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09020086 CITY OF CUPERTINO BUILDINr,DIVISION PERMIT a PERMIT NO. BUILDING ADDRESS: 10270 S FOOTHILL ALITY FIRST HOME— PERMIT ISSUE DATE OWNER'S NAME: IMPROVEMENTS A O. CONTROL NO. "ION : Ng (916) 788-2921 BUILDING PERMIT INFO ARCHI7ECTIENGINEER: BLDG ELECT PLUMB MHCH a o a a 1400 LICENSED CONTRACTOR'S DECLARATION Job Description inI hereby affirm that I am licensed under provisions of Chapter 9(commencing Z, with Section 7000)of Divisio 3 of the Business and Professions Code.and my license is in in ful��ARCHrrECT`S ��7�� RE—RF RMV SHKRF INSTL 7/16 OSB W GAF/ELK CMP j�z LicenCon S HNGL S CLS A 15 S Q F,p DatcContractor DECLARATION 1 understand my plans shall be used as public records �yU L O y Licensed Professional OWNER-BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the C20 following reason.(Section 7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,at repair any structure prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation z< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area YF (commencing with Section 7000)of Division 3 of the Business and Professions Code)or 1 2 0 0 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(5500). 35703052 . 00 0 I,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 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 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 I,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 I am exempt under Sec B do 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- sati n,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. 0 I have and will maintain Worker's Compensation Insurance,as mquired by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Work s Compens ioQ Ipsurancr r�met and Policy nyr`�tb�eJi am. Q Carrier. !//T/N&0 7lffre:Policy No.. J `2 `(L(2— CERTIFICATE L(ZCERTIFICATE OF EXEMP'T'ION 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 Workcrs'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"4 CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of fx the work for which this permit is issued(Sec.3097,Civ.C.) QLender's Name - C ander's Address (�C) 1 certify that I have read this application and state that the above information is LL"' cortecL I agree to comply with all city and county ordinances and state laws relating to 0 E` building construction,and hereby authorize representatives of this city to enter upon the Uabove-mentioned property for inspection purposes a (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 V Z in con seqgeof the granting is permit. Date APPLIC STA S ILL COMPLY WITH ALLNON-PI INT Issued by: SOUR Ti 12//6/0 Re-roof: — s afApp t/Co to 'to Type of Roof HAZ OUS 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)? All roof;shall be inspected prior to any roofing material being installed. C]Yes 0<0 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 nit hazardous air contaminants as defined by the Bay Area Air Quality Management all new naterials for inspection. District? �IQu It thehazardous materials requirements under Chapter 6.95ofthe Califor- nia Ith ,Secdons 25501;433 and 25534.1 understand that if the building d not t tenant to ism responsibility to notify the up of the M t or toils anccofaCcrtificatco(sae� Signature of Applicant Date G All roof coverings to be Class'A!'or better It toner or authorized age t ate oq� o0k(p CITY OF,CUPERTINO RLROOF CUPEkTINO PERMIT Y0PLICATION APN # _ Date: 7030, 2- (D ) Building Address: b2 S TL+ Owner's Name: j p,�P4,i J C-ty N Phone #: HOA: Yes ❑ No ® If yes, provide letter from HOA (�SZ) 2-Z1( - 93 Contractor: Phone #: (914) 7j, -2 7- Fax Fax #: 9(6,) 780 Cupertino Business License #: Contractor License #: Z— Type of Aoof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles -4 Asphalt Shingles Y\ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other (Specify) ❑ Other (Specify) Number of existing coverings ❑ Provide I.C.C.E.S. Report# ❑ To be Removed ❑ Provide Mfgr. Installation Specs. Job Description: Sl�a� /n s // `�� o st3, ►'� pov-' hJ/ JZ, �v�/("LI $1 C joss X�5 z_ -7 Residential Commercial Green Building: Please complete relevant potion 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: �6 Z vu 7ign e , Under nd Will Comply with Cupertino's Tear-Off Policy: ature Revised 02/05/09 ^� CITY OF CUPERTINO REROOF CITY OF CUPEkTINO FEE ;SCHEDULE Number of Fee ID Fee Description Fee Permit Type Squares Group 1REROOFCOM Re-roof'Commercial B 1COMMLROOF 1BCBSC Cal Blcg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICO Seismic. Commercial B 1 REROOFRES Re-roof'Residential B 1SFDWLR00F 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commi>sion Fee 1BSEISMICRE Seismic Residential B 1 REROOFMRES Re-roof Multi-Family B 1MFDWLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commi;>sion 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 mail inspection is required. 6. Any roofing which is applied withc ut first obtaining an inspection, will require the removal of all new:naterial 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 :an 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: Xt11XAMt1.%0 Job Site Address: 1® Z 70 Roofing Company Name: 14 F-I P,4+ -f- Applicant's Signature: Date: Greg Casteel Building Official Revised 07/30/08 INPUT Resources Energy IAD/Health M.Indoor Air Quality and Hnishes 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 0 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 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 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 1 1 Total Points Ty—ai—la—bl—el 1 1401 130 57 Total Points Project Received:1 0 0 0 G:data/progs/gre:nbuildingguidelinesiremodelers/greenpointsfinal2.12.D4protected.xis Community Development 10300 Torre Avenue a. Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 CUPERTINO Buildi.n De artment JOB ADDRESS: PERM ZO a 627o S - 4,,BCVb OWNER'S NAME: Y PHONE # e-Z5;r-ar GENERAL CONTRACTOR:QiZI- „L FAX# CqI6 v - ?,?YZ ( 5 ( I am not using any subcontractors: �- Z l8 S_gna a at Please check applicable subcontractors and corr plete 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