09050062 CITY OF CUPERTINO
BUILDING DIVISION PERMIT ,
� IRI � 1
PERMIT NO.
BUILDING ADDRESS:
10746 LINDA VI TA WESTERN
PERMIT ISSUE DATE
OWNER'S NAME:
S A &9 CONTROL NO.
PHONE:
(831) 27B-1837 BUILDING PERMIT INFO
clrrFZr/ENGINEER: BLDG ELECT PLUMB MECH
chi 0 p LICENSED CONTRACTOR'S DECLARATION Job Description
inI 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 and RE—RF T/O WD S H K ROOFING FILL S HTNG A S :.NEEDED
n v eff 7/� ��
Z License class �'� Lle" -7?, 40LBS FLT INSTL LITEWEIGHT METAL ICCES #5626 TILE
3 t-a Date�•/s ..J Contractor
ARCHITECTS DEC CLS A 3 0 S Q
! I understand my plans shall be used as lie rt:cor Is
;yU
H Licensed Professional
rn OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
no following reason.(Section 7031.5,Business and Prof Ons Code:Any city or county
K m Qi which requires a permit to construc4 alter.improve.demolish,or repair any structure
y^H prior to its issuance,also requires the applicant for such permit to file a signed statement Sq•Ft.Floor Area Valuation
Z< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9
2=$ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $15600
Y.y 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 mote than five hundred dollars(5500). 35608017 . 00
❑I.as owner of ft 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 dors 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 riot build or improve for purpose of
sale.).
❑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' B 8 P C for this reason
C3 am exempt under Sec
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby of inn under penalty of perjury one of the following declarations:
❑1 have and will maintain a Certificate of Consent to self-insure for Worker's Compen-
-+tion,as provided for by Section 3700 of the Labor Code,for the performance of the
-k for which this permit is issued.
Section
ve and will maintain Worker's Compensation Insurance,as required by
two.irker's
the Labor Code,for the performance of the work for which this permit is issued.
Compensation Insurance carrier and Policy number are:
Cartier a� Policy
No. $1 P 0110004n%
CERTIFIC TE OF EXEMPTION FROM WORKERS'
OMPENSATION INSURANCE
(This section teed 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,t 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 0 CONSTRUCTION LENDING AGENCY
[�rte. I hereby affirm that there is a construction lending agency for the performance of
a> the work for which this permit is issued(Sec.3097,Civ.C.)
W Q Lender's Name
0 z Lender's Address
U 0 1 certify that I have read this application and state that the above information is
corrccL I agree m ordinances and with all city and county ordinaand state laws relating to
V.
V building construction,and hereby authorize representatives of this city to enter upon the
(11 above-mentioned property for inspection purposes
ie (We)agree to save,indemnify and keep harmless the City of Cupertino against
to 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
P+ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued b
SOURCE REGULATIONS.
Re-roof:
Signature of Applicant/Contractor Dam 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)? All roof;shall be inspected prior to any roofing material being installed.
❑Yeso
o urate building occupant use equipment or devices which
If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new Tlaterials for inspection.
District?
❑Yeso
1 have read the hat nus mat
nice Health&Safetyerials requirements under Chapter 6.95 of the Califon
Code,Sections 25505,25533 and 25534.1 understand that if the building
4' mentss
urrendy have a tenant,that it is my responsibility to notify the occupant of the Date
reqasst be el prior to i ante of a Certificate of Occupancy S a Ie of Applica1 f coverings to be Class"� `'or better
ge Date
i)q c) oo�p 'a,
: CITY OF CUPERTINO
RE ROOF
CUPEkTINO PERMIT APPLICATION
APN # Date:
5
Building Address:
Owner's Name: �. �� _� Phone#:
HOA: Yes ❑ No If yes, provide leiter from HOA
Contractor: Phone#:
Fax #:
Cupertino Business License #: Contractor License #:
y zf--
Type of hoof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other (Specify) ❑ Other (Specify)
Number of existing coverings �_ _ ❑ Provide I.C.C.E.S. Report# Z4
To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description: dd S,(,,,, ,�� /r f�ts�� �r Nt-e,4,j c�
yJ, 14,r ti J- f.�?'%V erJ,/- r4.G-Ir( —A /z. C(C.j /fir S 0
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: --
/)-G if
I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
Sig atu
Revised 02/05/09
CITY OF CUPERTINO
REROOF
CITY OF
CUPEkT1NO 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
Commissicn Fee
1BSEISMICO Seismic Ccmmercial B
1RER00FRES Re-roof Residential B 1SFDWLR00F
j 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
/ Commissicn Fee
1BSEISMICRE Seismic Residential B
l REROOFMRES Re-roof Multi-Family B 1MFDWLROOF
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commissicn 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 ag.-ee 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 arty roofing installation.
4. To receive a final sign off from the Ci-.y,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 rr aterial 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 c;m be scheduled.
. IMPORTANT:
1. Flat roofs must have a minimum of 14 "per foot slope and demonstrate
•• that there is no ponding.
2. An I.C.B.O.report is required to be cn the job site at the time on inspection.
I understand and will comply with the above stated policy on re-roofing.
GHomeowner's Name:
Job Site Address: w?`)`� L'`'"
r
Roofing Company Name: �N
Applicant's Signatur
Date:
Greg Casteel
Building Official
Reirised 07/30/08
M.Ind oor Air Quality and Finishes
1 Use Loll -VOC Paw IAQ/Health pts y=yes 0
2.Use Low VOC,Water-Based Wood Finishes is IAQ/Health pts y=yes 0
3.Use Low1No VOC Adfres ;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 31AQ/Health pts y=yes 0
6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 0
7 Seal all EXPOSWPa+'dW�ar 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 t Resource pts y=yes 0
6.Install Recycled Content Carpet with Low VOCs 1 Resource pts y=yes I M01
. 1 1 1
Total Points Available: 140 130 57
Total Points Project Received: 0 0 0
G:data/progs/gre enbuildngguidelines/remodelers/greenpointsBnal2.12.04protected.xls