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09050122 CITY OF CUPERTINO BUILDING DIVISION PERMIT PERMIT NO. BUILDING ADDRESS: 1D806 — PERMIT ISSUE DATE OWNER'S NAME: S A CONTROL NO. BUILDING PERMIT INFO FARCHrrECT/ENGTIN,iNEER: BLDG PLUMB MECHapCLICENSED CONTRACTORS DECLARATION Job Description Ufirm that I am licensed under provisions o[Chapter 9(commencing Z of of eeDivision 3 of the Business and Pro[cssions Code.and my license isRE-RF RbEV MAXI-TILE LIGHT WEIGHT CONCRET TILE RF c tecL G- Lia f! 2 4 312Z License Class Contractor & : Date ARCHTCECTS DECLARA770N REPLC W/ 40 YR COMP CLS A 19 SQ; RF I S CURRENTLY 1 I undersand my pians shall be used as Public recent SHEETED - WARREN ROOF CORP PD FOR BUS LIC 5/19/9 L U.t; Licensed Professional OWNER-BUILDER DECLARATION 1 hereby affiact rm that 1 am exempt from the Contractors License Law for the ❑o following mason.(Section 7031.5,Business and Professions Code:Any city or county C$� which requires a permit to construct,alter.improve,demolish,or repair any structure Valuation y^H Prior to its issuance,also requires the applicant for such permit to file a signed statement S Ft.Floor Area that he is licensed pursuant to the provisions of the Contractors License law(Chapter 9 hfl 0 Yr (commencing with Section 7000)of Division 3 of the Business and Professions Code)or i that he is exempt therefrom and the basis for the alleged exemption.Any violation of APN Number Occupancy Type section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not mote than five hundred dollars(2500). 356140 5:1 . 00 0 I,ss owner of the property.or my employees with wages as their sole compensation, will do the work and the structure is not intended or offered for sale(Sec.7(M4,Business Required Inspections and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for sal.Q, however,the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). 0 1,as owner of the property,am exclusively contracting with licensed contractors to convect the project(Sec.7044.Business and Profession$Code:)The Contractors Li- cense Law docs 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' B&P C for this maven 0 I am exempt under See 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-insure for Workers Compen- .on,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 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 Workers Compensat`ion Insurance carrier and Policy number are: Carrie: /n..`,Ch-y Policy No.: rrifl.%'S 1 OQQL CERT IF1 TE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars(2100) 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. CONSTRUCTION LENDING AGENCY (~..h CA I hereby affirm that there is a convection lending agency for the performance of �+ the work for which this permit is issued(Sec.3097,Civ.C.) W A Lender's Name a Lenders Address Z I certify That I have read this application and sate that the above information is GUL cormet.1 agree to comply with all city and county ordinances and state laws relating to 0 U building construction,and hereby authorize representatives of this city to enter upon the U above-mentioned property for inspection purposes LL (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 rmit. Date V Z ( Vf APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued b`r: SOURCE RLA6� TIONS. 2!_-aQ Re-roofs Date Signature of ApplicanUContractor DaT of:roof HAZARDOUS MATERIALS DISCLOSURE Type Will the applicant or future building occupant store or handle hazardous material d as defined by the Cupertino Municipal Code.Chapter 9.12,and the Hcalth and Safety Coe,Section 25532(a)? j All roof:;shall be inspected prior to any roofing material being installed. 0Yes / 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 defined by the Bay Area Air Quality Management all new)materials for inspection. ,trict? 0 Yes I have read the hazardous materials requirements underChapter 6.95 of the Califon- ----- ��//� Oq nia Health&SafetyCode,Sections 25505,25533 and 25534.1 understand that if the building docs not currently have a tenant that it is my responsibility to notify the occupant of the Date require which must be met o issuance ora Certificate- Occupancy. Signature of Applicant -� All roof coverings to be Class'%``or better wner or authorized agent Date' CITY 01' CUPERTINO ai. R]EROOF CUPEkTINO PERMIT .APPLICATION APN If 0 Date. Building Address: O Q r ih r Owner's Name: � r; � J Phone #: HOA: Yes ❑ No © If Yes, provide 1 etter from HOA G - 2 S 2 2- Contractor: Contractor: Phone #: dog _ $LjLj- 4 S 7-7 Fax #: Cupertino Business License #: Contractor License #: 2- SLA $S 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) \, Vc- ❑ Other (Specify) Number of existing coverings 1 _ )d Provide I.C.C.E.S. Report# /34c� To be Removed Provide Mfgr. Installation Specs. � e Job Description: �e.w.ov-�- 1'►'tcy�� -�.1z. I ��L� W e�J�� Co H c r��� ���- C, . ( ace-. Lo orf 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: I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy: Signature Revised 02/05/09 CITY OF CUPERTINO y REROOF CUPEkTINO FEE SCHEDULE Number of Fee ID Fee Description Fee Permit Type Squares Group 1REROOFCOM Re-roof Ccmmercial B 1COMMLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMIC0 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 Rt.sidential 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 re-roofing.All roofs are Class "A"per Cupertino municipal code 16.04.080. 2. New roof coverings shall not be appl:.ed 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 a-iy 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 ne.il inspection is required. 6. Any roofing which is applied without first obtaining an inspection, will require the removal of allnew 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 c;m be scheduled. IMPORTANT: 1. Flat roofs must have a minimum of 1A "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. Homeowner's Name: S��•� A- ���� �0.^ Job Site Address: Lo R O G I rbc a - Roofing Company Name: Applicant's Signatures'- Greg Casteel Building Official Revised 07/30/08 M.Indoor Air Quality and Finishes 1,Use L -VOC part 1 IAQ/Health pts y=yes 0 2.Use Low VOC,Water-Based Wood Finishes ?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 6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 0 7.Seal all wed Pxodeb=4 or AJDF 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 N.Flooring 1.Select FSC Certified Wood Flooring 3 Resource pts y=yes 0 2.Use Rapidly Renewable Flooring Materials f Resource pts y=yes 0 3.Use Recycled Content Ceramic Tiles l 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 1 Resource pts y=yes 0 6.Install Recycled Content Carpet with Low VOCs t Resource pts y=yes 0 . i i 1 Total Points Available: 140 130 57 Total Points Project Received: 01 0 0 G:data/progs/gre anbuildingguidelines/remodelers/greenpointsfinal2.12.D4proteoted.xis Community Development 10300 Torre Avenue Ms,. Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 `'UPEkTINO Building Department JOB ADDRESS: PERMIT # o! Z /O " s T �D� OWNER'S NAME: PHONE # IYOZ- VILLL1977 GENERAL CONTRACTOR: 1.1a.r r ,,• FAX # q16 4 I- RLJL 1 Ni I am not using any subcontractors: -n S.gnature Date Please check applicable subcontractors and corrTete 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 -1 9-6q Owner/Contractor Signature Date