09020110 CITY OF CUPERTINO111
BUILDING DIVISION PERMIT 0 '
BUILDING ADDRESS: PERMIT NO.
11693 WESTSHORE CT BAKER ROOFING
PERMIT ISSUE DATE
OWNER'S NAME:
f-'I-ITIT Mf111
A CONTROL NO.
ONE:
(408) 559-5105
BUILDING PERMIT INFO
ARCHITECT/ENGINEER:
BLDG ELECT PLUMB0 MECH
0 0 0
Z o c LICENSED CONTRACTOR'S DECLARATION Job Description
m C I hereby affirm that I am licensed under provisions of Chapter 9(commencing
z m with Section 70of fect.of Division 3 of the Business and 'ons Cgc�p. nay license is RE RF ,&r S Q CLS A COMP 0 S B
a�y in full force and effect. iQY �si-� L,
Z License lass Lie.M /t L
n
—,Z DateI IL • Contractor
ARCHITECTS DECLARATION
1 understand my plans shall be used as public records
5wd
U.t; Licensed Professional
n 0.<
.< OWNER-BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the
p O following reason.(Section 7031.5,Business and Professions Code:Any city or county
K m 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 rile a signed statement Valuation
Z e that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 SCI.Ft.Floor Area
Y.H (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $12000
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). 36653012 . 00
❑I,as owner of the property,or my employees with wages as their sola 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
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.U.
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.).
❑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 Contractors
License Law.
❑I 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 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.
E(I have and will maintain Workers Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Workceess Compensation Insurance c er and Policy number alp
Cartier.S /,J V ��V Policy No.:—04�/ z
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 Workers Compensation provisions of the Labor Code,you must
Z forthwith comply with such provisions or this permit shall be deemed revoked.
Z O CONSTRUCTION LENDING AGENCY
[~i 1 hereby affirm that there is a construction lending agency for the performance of
py.7
the work for which this permit is issued(Sec.3097,Civ.C.)
W A Lender's Name
Lenders Address
Z
U C) I certify that 1 have read this application and state that the above information is
LL.1. coucct I agree to comply with all city and county ordinances and state laws relating to
O Vbuilding construction,and hereby authorise 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
tom„ liabilities,judgments,toss and expenses which may in any way accrue against said City
U Z in consequence of the granting of this permit. Date
►-r APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
S4411(_a
SOURCE REy�LATIgNS• r a Q
-�I . B - (� Re-roofs -
Signature of Applicant/Contractor Date
HAZARDOUS MATERIALS DISCLOSURE Type of Loof
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 roofs shall be inspected prior to any roofing material being installed.
❑Yes ❑No
If a roof:s installed without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant use equipment or devices which
L hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
.strict?
❑Yes ONO
1 have read the hazardous materials requirements under Chapter 6.95 of tha Califor-
nia Health&Safety Code.Sections 25505.25533 and 25534.1 understand that if the building
does not currently have a tenant that it is my responsibility to notify the occupant of the
requirements which must be met prior to issuance of a Certificate of Occupancy. S ignaturE of Applicant Date
Owner or authorized agent
Date All roof coverings to be Class'�V'or better
D",/L-
,po / / 0
CITY OF CUPERTINO
} f RE,ROOF
CUPEkT1NO PERMIT APPLICATION
APN # (o/- 5 ` Date:
3
Building Address:
Owner's Name: ,rr " Phone #:
C.�t 2y�i
s— -5
HOA: Yes F] No ❑ If yes, provide le-ler from HOA
Contractor: is>9K T-jt- Phone #:
Fax #:
Cupertino Business License #: Contractor License
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles WAsphalt Shingles
wl Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other (Specify) ❑ Other (Specify)
Number of existing coverings ❑ Provide I.C.C.E.S. Report #
�k To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description:
S
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.
Valu tion,
I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
,,T-`
Signature
Revised 02/05/09
CITY OF CUPERTINO
` RE,ROOF
CITY OF
CUPEkTINO 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
1 REROOFMRES Re-roof Multi-Family B 1MFDWLROOF
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
1BSEISMICRE Seismic F.esidential B
1 BUSLIC 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 r 2-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 Citi,the following steps are
required:
1) Pre-inspection and/or tear off apps oval.
2) In-progress inspection approval.
3) Final inspection approval.
a) Spark arrester installation.
5. If plywood is installed,a plywood nai.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 cazL 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. mac.tr
Job Site Address: l o 7 ) 0
Roofing Company Name:
Applicant's Signature: Date: ('
Greg Casteel
Building Official
Revise 107/30/08
Green Building Plan Check
Index of Green Building Points/Categories
A. Category Example of an Index or Table of Green Plan Sheet or Page Points
Building Points Categories that must be
shown and referenced on the Project
Plans See below
B. Site 9. Install H.E. Irrigation, (details/spec)* L-1 2 points
11. Permeable Paving, Note L-1 2 points
C. Foundation 1. Use 15 % Flyash Concrete, (note:) S-1 5 points
D. Structural 3. Uses Wood I-Joist, (See Spec.) S-2 2 points
5. Use Truss with heels, (detail) S-2 2 points
6. B. OSB Sheathing, detail S-2 2 points
E. Ext. Finish 1. Composite Decking, (Note/Spec ) A-3 2 points
4. B. Fiber Cement Siding, (Note/Spec.) A-4 2 points
F. Plumbing 1. Insulate all H.W. pipes, (Note/Spec.) P-1 2 points
5. Tankless W.H., (Note/Spec.) A-2 2 points
11.A 2500 Gal. Tank, (Note/Spec L-1 10 points
G. Electrical 4. E. Ceiling Fans, (Note/Spec.) A-3 4 points
H. Appliances 1. Energy Star Dishwasher, (Note/,Spec.) A-3 1 point
3. Energy Star Refrigerator, Note/:3ec. A-3 1 point
P. Other 1. List Green Features on Plans A-1 1 point
TOTAL POINTS1 40 points
Plan Review Process Work Book Page-I2-Revised 3/25/0 3