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09050153BUILDING DIVISION PERMIT BUILDING ADDRESS: 19905 F OWNER'S NAME: ARCHITECT/ENGINEER: a p a LICENSED CONTRACTOR'S DECLARATION v p I hereby affirm that I am licensed under provisions of Chapter 9 (commencing V,4 ,4 with Section 7000) of Division 3 of the Business and Professions Code. and my license is n < a in full force and effect. 3 fo L, j Z License Class Lle• art (J '�" - 3 Date Contractor ARCHITECTS DECLARATION I understand my plans shall he used as public records 7yU L O y Licensed Professional OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the p O following mason. (Section 7031.5, Business and Professions Code: Any city or county .t Pi 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 t- (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 arty applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500). ❑ 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. 7144, Business and Professions Code: The Contractor's License Law docs nor 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.). ❑ 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 themon, and, who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's 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: have and will maintain a Certificate of Consent to self-insum 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. ❑ I 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 Worker's C%mp�ensauon Insurance carrier and Policy number am: Carrier. G P-4,14 Policy No.: A6 3? OOU /2 f( CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($1110) 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 w 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 Lender's Address I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building convection, and hereby authorize 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. APPLICANT U STANDS AND WILL COMPLY WITH ALL NON -POINT SOURCE REG A NS. Signatu icant/Conu=tor D to 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(x)? ❑ Yes -IRRo Will the applicant or future building occupant use equipment or devices which hazardous air contaminants as defined by the Bay Area Air Quality Management Act? ❑Yes \RKo I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health & Safety Code, Sections 25505.25533 and 25534.1 understand that if the building docs not currentl have a tenant, that it is my responsibility to notify the occupant of the requirements i h must be me nor to issuance of a Certificate of Oc C, - Parry. 2 d Own hot d agent are 408)298-9399 Job Description RE -RF RJ4V 1LYR EXTNG SHKRF, INSTL 7/16" OSB, WINTERGUARD RFRS SELCT FLT& PRES TL SHNGLS BY CERTAIN`L'EED CLS A 3 3 SQ 3q. Ft. Floor Area 31630073.00 Issued by Re -roofs Type of Roof Occupancy Type Required Inspections All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new nlaterials for inspection. StgaWrure of Applicant Date All roof coverings to be Class';W' or better PERMIT NO. 0goviol 51 PERMIT ISSUE DATE S2899 A CONTROL NO. BUILDING PERMIT INFO BLDG ELECT PLUMB MECH Job Description RE -RF RJ4V 1LYR EXTNG SHKRF, INSTL 7/16" OSB, WINTERGUARD RFRS SELCT FLT& PRES TL SHNGLS BY CERTAIN`L'EED CLS A 3 3 SQ 3q. Ft. Floor Area 31630073.00 Issued by Re -roofs Type of Roof Occupancy Type Required Inspections All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new nlaterials for inspection. StgaWrure of Applicant Date All roof coverings to be Class';W' or better 01 CITY OF CUPERTINO acN:_ REROOF CUPEkTINO PERMIT YWPLICATION APN # 30 - C '7. J JV& Date: Aj5 Building Address: Owner'sNa e: z�`c Phone #: S 7-%2 Contractor: f� �% s �°� Phone #: �j ffJI�G Fax #: Cupertino Business License #: Contractor License #: 7,�) � RChi 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 ❑ Other (Specify) ❑ Other (Specify) Number of existing coverings I ❑ Provide I.C.B.O. Report # To be Removed ,� Provide Mfg. Installation Specs. •. `' 1't (r`(i" (ori /� Job Des ription. ' y�c� y� / , -� � .