09050087 CITY OF CUPERTINO �
BUI!,.DING DIVISION PERMIT
PERMIT NO.
BUILDING ADDRESS:
11678 OLIVE SPRING CT CASTILLC ' R PERMIT ISSUE DATE
OWNER'S NAME:
A CONTROL NO.
PHONE:
(4 0 8) 2 51 -3 5 65 BUILDING PERMIT INFO
:HITECI7ENGINEER: BLDG ELECT PLUMB MECH
Ll p Z LICENSED CONTRACTORS DECLARATION Job Description
LlU I hereby affirm that I am licensed under provisions of Chapter 9(commencing
_zro with Section nsCodc.andmylicenseis RE—RF T,'O EXT WDSHKS INSTL #30LB FELT& AGAF/ELK
n;y in full force and effect.. 31 Lle d
3 n z License Class GRND CAT JYN COMP CLS A 2 2 S Q
p
Date
RCHITECTS DEC TION
tt I understand my plans shall be used its public records
?�U
WO on Licensed professional
OWNER-BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractors License Law for the
Do following reason.(Section 7031.5,Business and Professions Code:Any city or county
g which requires a permit to construct,alter,improve,demolish,or repair any structure
y—y prior to its issuance.also requires the applicant for such permit to file a signed statement $q.Ft.Floor Area Valuation
that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9
zF C (commencing with Section 70110)of Division 3 of the Business and Professions Code)or 9 8 Q Q
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(S500). 36654103 . 00
❑I,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure isnot intended oroffered for side(Sec.7044,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 sale.11.
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 Contractors Li-
cense Caw 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
❑I am exempt under Sec.
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑1 have and will maintain a Certificate of Consent to self-insure for Workers Compen-
rion,as provided for by Section 3700 of the Labor Code,for the performance of the
is for which this permit is issued.
LJ 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 Compensation Insurance carrier and Policy numbel aim
Q
Carrier. ��.�1—��(!/ Policy No•
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars($100)
or less)
1 certify that in the performance of the work for which this permit is issued,1 shall not
employ any person in any manner so as to become subject to the Workers'Compensation
Laws of Califomia.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
2 forthwith comply with such provisions or this permit shall be deemed revoked.
Z� CONSTRUCTION LENDING AGENCY
(-t►. 1 hereby affirm that there is a construction lending agency for the performance of
py�✓ the work for which this permit is issued(See.3097,Civ.C.)
W Q Lendces Name
Z
Lenders Address
U 0 1 certify that I have read this application and state that the above information is
VI correcL 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
above-mentioned property for inspection purposes
W
W (We)agree to save,indemnify and keep harmless the City of Cupertino against
„E ry rA liabilities,judgments,costs and expenses which may in any way accrue against said City `
V Z in consequence of the granting of this permit. Date
r--� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
SOU�RE ..� �> Re-roof:Si aractor Dam 'j' of Roof
HAZARDOUS MATERIALS DISCLOSURE Type ill the applicant or future build' occupant store or handle hazardous material
as defined by the Cupertino Municip ode.Chapter 9.12,and the Health and Safety
Code,Section 25532(a)7 All roof;shall be inspected prior to any roofing material being installed.
0Yes If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or future buil' occupant use equipment or devices which
emit hazardous air contaminants as ned by the Bay Area Air Quality Manascmcnt all new materials for inspection.
District?
❑Yes O
I have read the hazardous materials requirements under Chapter 6.95 of the or= "' ) y
ell
nia Health&Safety Code,Sections 25505.25533 and 25534.1 understand that if the buil t / O
docs not currently have a tenant that it is my responsibility to notify tax occupant of the Date
requirements w�agcnt
" uancc oC a Certifcax o(occup cy. O S ignatul of Applicant
All roof coverings to be Class"A"or better
0 nen o uthDatc
pC)-5 �� 7
CITY OF CUPERTINO
RE ROOF
CUPE�FINO PERMIT APPLICATION
APN # Ce `-f -9 4 Date:10 `5
Building Address:
Owner's Name: Vl Ce rl,� Y-
�'kee� Phone#:
HOA: Yes ❑ No ❑ If yes, provide letter from HOA
Contractor: Phone #: .� 1�
CASs ( ��S 1� Fax #:
Cupertino Business License #: Contract Licen e #.
Type of Itoof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ ilt-Up roof
❑ s halt Shingles Asphalt Shingles
P g
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:1�r ,^ P /jhakR,- w�1'l 5 LL :36
_.
Residential Commercial
Green Building: Please complete relevant po rtion 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: 1 -
�L
I Have Read Understand and Will Comply with Cupertino's Tear-Off Policy:
Signa re
Revised 02/05/09
CITY OF C UPERTINO
J RER OOF
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
Commission Fee
1BSEISMICO Seismic Commercial B
1REROOFRES Re-roof Re,,.idential B 1SFDWLR00F
r 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
1 Commission Fee
1BSEISMICRE Seismic Residential B
1REROOFMRES Re-roof Multi-Family B 1MFDWLROOF
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission 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 agree to comply with 2007 IBC Standards
and manufacturers specifications on:-e-roofing.All roofs are Class "A"per Cupertino
municipal code 16.04.080.
2. New roof coverings shall not be appLed 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 naf.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 cim be scheduled.
IMPORTANT:
1. Flat roofs must have a minimum of 1iE "per foot slope and demonstrate
that there is no ponding.
2. An I.C.B.O.report is required to be crn the job site at the time on inspection.
I understand and will com 1 with the above stated policy on re-roofing.
Homeowner's Name:
Site Address:
Job s
Roofing Company Name: S I T i
APPlicants' _ .� Date' C)T
�' �a
Greg Casteel
Building Official
Revised 07/30/08
Indoor Air Quallity and Finishes
1 l�t,�w�No-YOG p 1 IAQ/Health pts y=yes 0
2.Use Low VOC,Water-Based Wood Finishes IAQ/Health pts y=yes. 0
3.Use Lowly VOG Adhesim IAQ/Health pts y=yes 0
4.Use Salvaged Materials for Interior Finishes :I Resource pts y=yes 0
5.Use Engineered Sheet Goods with no added Urea
Formaldehyde Ei IAQ/Health pts y=yes 0
6.Use Exterior Grade Plywood for Interior Uses IAQ/Health pts y=yes 0
7.o�.all P,�at1i1DF �lIAQ/Health pts y=yes 0
8.Use FSC Certified Materials for Interior Finish l 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 E Resource pts y=yes 0
2.Use Rapidly Renewable Flooring Materials 4 Resource pts y=yes 0
3.Use Recycled Content Ceramic Tiles Resource pts y=yes 0
4.Install Natural Linoleum in Place of Vinyl i IAQ/Health pts y=yes 0
5.Use Exposed Concrete as Finished Floor Resource pts y=yes 0
6.Install Recycled Content Carpet with Low VOCs Resource pts y=yes 0
Total Points Available: 1401 1301 57
Total Points Project Received: 0 O=
G:datalpr gre:nbuildingguidelines/remodelers/greenpointsfinat2.12.o4protected.xis
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
`CITY OF Fax(408)777-3333
CUPEkTINO
Bitildin De artment
JOB ADDRESS: „ PERMIT #U 0 U v
l Cod� 1 tv� r-;� -
OWNER'S NAME: PHONE # �L
GENERAL CONTRACTOR: t z j FAX # ( - S
I am not using any subco
Signature Date
Please check applicable subcontract and co m tete the following ' ormation:
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