09040008 CITY OF CUPERTINO
BUILDING DIVISION PERMIT '
• PERMIT NO.
BUILDING ADDRESS: 09040008
10632 LA RODA DR QUALITY FIRST HOME
PERMIT L5UE DATE
OWNER'S NAME: IMPROVEMENTS
fiAMMIJ T RTC''HARTI C' ATTTI DAMFT A A 6 0 C 0= 0 9 9 CONTROL NO.
,NA:
(916) 788-2921
BUILDING PERMIT INFO
ARCHITECI7ENGINEER: BLDG EO PL
UMB MECH
I ed p LICENSED CONTRACTOR'S DECLARATION Job Description
U I hereby affirm that I am licensed under provisions of Chapter 9(commencing
with Section 7000)of that
3 of the Business and Professions Code.and my license is
RE—RF RNV S HKRF R PLC W/ 7/16 0 S B 3 0 YR TMBRLN
��y in full force an ff c
Dn4 License Class Co^actor . W/DECK F.RMOR CLS A 28SQ
Date
ARCHITECTS DEC
1 understand my plans shall be used as public records
rn 6
�yU
U.F. Licensed Professional
O< OWNER-BUILDER DECLARATION
>. I hereby alTirm 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 2.0 which requires a permit to conswct,alter,improve.demolish,or repair any sWcture Valuation
.1—w prior to its issuance,also requires the applicant for such permit to file a signed statement t' Ft.Floor Area
?< that he is licensed pursuant to the provisions Of the Contractor's License Law(Chapter 9 'q $23147
x f$ that
with Section 7000)of Division 3 of Business and Professions Code)or
A .. that he is exempt therefrom and the basis for the alleged exemption.Any violation of
ppN Number Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not mote than five hundred dollars(5500). L36933016 . 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
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
build�im roves thereons u-.
cense Law does not apply to an owner of property P
who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's
License Law. B&P C for this reason
0 I am exempt under Sec
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-
,ation,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 Workces Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy num er am: 149,
Cartier. Jl Policy No.:
CERTI LATE OF E7(EMPTION FROM WO ER'
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
,J z forthwith comply with such provisions or this permit shall be deemed revoked.
Z CONSTRUCTION LENDING AGENCY
H►�. I hereby&[firm that there is a construction lending agency for the performance of
�i 5 the work for which this permit is issued(Sec.3097,Civ.C.)
W Q Lenulces Name
Z
Lender's Address
V C) I certify that 1 have read this application and state that the above information is
cormcL I agree to comply with all city and county ordinances and state laws relating to
Vbuilding construction,and hereby authorize representatives of this city to enter upon the
Uabove-mentioned property for inspection purposes
(We)agree to save,indemnify and keep harmless the City of Cupertino against
RH Cr) liabilities,judgments,costs and expenses which may in anyway accrue against said City
V Zin consequence of the granting of this permit. Date
-- APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
SOU R�Applican
NS.
0 Re-roofs
Signal onttactor °are T Of Roof
HAZARDOUS MATERIALS DISCLOSURE Type
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)? ..l All roof,- shall be inspected prior to any roofing material being installed.
C]Yes C]No
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
it hazardous air contaminants as by the Bay Area Air Quality Management all new materials for inspection.
.Istrict?
0 Yes ONO
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Cade,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 Date
require nus which must be met prior to issuance of a Certificate of Occupancy. S ignatur, A�pplic
All roof coverings to be Class'`'or better
0wncr orizcd a Date
vu �
-�, CITY OF CUPERTINO
4_ REIROOF
CUPEkTINO PERMIT APPLICATION
APN # Date:
3� q -3 �,L, I (rte . ,� 0 - -�
Building Address: 11
/0,
Owner's Nam
mPhone #:
e:
R�cl�,r� �CLmI� ✓
HOA: Yes ❑ No ❑ If yes, provide letter from HOA
Phone #: G1 I(�-(� -93 %
Contractor:
i- A rrveS+ ome n f Fax #:
Cupertino Business License #: Contractor License #:
Type of P.00f Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
$^ood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other (Specify) ❑ Other (Specify)
Number of existing coverings ❑ Provide I.C.C.E.S. Report #
w/To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description: g,grf,4XUQ o`a Zj-ay(, 9,60; .
R,epkoce qcai Deck 4enlcr
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 inclex.
Valuation:
I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
Sign e
Revised 02/05/09
CITY OF CUPERTINO
a,_,
REROOF
CUPEkINO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1 REROOFCOM Re-roof Commercial B 1COMMLROOF
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
1BSEISMICO Seismic Corr.mercial B
1RER06FRES Re-roof Residential B 1SFDWLR00F
2�
113 Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
1B3EISMICRE Seismic Residential B
1RER00FMRES Re-roof Multi-Family B 1MFDWLROOF
1BCBSC Cal Bldg Stzndards B ALL PERMIT TYPES
Commission. Fee
1BSEISMICRE Seismic Residential B
1BUSLIC Business Lil;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 i e-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 na l inspection is required.
6. Any roofing which is applied withou':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 Raid 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 ori the job site at the time on inspection.
I understand and will comply with the above stated policy on re-roofing.
Homeowner's Name: 1 Aam
Job Site Address:
Roofing Company Name: \ {' �AL M e, T�+'Y,)0c-A0m e71
Applicant's Signature: r' Date: I _
L
Greg Casteel
Building Official
Revised 07/30/08