09050131 77
CITY OF UPERTINO � � .. � r
BUILDING DIVISION PERMIT
PERMIT NO.
BUILDING ADDRESS:
19141 MEIGGS LN ANTHONY RAI4IEaL_EDDf1NG-- 09090131
PERMIT ISSUE DATE
OWNER'S NAME: INC
T S A CONTROL NO.
INE:
(4 0 8) 264-5562 BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
20 0 LICENSED CONTRACTOR'S DECLARATION Job Description
Up I hereby affirm that I am licensed under provisions of Chapter 9(commencing
Z q with Section 7000)of Division 3 of the Business and Professions Code,and my license is RE—ROOF W 30 YR DIMENSIONAL FIBERGLASS SHINGLES
a in full force and eff t.
;M4 LicenacCl 3 C^o rk�YWOOr & SOLD SHEATING AND INSTALL 32X32
t p
Date n
g RCHITECTSDECLA WN &en"
aSKYLIGHT.
a=rt,'U 1 understand my plans shall be used u public records
SU
`Q y Licensed Professional
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
a0 following reason.(Section 7031.5,Business and Profe-Wons Cafe:Any city or county
construct.alter,improve,demolish,or repair any structure
which requires a permit to cons
prior to is 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
Y r (commencing with Section 7000)of Division 3 of thc Business and Pro fcssians Code)or $5000
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 more than five hundred dollars(M)• 3 7 5 3 7 0 C 1 . 00
0 I,Is 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 Conuactoes License Law does not apply to an owner of
property who builds or improves thereon,and who does such work himself or through his
town employees,provided that such improvements are not intended or offered for sale.It,
however,the building or improvement is sold within one year of completion,the owner-
builder will have am burden of proving that he did not build or improve for purpose of
sale.).
0 I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044.Business and Professions Cale:)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&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-insum for Worker's Compen-
..tion,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 Workers Compensation Insurance,as mquimd by Section
TM of the Labor Code,for the performance of the work for which this permit is issued.
CMy artier ked s�mpensation lrytyrancc ca 'cr an icy No.:number` .
.LO. �- Poli No.:001 <y
CERTIFICATE OF EX PTION FROM WORKERS'
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 Workers Compensation provisions of the Labor Code,you must
,J O forthwith comply with such provisions or this permit shall be deemed revoked.
z c-- CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for the performance of
p(> the work for which this permit is issued(Sec.3097,Civ.C.)
Liz Q Lender's Name
0 Lender's Address
U 0 1 certify that I have read this application and state that the above information is
w H correct.I 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
Uabove-mentioned property for inspection purposes
>4 Wa (we)agree to save,indemnify and keep harmless the City of Cupertino against
tIn liabilities,judgments,costs and expenses which may in any wa accrue against said City
U Z in consequence of the gran g of this permit. Date
11" APPLICA DER NDS AND L Y WITH ALL NON-POINT Issued by:
SOUR E
S Re-roof:,
^ for
Da
H DOU MA AIS DISCLOSURE Type of Roof
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 3 shall be inspected prior to any roofing material being installed.
0Yes 09P 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
nit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
liStrlCl?
Yes
a� D
1 have read she hvardows 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 ave a tenant,;710w;responsibility to notify the occupant of the
reyui must m uancc of a Ccrtificate of Occupancy. 1 Ica Date
J. All roof coverings to be Class or better
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CITY OF CUPERTINO
a REROOF
CUPEkTINO PERMIT APPLICATION
APN # 0� Date:
9Y.
Building Address:
/q y / �/ s
Owner's Name: -a�,�4 a�►�� Phone #:
HOA: Yes ❑ No ❑ If esprovide letter from HOA
Contractor: elo r Phone
r C - Fax #: 7
Cupertino Busi ess License #: Contractor License #:
(3 63 -�
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
;?f--Asphalt Shingles ,b- 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#
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description: ��
;�ley"
95
Residential / n S Tai/ �,v 3z Commerc'al
-7—
Green
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:
e/aW!��
Signature
Revised 02/05/09
CITY OF CUPERTINO
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
1BSEISMICO Seismic Commercial B
1RER00FRES Re-roof Residential B 1SFDWLR00F
. zo v
I 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 Rosidential B
1BUSLIC Business License B
i �`
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 a€;ree 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 C;ty,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 n►aterial down to the sheathing,
so a proper City inspection can be pe rformed.
7. NOTE: If you call for a plywood nail inspection and the job is not ready,
you will be charged a re-inspection fae of$176.18. The re-inspection fee must
be paid before another inspection c in be scheduled.
IMPORTANT:
1. Flat roofs must have a minimum of?i "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:
Job Site Address: /
Roofing Company CName:
Applicant's Signature: Date: 49
Greg Casteel
Building Official
Revised 07/30/08
INPUT ROSOU-CLS Energy A-�'HEaft�
M.Indoor Air Quality and Finishes
1.Use`iO►ND-VOC:P i 1 IAQ/Health pts y=yes 0
2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes 0
3.Use LowlNo VOC Adhesives 3 IAQ/Health pts y=yes 1 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
0
6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes
7.Seal all Paxtideboard or 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 4 Resource pts y=yes 0
6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes 0
Total Points Available: 1401 1301 57
Total Points Project Received: 01 0 0
G
G:data/progs/gi:enbuildingguidelines/remodele rstgreenpointsfinal2.12.04protected.xis
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
';UPEkTINO
Buildi.n De artment
JOB ADDRESS: S 2� 1u J PERMIT # Qq 0 CS
OWNER'S NAME: ":\)a,,L c PHONE #
GENERAL CONTRACTOR: C- /H #
.y
I am not using any subcontracto
gnature Date
Please check applicable subcontractors and corr plete 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
Owner/Contractor Signature Date