�����r� l '� ,'�! '�r :» or Residential Commercial ❑ Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if Green Building Checklist & attach it to the applicationeor if there are any restrictions: ❑ applicable, include in plan set & the sheet ind Valuation: /a .5 9 3 — 2 I Have Read, Understand and Will Comply with Cupertino's Tear -Off Policy: Signatu Revised 6/16/08 b((Q CITY OF CUPEk INN CITY OF CUPERTINO REROOF FEE SCHEDULE Number of Squares Fee ID Fee Description Fee Group Permit Type 1REROOFCOM Re -roof Commercial B 1COMMLROOF 1BSEISMICO Seismic Comm.-rcial B 33 1RER00FRES ' Re -roof Reside atial B 1SFDWLROOF 1BSEISMICRE Seismic Residential B 1REROOFMRES Re -roof Multi -=gamily B 1MFDWLROOF 1BSEISMICRE Seismic Residential B 1BUSLIC Business License B Revised 6/16/08 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 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 or. 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: � l �C/� '' �GZ < Roofing Company Name:j� .` - r c Applicant's Signature: Date: _ y Greg Casteel Building Official Revised 07/30/08 1. Install Energy -Efficient Windows a. Doublem-Panad 1 Energy pt y=yes b. Low -Emissivity (Low -E) 2 Energy pts y=yes c. Low. Conductivity Frames 2 Energy pts y=yes 2. Install Low Heat Transmission Glazing 1 Energy pt y=yes J. Heating Ventilation and Air Conditioning 1. Use Duct Mastic on All Duct Joints 2 Energy pts y=yes 2. Install Ductwork within Conditioned Space 3 Energy pts y=yes, 3, Vent Range Hood to the Outside 1 IAOJHealth pt y=yes 4. Clean all Ducts Before Occupancy 2 IAQ/Health pts y=yes 5. Install Solar Attic Fan 2 Energy pts y=yes 6. Install Attic Ventilation Systems 1 Energy pt y=yes 7. Install Whole House Fan 4 Energy pts y=yes B. Install Sealed Combustion Units 5 IAQ/Health pts y=yes a. Furnaces 3 IAQ/Health pts y=yes b. Water Heaters 3 IAQ/Health pts y=yes 9, Replace Wall -Mounted Electric and Gas Heaters with Through -the -Wall Heat Pumps 3 Energy.pts y=yes 10. Install 13 SEER/11 EER or higher AC with a TXV 3 Energy pts y=yes 11. Install AC with Non -HCFC Refrigerants 2 Resource pts y=yes 12. Install 90% Annual Fuel Utilization Efficiency (AFUE) Furnace 2 Energy pts y=yes 13. Retrofit Wood Burning Fireplaces 10 Energy pts y=yes a. Install EPA certified wood stoves/inserts 1 IAQ/Health pt y=yes b. Install/Replace Dampers 1 Energy pt y=yes c. Install Airtight Doors 1 Energy pt y=yes 14. Install Zoned, Hydronic Radiant Heating 3 Energy pts y=yes 15. Install High Efficiency Filter 4 IAQIHealth pts y=yes 16. Install Heat Recovery Ventilation Unit (HRV) 5 IAQ/Health pts y=yes 17. Install Separate Garage Exhaust Fan 3 IAQ/Health pts y=yes K. Renewable Energy and Roofing 1. Pre -Plumb for Solar Water Heating 4 Energy pts y=yes 2. Install Solar Water Heating System 10 Energy pts y=yes 3. Pre -Wire for Future Photovoltaic (PV) Installation 4 Energy pts y=yes 4. Install Photovoltaic (PV) System (1.2 kw = 6 points, 2.4 kw =12 points, 3.6 kw =18 points) Up to 18 Energy pts 6. Select Sate a le Roofing Materials 1 Resource pt y=yes 7. Install Radiant Barrier 3 Energy pts y=yes L. Natural Heating and Cooling 1. Incorporate Passive