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09020031X00 I MZ s yy0 � U. X03/l [Q coc ,Off �za EFC i C z CITY OF CUPERTINO DIVISION PERMIT G� I.N.'II3 : BUILDING ..... BUILDING ADDRESS: PERMIT NO. 859 BETTE AVETBD TO BE nqo2on-�i OWNER'S NAME: PERMIT ISSUE DATE SHONE: §AWAWY-W�CONTROL NO. 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 in full force andeffen _ Qg RE—RF W/ 1/2" RADIANT BARRIER PLYWD 30LB FLT& 40 L.icenac Cl Lic. K Date — Contractor cYR CLS A COMP SHNGL r 2 9 SQ ARCHITECPS DECLARATION I understand my plans shall be used as public records **A & R ROOF EXPEERTS INC PD FOR BUS LIC Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the 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 prior to its issuance, also requires the applicant for such permit to file 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 Cade) or $16500 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). 36927041 .00 0 1, as owner of the property, or my employees with wages as their sole compensation, Required Inspections will do the work, and the structure is not intended or offered for sale (Sec. 7044. Business and Professions Code: The Contractor's 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.). 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 DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a Certificate of Consent to self -insure for Worker's Compen- on, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. (:11 have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Cade, for the performance of the work for which this permit is issued. My Wor�k^ees Compensation Insurance carrier and Policy number am: Carrier) l ^rI 4, FV V Q Policy No.0 3 0 e 28% 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, 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 forthwith comply with such provisions or this permit shall be deemed revoked. ) CONSTRUCTION LENDING AGENCY 1 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.) Lender's Name L.cndees Address I certify that 1 have read this application and state that the above information is + torten. I agree to comply with all city and county ordinances and state laws relating to building construction. and hereby authorise 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. y APPLICANT UNDERSTAS AND WILL COMPLY WITH ALL NON -POINT G Issued by Date SOURCE REGULATIONS. , C1 %^A,(3 �� `�e_ZKn 2- - Re -roofs _ Type of Roof Signature of Applicant/Contractor Date 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)? Yes All roofs ;hall be inspected prior to any roofing material being installed. ❑ lg'tvo If a roof i.; installed without first obtaining an inspection, I agree to remove Will the applicant or future building occupant use equipment or devices which 'I hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. rict? 0 Yes o 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- Safety Code, Sections 25505.25533 and 25534.1 understand that if the building nia Health & sAcS%1 docs not currently have a tenant, that it is my responsibility to notify the occupant of the requirements whit ust be met prior to issuance of a Certificate of Occ a ry. �`� Signature of Applicant Date Ca , VN �+ -�'g z All roof coverings to be Class" `' or better Owner or authorized agent Date CITY OF CUPEkTINO CITY OF CUPERTINO REROOF PERMIT APPLICATION I () 9 Dai°3i APN # � � � . � � t � � Date: I Building Address: G Owner's Name: Phone #:40Y-3 Contractor: Phone k1loy) 2113 - 4f 732 h + C,,- ( 049) 3%C1- 91C �v Fax #: Cupertino Busin ss License #: Contractor License #: ��� e'd 8 Type of Roof Covering: Existing: Proposed: ❑ Built -Up Roof ❑ Built -Up roof * Asphalt Shingles w Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other (Specify) ❑ Other (Specify) Number of existing coverings q'. 9 ❑ Provide I.C.B.O. Report # ❑ To be Removed ❑ Provide Mfgr. Installation Specs. Job Description: l�%' �`� U L aA� 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: il/� <-6 C-6. � I Have Read, Understand and Will Comply with Cupertino's Tear -Off Policy: Signature Revised 01 /07/09 CITY OF CUPERTINO RER OOF CUPEkTlNO FEE SCHEDULE Number of Squares Fee ID Fee Description Fee Group Permit Type 1REROOFCOM Re -roof Cor:unercial B 1COMMLROOF 1BCBSC Cal Bldg Stmdards Commission Fee B ALL PERMIT TYPES 1BSEISMICO Seismic Commercial B 9 1RER00FRES Re -roof Residential B 1SFDWLROOF / 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES ` 1BSEISMICRE Seismic Residential B 1REROOFMRES Re -roof Multi -Family B 1MFDWLROOF 1BCBSC Cal Bldg Stmdards Commission Fee B ALL PERMIT TYPES 1 BSEISMICRE Seismic Residential B I 1 BUSLIC Business Li,;ense 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 r 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 b-iilding inspector when the re -roofing is completed. 3. All roofs shall be inspected prior to ar.y 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 rnz terial down to the sheathing, so a proper City inspection can be per Formed. 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: Job Site Address: _95i 6e -6(f A V. _ Roofing Company Name: A* )� Pe Y fS (tIC Applicant's Signature:Wk= ✓LC. Date: Greg Casteel Building Official Revised 07/30/08 1. Use Low/No-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 B. 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 13 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: 140 1301 57 61-1 01 0 0 �vtp, GAata/progs/gree nbuildngguidelines/remodelers/greenpointsfinal2.12.04protected.xis CITY OF %HkTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax(408)777-3333 Building Department JOB ADDRESS:PERMI 6 - C�T #a OWNER'S NAME: PHONE # 3 - z GENERAL CONTRACTOR: FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete 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