09050145 CITY OF CUPERTINO '
�T�Q�1�:
BUILDING DIVISION PERMIT
uT
PERMIT NO.
BUILDING ADDRESS:
10536 WHITNEY WAY LINDY RCOFING COINC.- 09090145
PERMIT ISSUE DATE
OWNER'S NAME:
_ (lT1FTl R Z137T`j SIARMA CONTROL NO.
)NE:
(408) 28( -9990
BUILDING PERMIT INFO
ARCHiTFCT/ENGINEER: BLDG ELECT PLUMB
MECH
O
p Z LICENSED CONTRACTOR'S DECLARATION Job Description
U I hereby affirm that I am licensed under provisions of Chapter 9(commencing
Z with Section 7 d of of Division 3 of the Business and Pr`Professions and my license is RE-RF RMV EXT RF, I N S T L 1/2" 0SB, 3 0#FLT & 3 4 S Q
in full fottt and of L��/ L � O
5 i License Class /J�t �. LIFETIME DIM COMP, CLS A
a Date Contractor
ARCHITECTS DECLARATION
I�:3 I understand my plans shall be used as public records
�yU
L
U.H Licensed Professional
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
L p O following reason.(Section 7031.5,Business and Professions Code:Any city or county
y^V which requires a permit to construct,alter,improve,demolish,or repair any structure
prior to its issuance,also requires the applicant for such permit to file a signed statement Ft.Floor Area Valuation
G shat he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9
jigF-$ (commencing with Section 7000)of Division 3 of the Business and Professions Code)ur $14000
L .. 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)• 36939025 . 00
0 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 Contractor's 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 arc 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.).
0 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 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 Caw.
0 1 am exempt under See. B&P C for this reason
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-insure 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.
0 I have and will maintain Workefs Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Warkees Compensation Insimpme csrri d Policy number are: 06 r")( Q
Cartier. 9-TAI tF _Policy No.: U
CERTIFICATE OF EXEMPTION 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 Worker's Compensation provisions of the Labor Code,you must
7-. forthwith comply with such provisions or this permit shall be deemed revoked.
Z R CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
fx the work for which this permit is issued(Sec.3097,Civ.C.)
W QLender's Name
ca. Lender's Address
I certify that I have ad this application and state that the above information is
LUL 1-4
mad
1 agree to comply with all city and county ordinances and state laws relating to
0 V building consumction,and hereby authorize representatives of this city to enter upon the
Lia above-mentioned properly for inspection purposes
a (We)agree to save,indemnify and keep harmless the City of Cupertino against
Hliabilities,judgments,costs and expenses which may in any way accrue against said City r
V Z in consequence of the granting of this permit. Date J�_/2-
APPLICANT UNDERSTANDS AND WILL COMPLY WITHAL NON OINT Issued by:
SOURCE REGULATIONS. c�
Re-roofs
sig pplicant/Conuactor Dale Z' of Roof
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 roofs shall be inspected prior to any roofing material being installed.
0 yes
If a roof:s installed without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant use equipment or devices which
est hazardous air contaminants as mcd by the Bay Area Air Quality Management all new materials for inspection.
tsuict?
0 Yes u
1 have read the by rdous materials requirements under Chapter 6.95 of the Cali(or- r
nia Health&Safety Code,Sections 25505.25533 and 25534.1 understand that if the building
does not currently have a tenan4 that it is my responsibility to notify the occupant of the
re 1j
mems which m be met prior to issuance of a Certificate of upancy. S i aturE of Appl ieant Date
— ��— -L2 ��( All roof coverings to be Class'"or better
Owne orizcd agent Da
CITY OF CUPERTINO [
RE ROOF
CUPEI�TINO PERMIT APPLICATION
1
APN # Date: — ----
Building Address: --
Owner's Name: Phone #:
(� c(ct ka V I V, -,IS-3 53 2-F
Contractor: p-- / — Phone
�J Fax yo – 6. - �G
Cupertino Business License #: Contractor License #:
Type of Raof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles Asphalt Shingles
Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) T_ ❑ Other(Specify)
Number of existing coverings— ❑ Provide I.C.B.O. Report #
To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description: r e VhO L/,It Inn 0I �?_
i
3 (?'t� Sy
Residential Ey Commercial ❑
Fire Zone: Yes ❑ No EV, Confirmed with Planning Dept. if
there are any restrictions: ❑
Valuation: - —
I Have Read, Understand and Will Comply with Cupe-tino's Tear-Off Policy:
Sie5ere , --- - - ------
CITY OF C UPERTINO
R.EROOF
`'UPEkTINO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1REROOFCOM Re-roof Corunercial B 1COMMLROOF
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
1BSEISMICO Seismic Commercial B
1RER00FRES Re-roof Residential B 1SFDWLR00F
1BCBSC Cal Bldg Standards 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
Commission Fee
1BSEISMICRE Seismic Residential B
1 BUSLIC Business U.ense 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 1997 UBC Standards
and manufacturers specifications on re-r)ofing.
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 ioofing 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 irspection is required.
6. Any roofing which is applied without fir it obtaining an inspection,
will require the removal of all new material down to the sheathing,
so a proper City inspection can be perfor ned.
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 can b 2 scheduled.
IMPORTANT:
1. Flat roofs must have a minimum of 1/4 " 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 slated policy on re-roofing.
Homeowner's Name: Ct K at ll�
Job Site Address: l 05- 3 �e t` H_T'�-
Roofing Company Name: Lko, ckcj\ 127
Applicant's Signature: t—� Date:
Greg Casteel
Building Official
Revised 11/2/04
M.Indoor Air Quality and Finishes
1.13se tDwNo-VOC Pain 1 IAQ/Health pts y=yes 0
2.Use Low VOC,Water-Based Wood Finishes 2 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.Sea]all F)posed Partideboard 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 3 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
1 i 1
Total Points Available: 1 1401 130 57
Total Points Project Received:1 01 01 0
G:datalprogs/gresnbuildingguidelines/remodelers/greenpointsfinal2.12.D4protected.xls
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�MkTINO
Building Department
JOB ADDRESS: PERMIT #
C53Co GO 417 A) I t`' , 0 �t�S�_� `�S
OWNER'S NAME: av,t/ PHONE # (J
GENERAL CONTRACTOR: FAX # �?
I am not using any subcontractors- ) LA '2,",
Si;mature Date
Please check applicable subcontractors and complete 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