z PHONE # GENERAL CONTRACTOR: G - FAX # I am not using any subcontractors: Signature Date Please check avvlicable subcontractors com lete the following information: Owner/ Contractor Signature Date 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