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09010101 CITY•OF CUPERTINO BUILDING DIVISION PERMIT �- Z ' PERMIT NO. BUILDING ADDRESS: 09M 01 M 19733 T PERMIT ISSUE DATE OWNER'S NAME: -22-4-S A FeRTUNH BR SA CONTROL NO. t0 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH RE-ROOF 19 1/2 SQ INSTALL roc LICENSED CONTRACTOR'S DECLARATION PRESIDENTIAL COMP. Job Description m C I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing ry ^ry Z w with Section 7000)of Division 3 of the Business and Professions Code,and my license is a ir y in full force and effect 06 L�' t2 Z License CI Lam• F Date Contractor ARCHITECTS DECLA ATI -t I understand my plans shall he used as public records D06U OIn Licensed Professional 0:1 OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the COO following reason.(Section 7031.5,Business and Professions Code:Any city or county 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 statementValuation that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area YFZ- (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 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(3500). 0 1,as owner of the property,or my employees with wages as their sole compensation, will do the work and the structure is notintended or offered for sale(Sec.7044.Business Required Inspections and Professions Code:The Contractor's 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 We.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.). 0 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. 0 1 am exempt under Sec .B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATIO14 1 hereby affirm under penalty of perjury one of the following declarations: 0 I have and will maintain a Certificate of Consent to self-insure for Worker's Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. 0 1 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 Workees1C_om_peensation Insurance carrier and Policy number are: Carrier. ST 7 e Irk n 1 Policy No.�2,�V—70J 01 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or less.) 1 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 ,J O forthwith comply with such provisions or this permit shall be deemed revoked. Z" CONSTRUCTION LENDING AGENCY (~-r I hereby affirm that there is a construction lending agency for the performance of fix the work for which this permit is issued(Sec.3097,Civ.C.) Ira Q Lender's Name Z Lender's Address U 0 1 certify that I have read this application and state that the above information is VL► correct I agree to comply with all city and county ordinances and state laws relating to C Vbuilding 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 to liabilities,judgments,costs and expenses which may in any way accrue against said City t _, U Z in consequence of the granting of this permit. ►-t APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date2 SOURCE RF,GU S. ' Re-roofs Sig pplicant/Comractor Dare Type Of Roof HAZARDOUS MATERIALS DISCLOSURE yP Will the applicant or future building occupant store or handle hazardous material a✓ as defined by the Cupertino Munici 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. 0 Yes o 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 dcftncd by the Bay Area Air Quality Management all new materials for inspection. District? 0 Yes Nu 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505.25533 and 75534.1 understand that if the building 2 d does not currently have a tenant,that it is my responsibility to notify the occupant of the requirements which ust be met ' r w issuance of a Certificate of 0c p / ig ature of Appl ieant Da(e oS All roof coverings to be Class'n"or better er r auth ii.d agent Datc CITY OF CUPERTINO . . REROOF CUPEkTINO PERMIT APPLICATION 0 APN # jL0q 09 n400 Date: � -Z Building Address: 11 .}3 3 Wl,h t@ fD r e Owner's Name: Phone #: c�I�urd, Churi) Z 5Z — 5881 Contractor: Phone #: Fax #: 15-& - oZ 3 3 Cupertino Business License #: Contractor License #: Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles X Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ,y3, Other (Specify) V�AX� } �� _ ❑ Other (Specify) Number of existing coverings I ❑ Provide I.C.B.O. Report# To be Removed ❑ Provide Mfgr. Installation Specs. Job Description: p5( T h5ta ll pre5ideiltia I rompo3i'j dh ovelrdew ' " OSS. L1a,-25 q ¢off: 30 Ib• f���". 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: A 11 ' 0 y 3 - I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy: eigghature-7 Revised 01/07/09 CITY OF CUPERTINO y REROOF f� CUPETINO 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 1RER00FRES Re-roof Residential B 1SFDWLR00F 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee / 1BSEISMICRE Seismic Residential B 1RER00FMRES 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 Tone 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: J9 9-33 W�y t r r 5 rt e k d r• Roofing Company Name: vv e s4h-V v2-OCAi✓t r N C- Applicant's Signature: Date: Greg Casteel Building Official Revised 07/30/08 r . ndoor Air Quality and FlnlSheS 1.Use LoWNO-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 I 1 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 f I Total Points Available: 1 1401 1307----57 Total Points Project Received: 01 01 01 c z3�v°1 G.datalprogslgreenbuildngguidelines/remodelers/greenpointsfinal2.12.04protected.xls CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: SylviaM COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot : APN 36909024 . 00 DATE ISSUED. . . . . . . : 01/23/2009 RECEIPT # . . . . . . . . . BS000007026 REFERENCE ID # 09010101 SITE ADDRESS 19733 WINTERGREEN DR SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER RICHARD CHUNG ADDRESS . 19733 WINTERGREEN DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-3330 RECEIVED FROM . . . . : WESTSHORE ROOFING CONTRACTOR . . . . . . . : PAUL FOWLER LIC # 21417 COMPANY . . . . . . . . . . : WESTSHORE ROOFING INC ADDRESS : 2245-A FORTUNE DR CITY/STATE/ZIP . . . : SAN JOSE, CA 95131 TELEPHONE . . . . . . . . : (408) 694-0060 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- 1BCBSC VALUATION 11, 048 .00 1 . 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 11, 048 .00 1 .20 0 . 00 1 .20 0 . 00 1REROOFRES SQ FEET 20 .00 260 . 00 0 . 00 260 . 00 0 . 00 ---------- ---------- ---------- ----- TOTAL PERMIT 262 .20 0 .00 262 .20 0 .00 METHOD OF PAYMENT AMOUNT -- - REFERENCE NUMBER ----------------- -------------- CREDIT CARD 262 .20 MASTER CARD --------------- TOTAL RECEIPT 262 .20 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- --------------------------- __ _ -- -------------- 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 604 ROOF IN-PROGRESS 605 FINAL REROOF Community Development am 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY of Fax(408)777-3333 XPEkTINO Buildin De artment JOB ADDRESS: 1 133 WP^i ejrcev% dr- PERMIT # /e-91 OWNER'S NAME: PHONE # eY -UZvo GENERAL CONTRACTOR:W1*AS1A0\r4- FAX# y s-6 - oZ3 I am not using any subcontractors: 12,3 A 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 //Z 3 0 Owner/Contractor Signature Date