Solar Heating 5 Energy pts y=yes 2. Install Overhangs or Awnings over South Facing Windows 3 Energy pts . y=yes 3. Plant Deciduous Trees on the West and South Sides 3 Energy pts y=yes Due to Green Points Rating System for Remodeling Projects the diversity of remodeling project 'types, assigning a to al points value to a project to be considered environmentally friendly is not feasible. However, 25 measures have been highlighted to s gnify that every effort should be made to incorporate them into your projects. These items have been chosen based upon their impact on the environment and the health of the home in coordinajon with ease of implementation and relative low cost. These measures can be used as a starting point for 'greening' your project. 1. Recycle Job Site Construction & Demolition Waste 65°0 =1 point; 751% = 2 points; 80% = 4 points 2. Salvage Reusable Building Materials 3. Remodel for Mixed Use, Adaptive Reuse, and Historic Preservation 4. Protect Native Soil 5. Minimize Disruption of Existing Plants & Trees 6. Implement Construction Site Stormwater Practices 7. Protect Water Quality with Landscape Design B. Design Resource -Efficient Landscapes and Gardens 9. Reuse Materials/Use Recycled Content Materials for Landscape Areas 10. Install High -Efficiency Irrigation Systems 11. Provide for On -Site Water Catchment / Retention B. Foundation 1. Incorporate Recycled Flyash in Concrete 25% Recycled Flyash = 2 points; Add 1 point for every 10% increase of ffyash, up to 5 points 2. Use Recycled Content Aggregate 3. Insulate Foundation/Slab before backfill C. Structural Frame 1. Substitute Solid Sawn Lumber with Engineered Lumber 2. Use FSC Certified Wood for framing (For every 10% of FSC lumber used = 2 points, up to 10) 3. Use Wood kkists for Floors and Ceilings 4. Use Web Floor Trusses 5, Design Energy Heels on Trusses 6" or more 6. Use Finger -Jointed Studs for Vertical Applications 7. Use Engineered Studs for Vertical Applications B. Use Recycled Content Steel Studs for Interior Framing 9. Use Structural Insulated Panels (SIPs) I Floors b. Wall c. Roof 10. Apply Advanced Framing Techniques 11. Use Reclaimed Lumber for Non Structural Applications 12. Use OSB lours b. Shaathi up to 4 Resource pts 4 Resource pts y=yes I Resource pts y=yes Resource pts y=yes Resource pt y=yes. ,' Resource pts y=yes 2 Resource pts y=yes ,! Resource pts y=yes 2 3esource pts 0 0 0 0 0 p 2 Fesource pts y=ye 2 Energy pts y=ye 2 3esource.pts Resource pts y=yes 0 Resource pts y=yes 0 Resource pts Y --yes 0 up to 5 Resource pts 2 Resource pts y=yes Energy pts Y --yes 3 Resource pts y=yE .up to 10 Resource pt; 2 3esource pts y=ye 2 Fesource pts y=ye 2 Energy pts y=ye 2 3esource.pts y=ye 2 3esource pts y=ye. 2 Resource pts y=ye 3 Energy pts y=ye; 3 Energy pts y=ye: 3 Energy pts y=yeE 4 Resource pts y=yeE 3 F esource pts y=yes 1 Fesource pt y=yzs 1 Fesource pt y=yes Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Buil_ innepa, ry- ent JOB ADDRESS. -—'I, ' C PERMIT ���, I �5 OWNER'S NAME: L �, I PHONE GENERAL CONTRACTOR: G:��5 .� r i� I Fi�X 1 am not using any subcontractors: Signature Please check applicable subcontractors and com 1 ate the following infol � CON'!IT&CIO Cabinets Millwork 4�T51 E?SS N1 MF I I I 1 Cement Finishing I IElectrical (Excavation Fencing Flooring: Carpeting I Linoleum. / Wood I Glass / Glazing I Heating insulation Landscaping I I I Lathing I Masoluiy I Ornamental Sheet Metall Painting / Wallpaper Paving Pi asteri_ng PIurnbing Roofing Septic Tank I Sheet Metal I -Sheet Rock Tile Y l Owner/ Contractor Signature