09050061 CITY OF CUPERTINO �s ` �v�.
BUILDING DIVISION PERMIT 1 � 7� WR 1� aoa
BUILDING ADDRESS: PERMIT NO.
1
OWNER'S NAME: PERMIT ISSUE DATE
040W 13AN WIN !328 ?RiipE em�s RB
PHON S A CONTROL NO.
(831) 273-1837
'HITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT o
PLUMB MECH
a a 0
O p LICENSED CONTRACTOR'S DECLARATION
m I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing Job Description
U with Section 7000)of Division 3 of the Business and Professions Code,and my license is
°may in full force andeff t,;a RE-RF T/0 2LYR WD ROOFING FILL SHEATNG .AS NEEDED
D&z License Class 1 Lle.if
�F Dato�u�aaaContracto 40LB FLP, INSTL LITE METAL TILE PER ICCES #5626
ARCHITECT'S D ON
i j U I understand my plans shall be used as public records CLS A 2]S Q
0
4 O In Licensed Professional
rn 3 OWNER-BUILDER DECLARATION
e 2 1 hereby affirm that 1 am exempt from the Contractor's License law for the
L
00 following reason.(Section 7031.5,Business and Professions Cale:Any city or county
Pi which requires a permit to construct,alter,improve,demolish,or repair any structure
=y 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 ;q.Ft.Floor Area Valuation
yt- (commencing with Section 7000)of Division 3 of the Business and Professions Cade)or
y .. that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not more than five hundred dollars($500). 36618003 . 00 p y yp
❑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.7044,Business
and Professions Code:The Contractor's License Law does not apply to an owner of Required Inspections
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.).
❑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 u-
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.
❑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:
❑1 have and will maintain a Certificate of Consent to self-insure for Worker's Compen-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
rk for which this permit is issued.
have and will maintain Workers Compensation Insurance,as required by Section
700 of the Labor Code,for the performance of the work for which this permit is issued.
My Workers Compensation insurance carrier and Policy number am:
r.�
Carrier. Cl#.4 Policy No.: OJT 4��s
CEIITIFICAJE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for ono hundred dollars($100)
or Icss.)
I certify that in the performance of the work for which this permit is issued.I shall nes
employ any person in any manner so as to become subject to the Workers'Compensation
Laws of Califemia.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Workces Compensation provisions of the Labor Code,you must
Oforthwith comply with such provisions or this permit shall be deemed revoked.
Z" CONSTRUCTION LENDING AGENCY
[�►�- I 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.)
W
A Lender's Name
Z Lenders Address
U Q 1 certify that I have read this application and state that the above information is
LL"" corecL I agree to comply with all city and county ordinances and state laws relating to
oE" building construction,and hereby authorize representatives of this city to enter upon the
w above-mendoncd property for inspection purpose&
ttt1-^e1r (Wc)agree to save,indemnify and keep harmless the City of Cupertino against
m..m rA liabilities,judgments,costs and expenses which may in any way accrue against said City
U Z in consequence of the granting of this permit.
"^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Signature of Applicant/Contractor Date i
HAZARDOUS MATERIALS 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 roofs sl fall be inspected prior to any roofing material being installed.
❑res o
Well the applir ant o future building occupant use cyuipmcnt or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new ma serials for inspection.
District?
❑Yes
1 have read the hazard s materials requirements under Chapter 6.95 of the Califor-
nia Health&Safely Code,Sections 25505,25533 and 25534.1 understand that if the building /Z�
docs n currently have a tenant,that it is my responsibilit to notify the occupant of the
requi nts whi be to iss ficatc of occupancy. Sig state o F ApplicaZi/lIr-oocoverings
Date
caner or thorizc crit Date to be Class'n"or better
CITY OF CUPERTINO v
REROOF
Ell,
CUPEkT1NO PERMIT APPLICATION
APN # p Date:
Building Address: 2— Pr
Owner's Name: L� L� �,,, Phone#4,0 9-
FJ9- Z r;,- 4 010
HOA: Yes ❑ No ❑ If es provide letter from HOA
Contractor: Phone #:4.�,v S 4 �, ,r—
Fax #: ❑sri i�g�
Cupertino Business License #: Contractor License #:
G�-r�2�
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) -;K Other (Specify) A,14-tAl f-/-t
Number of existing coverings ❑ Provide I.C.C.E.S. Report# f7.*u&
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description: ,� ,G.1/ �•l e .•� A-s �,ec .ej
�/J �6x 7� /�✓l�r►�� /'^G7'4- �i/�C. BOE/ 2 2fi G14rf
Residential CommercialLj
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: -
�r.o'v�
I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
Signa re
Revised 02/05/09
CITY OF C UPERTINO
_all, REROOF
CUPEkTINO FEE SCHEDULE
Number of Fee ID Fee Descri ption 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
-1 1REROOFRES Re-roof ReEidential B 1SFDWLR00F
1BCBSC Cal Bldg St,mdards B ALL PERMIT TYPES
Commissioji Fee
1BSEISMICRE Seismic Re,,,idential B
1REROOFMRES Re-roof Multi-Family B 1MFDWLROOF
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
1BSEISMICRE Seismic Residential B
1BUSLIC Business Lizense 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 i e-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 buildi-ig inspector. A final inspection and
approval shall be obtained from the t wilding 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 City,the following steps are
required:
1) Pre-inspection and/or tear off apF roval.
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 m aterial down to the sheathing,
so a proper City inspection can be performed.
7. NOTE: If you call for a plywood nai.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 csm be scheduled.
IMPORTANT:
1. Flat roofs must have a minimum of lii "per foot slope and demonstrate
that there is no ponding.
2. An I.C.B.O.report is required to be on 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: Z— Pro rc ,Zvtc A✓
Roofing Company Name:
Applicant's Signature• Date:
Greg Casteel
Building Official
Revised 07/30/08
M.Indoor Air Quality and Finishes
1.11se -VOOPaw IAQ/Health pts y=yes 0
2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes 0
3.Use LoM%O VM AdWOVOS 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 3IAQ/Health pts y=yes 0
6.Use Exterior Grade Plywood for Interior Uses I IAQ/Health pts y=yes 0
7.SO all E*Med Par*le�c AW Or MDF 1 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 E Resource pts y=yes 0
2.Use Rapidly Renewable Flooring Materials z Resource pts y=yes 0
3.Use Recycled Content Ceramic Tiles I 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
1 1
Total Points Available: 1 1401 130 57
Total Points Project Received: 01 01 — 10
G:data/progs/gree nbuildngguidelines/remodelers/greenpointsfinal2.12.D4protected.xls
Community Development
10300 Torre Avenue
t = Cupertino CA 95014
Telephone(408)777-3228
Fax(408)777-3333
CITY OF
CUPEkTINO
Buildin Deartnt
JOB ADDRESS: 7]> Pr PERMI��' oq U�5 0U(,a 1
OWNER'S NAME: PHONE # YcO- 3,61 / r—
GENERAL CONTRACTOR: ,,�, �vu�«- FAX # J S'S'+� 3
I am not using any subcontractors:
Si,nature Date
Please check applicable subcontractors and com:olete 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
O e tractor Signature Date