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09050170 CITY OF CUPERTINO BUILDING DIVISION PERMIT CSI TRACTC?R NVWN k` QN� PERMIT NO. BUILDING ADDRESS: 912 SEPTEMBER DR NEW AGF: DESIGNS nanizni7n PERMIT ISSUE DATE OWNER'S NAME: R KTTMARA17ATIT1TRT jJ SAWWW140—. CONTROL NO. eHONE: (831) 347-0789 BUILDING PERMIT INFO ARCHiTECTIENGINEER: BLDG ELECT PLUMB MECH a p C LICENSED CONTRACTOR'S DECLARATION Job Description m I hereby affirm that I am licensed under provisions of Chapter 9(commencing _Zro with Section70(>U)ofDivision3ofthe Business and Professions Code,and mylicense is RE-ROOF TEAR OFF SHAKE ADD APPROVED UNDERLAY 25 n D y in Tuft force and effec� /V Ll</ Daz pa�"� a ��r 7 YRS CLASS A 25 SQUARES ARCHITECTS DECLARATION a< 1 understand my plans shall be used as public records 50. U.y Licensed Professional n y OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractors License Law for the a0 following Reason.(Section 7031.5,Business and Professions Code:Any city or county K m li which requires a permit to contact.alter,improve,demolish,or repair any structure y Z y prior to its issuance,also requires the applicant for such permit to file a signed statement Ft. Floor Area Valuation < that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq yt—$ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $6000 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 mom than five hundred dollars(5500). 36214009 . 00 ❑1,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 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.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 contact the project(Sec.7044,Business and Professions Code:)The Contractors Li- cense Law does not apply to an owner of property who builds or improves themon,and who contracts for such projects with a contractor(s)licensed pursuant to the Contractors License Law. ❑I am exempt under Sec B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: ❑I have and will maintain a Certificate of Consent to self-insure for Workers Compen- sation,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 required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Worker �C./q-ro�-PC/p�sation Insurance carrier and Policy number am: G Carrier f oT7t' L/.rU Policy No, CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section treed not be completed if tae permit is formic hundred dollars($100) or Icss.) 1 cenifv 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 Oforthwith comply with such provisions or this permit shall be deemed revoked. „Z„t' CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of i� the work for which this permit is issued(Sec.3097,Civ.C.) W QLendces Name � Z Lenders Address U O I certify that I have read this application and state that the above information is VL correct.l agree to comply with all city and county ordinances and state laws relating to O V building construction,and hereby authorize representatives of this city to enter upon the OWa above-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against liabilities,judgments,toss 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: SOUR GUjIATIONS. Re-roofs SigdaL?rf ofApplicaDO °aDateHAZA 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 3 shall be inspected prior to any roofing material being installed. fi ❑Yes Will the applicant or future building occupant use equipment 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 'Materials for inspection. District? ❑Yes ODwr — 1 have mad the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building docs not curten I ha ten t,that it is my responsibility to notify the occupant of the requirement whir t ei prior w issuance of a Ccrtifiratc of�p�. � S ignatui e of Applicant Date Y All roof coverings to be Class'n"or better Owner or u recd agent Date w Community Development 10300 Torre Avenue ;31`` Cupertino CA 95014 Telephone(408)777-3228 CIV OF Fax(408)777-3333 'UPEkTINO Building Department JOB ADDRESS: PERMIT # Q 6SO�6"9; 9` 2 eti,�✓ ti ? �� Cm � j l�/ b eb S�17 O OWNER' NAME: PHONE #20 g S/7' GENERAL CONTRACTOR: FAX# I am not using any subcontractors: Signature le Date Please check applicable subcontractors and corn_ lete the following information: SUBCONTRACTOR BUSI:4ESS 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 _,e_-X-- S" er/Contractor Signature Date CITY OF CUPERTINO REROOF CUPEI�TINO PERMIT APPLICATION 0501 -70 APN # � �� Q� Oa Dates_ Building A dres O/ z- cl e' "?4 qj—/�� Owner's Na e: �� :u�ta�rava�v,�i �j�. Phone #: HOA: Yes ❑ No [ If Yes, provide letter from HOA Contractor: Phone #: p,?I a417. 671d4l9 4 Le I') ,t bfTf es Fax #: I& N/ - Say 6 Cupertino Business L cense #: Contractor License #: 773G1Z,� Type of Aoof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles aAsphalt Shingles U--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: ��'� �'h a � - Gl r�� A100Veo,( ��a�►c� vr�a�� /a e�dd�' �/�Cdr Sh,It9 k m- r - C')a j- Residential Commercial Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if Green Building Checklist & attach it to the v.pplication 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: // Signa Revised 02/05/09 CITY OF CUPERTINO REROOF 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 Commission Fee 1BSEISMICO Seismic Commercial B 1REROOFRES Re-roof ReEidential B 1SFDWLR00F 1BCBSC Cal Bldg Stindards B ALL PERMIT TYPES Commission Fee / 1BSEISMICRE Seismic Residential B 1REROOFMRES Re-roof Multi-Family B 1MFDWLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commissio a Fee 1BSEISMICRE Seismic Re3idential B 1BUSLIC Business L:cense 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 buildiag 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 azy 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 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 can be scheduled. IMPORTANT: 1. Flat roofs must have a minimum of 1i4 "per foot slope and demonstrate that there is no ponding. 2. An I.C.B.O. report is required to be o::i the job site at the time on inspection. I understand and will comply with the above stated policy on re-roofing. Homeowner's Name: , ku mo r eto o o r Ue 1(I Job Site Address: q l Z- L � e#-fJ�l �r C tf.�c'/�i�td �0• �` �� Roofing Company Name: W -eJ 9ir1 Applicant's Signature: Date: k�64r Greg Casteel Building Official Revised 07/30/08 Ener M.Indoor Air Qualfty and Finishes • 1.Use Lowft-VOC Paint 1 IAQ/Health pts y=yes 0 2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes 0 3.Use Lowft 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 eM ExI used Parddebeard 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 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:1 1 1401 130 57 Total Points Project Received: 01 01 0 G:data/progs/gr:enbuiidingguidelines/remodelers/greenpointsfina12.12.04protected.xis