09010119 CITY OF CUPERTINO r ;
BUILDING DIVISION PERMIT
BUILDING ADDRESS: PERMIT NO.
20725 SCOFIELD DR R E ROOFING & CONSTRUCTION 1
OWNER'S NAME: INC PERMIT ISSUE DATE
ONE: 2099 S A CONTROL NO.
(408) 626-9320
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
O p LICENSED CONTRACTOR'S DECLARATION
m I hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description
t` with Section 7000)of Division 3 of the Business and Professions Code,and my license is
� y in full force and eff 2. 1 RE-ROOF - RMV EXT 2 LYR RF& INSTL NEW OSB 15# FLT
v�Z License Cl s Lief!
q Date Con
& CLS A COMP 24SQ
eARCHrrEcrs D RATIOI�f
Pm U 1 u nd y plans shall be used as pu is rec
a
Licensed Professional
n rn 3 OWNER-BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractors License Law for the
L q O following reason.(Section 7031.5,Business and Professions Code:Any city or county
t: which requires a permit to construct,alter,improve,demolish,or repair any structure
Z y prior to its issuance,also requires the applicant for such permit to rile a signed statement
< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation
E91=-q (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 $10000
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(S.W. 35709015 . 00
❑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 Conuactoes 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 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 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 Sea B&P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
'have and will maintain a Certificate of Consent to self-insure for Workers Compen-
-ron,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 sued.
My Wor Compensa'on insurance carrier and Policy n bcr arc: i/
Cartier. � Poliry No.: `V
C IFICATE OF EXEMPTION FROM ORKERS'
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,I 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 R CONSTRUCTION LENDING AGENCY
F" I hereby affirm that there is a construction lending agency for the performant:c of
the work for which this permit is issued(Sec.3097,Civ.C.)
W
Q Lenders Name
►7 z Lenders Address
U O I certify that 1 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
0U building construction.and hereby authorize 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
rA liabilities,judgments,costs and expenses which may in any way accrue against said City
IJ z in co uencc of the granting of this permit. I
r" APPLICA UNDERSTANDS AND WILL COMPLY WITH AL NON POINT Issued by: Date _
SOUA�5
RCE RE M. "'
1 Re-roofs ''
Signature ofApplicant/ContraZior Datb f
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future g occupant store or handle hazardous material
as defined by the Cupertino Mu "1pal 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
Will the applicant or future buildi occupant use equipment or devices which
If a roof is installed without first obtaining an inspection,I agree to remove
t hazardous air conXrdausmatcdals
ncd by the Bay Area Air Quality Management all new materials for inspection.
:flet?
❑Yes
1 have read the requirements under Chapter 6.95 of the Califor-
nia &Safety Code,Sections 25505,25533 and 25534.1 understand that if the building
oes not c ratty have a is my responsibility m notify tete up of the
rcyuircmc 'muet pdo once of a certificate erOc a cy Signature of Applicant Date
All roof coverings to be Class" `'or better
odzed agent a
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot :
APN 35709015 . 00
DATE ISSUED. . . . . . . : 01/28/2009
RECEIPT #. . . . . . . . . BS000007060
REFERENCE ID # . . . : 09010119
SITE ADDRESS . . . . . : 20725 SCOFIELD DR
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . . JANE HOYT
ADDRESS . . . . . . . . . . : 20725 SCOFIELD DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : R E ROOFING & CONST
CONTRACTOR PROCTOR, PAUL LIC # 20615
COMPANY R E ROOFING & CONSTRUCTION INC
ADDRESS . . . . . . . . . . : 15230 CLYDELLE AVE
CITY/STATE/ZIP . . . : SAN JOSE, CA 95032
TELEPHONE . . . . . . . . : (408) 626-9320
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 10, 000 . 00 1 . 00 0 . 00 1 . 00 0 . 00
1BSEISMICR VALUATION 10, 000 . 00 1 . 00 0 . 00 1 . 00 0 . 00
1REROOFRES SQ FEET 24 . 00 312 . 00 0 . 00 312 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 314 . 00 0 . 00 314 . 00 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 314 . 00 #1192
---------------
TOTAL RECEIPT 314 . 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
2 REROOF
F
CUPEkTiNO PERMIT APPLICATION
APN# 3_5 70 D ) S, Date:
Building Address:
� ? 2-1 tL-L R
Owner's Name: Phone#:
Contractor:;LLQ ►t�1 C ` '� .� Phone
i Fax#: � -
Cupertino Business License #: _ _ Contractor License #-
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles _ Asphalt Shingles
Wood Shakes /❑ \Wood Shakes
Wood Shingles ❑ Wood Shingles
❑ Other (Specify) ❑ Other (Specify)
Number of existing coverings 2 ❑ Provide I.C.B.O. Report#
�To
be Removed ❑ Provide Mfgr. Installation Specs.
Job Description:. AuW G V i o� 2 L_ ` L)4 O'� �c��F ` 1 ri5l A
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.
Valuationt , 0 6L;
I-Faye Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
2 6
Signature
Revised 01/07/09
a4CITYF
CITY OF CUPERTINO
REROOF
I�CUINO 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
1BSEISMICRE Seismic Residential B
1BUSLIC 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:
Job Site Address: �L0
Roofing Co pany_.Niam
Applicant's Signature: �. . --`_\ 4 �=� _ Date:
t,
Greg Casteel
Building Official
Revised 07/30/08
INPUT Piesourres Energy A!
M.Indoor Air Quality and Finishes
1.Use Low/No-VOC Paint 1 IAQ/Health pts y=yes 0
2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/HeaJth 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 6IAQ/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 Lim 0
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
t 1
Total Points Available: /�- 140 130T--'5-71
Total Points Pro'ect Reced: f' / 0 0 -,
eiv
G:data/progs/greenbuildngguidelines/remodelers/greenpointsfinal2.12.04protected.xis
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
flffkTINO
Building Department
JOB ADDRESS: �2� � �.1L'�, PERMIT # O9 0) D
i 19
OWNER'S NAME: PHONE # 6 g -vE -,132,J
GENERAL CONTRACTOR: - FAX #
I am not using any subcontra rs:
- a 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