09060045 CITY OF CUPERTINO
I
BUILDING DIVISION PERMIT
Cdr TR�•G�f?R � M TItIN
PERMIT NO.
BUILDING ADDRESS:
10576 To
PERMIT LSSIIE DATE
OWNER'S NAME:
S A CONTROL NO.
^10
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
u p p LICENSED CONTRACTOR'S DECLARATION Job Description
U C I hereby affirm that I am licensed under provisions of Chapter 9(commencing
z m with Section 70(10)of Division 3 of the Business and Professions Code,and my license is
'may in fullCoreeandeff �(oU RE-RF RAV EXTNG WDSHKS& INSTL OSB PLY, NEW RF
Z License C Lic' 2 7 S Q
ARCHTff
TECCS DECLARATION sa��
o I understand my plans shall be used as public records NEW GUT PRS & DOWNSPOUTS CLS A - CONTRACTOR, NORTH
ra. LicensedPnhfcssional CURRENT BUILDERS PD FOR BUS LIC
L.
y; OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Conuactofs License Law for the
Cp$OoC following reason.(Section 7031.5,Business and Professions Code:Any city or county
!i which requires a permit to construct.alter,improve,demolish,or repair any structure
prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation
P Ft.Floor Area
2< that he is licensed pursuant to the provisions of the Contractor's ULcnse Law(Chapter 9 Sq
Y.(-$ (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(5500). 36933020 . 00
❑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 oroffered 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 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 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.
❑1 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:
have and will maintain a Certificate of Consent to self-insure for Worker's Compcn-
,n,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 Worker's Compensation Insurance,as required by Section
X3700 of the Labor Code,for the rance cer performance of the work for which this permit is issued
My Workees Compensation Insu • and Policy number arc:
Carrier. Polity No.:_-UaQ_d_66Jzq
'CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not becompleted if the permit is for one hundred dollars($100)
or Icss)
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'Compensadon
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 Codc,you must
,J O forthwith comply with such provisions or this permit shall be deemed revoked.
Z 2 CONSTRUCTION LENDING AGENCY
[~-d hV)-c I hereby affirm that there is a construction lending agency for the performance of
Ix> the work for which this permit is issued(Sec.3097,Civ.C.)
WGI.A Lender's Name
Lender's Address
U 0 1 certify that I have read this application and state that the above information is
V.rr correct.1 agree to comply with all city and county ordinances and state laws relating to
0 U building convection,and hereby authorize representatives of this city to enter upon the
U above-mentioned property for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
rA liabilities,judgments,costs and expenses which may in any way accrue against said City
V,r in consequence of the granting of this permit. Date r •f✓ /
�-+ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued b):
S G
�i Re-roofs
Signature of Applicant/Contractor f Dae T 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
Cole,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes ?No
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
hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
ict?
❑Yes )63No p
I have read the hazardous materials requirements under Chapter 6.95 of the Califo
nia Health&Safety Code,Sections 25505,25533 and 75534.1 understand that if the building (� (J
docs not currently have a tenant,that it is my responsibility to notify the occupant of the
re n r to issuance of a Certificate of Oc Signature of Applicant Date
loi All roof coverings to be Class'%"or better
Owncel6r autharizcd agent Date
07, c)
CITY OF CUPERTINO
a.E RE ROOF
CUPEkT1NO PERMIT APPLICATION
APN #2w� _-3o-2o- 6
0 Date:
Building Address: I O5'1fo a
Owner's Name: a,� ,� c vv- Phone #: q&g - ZS-7--0Clc0
HOA: Yes ❑ No ❑ If yes, provide letter from HOA
Contractor: N�4-_ � 1Aes Phone #: � {Z f
Fax #: 140% 2,q-q06
Cupertino Business License #: Contractor License M
Type of hoof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles �o Asphalt Shingles
/19 Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other (Specify) o Other (Specify)
Number of existing coverings ❑ Provide I.C.C.E.S. Report#
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
Job Descriptio t✓�e.•� j!9 Rel , 'V1,'""'
Residentialj� Commercial
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 wits Cupertino's Tear-Off Policy:
Signature
Revised 02/05/09
CITY OF CUPERTINO
an REROOF
OF
CUPEkT]NO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1REROOFCOM Re-roof Commercial B 1COMMLROOF
1BCBSC Cal Bldg Stsmdards B ALL PERMIT TYPES
Commission Fee
1BSEISMICO Seismic Commercial B
�n 1REROOFRES Re-roof Residential B 1SFDWLROOF
/ 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission 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 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 ag-ee 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 b wilding 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 Ciiy,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 withou':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 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 be scheduled.
IMPORTANT:
1. Flat roofs must have a minimum of 1/ "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 they above stated policy on re-roofing.
Homeowner's Name: '/0 - V_V_
Job Site Address: I o S�7-6
Roofing Company Name:
Applicant's Signature: Date:
Greg Casteel
Building Official
Revived 07/30/08
M.Indoor Air Quality and Finishes
1.Use Lvwll+lo-VOG 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
D
6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes
7.Seed dME) osed�,artialetioard 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
1 1
1 1 !
Total Points Available: 1 1401 1301 57
Total Points Project Received: 1 01 0 0
G:data/progs/grE enbuildngguidelinWremodelers/greenpointsfina12.12.04protected.xls
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
';UPEkTIN0
Building De artmen
JOB ADDRESS: 1p 37-6 /;.M'PeC\a PERMIT # O O
�j `I
OWNER'S NAME!r•v%. _/a PHONE #
GENERAL CONTRACTOR: &&q4-, e4 FAX #
I am not using any subcontractors:
Si gnature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSI14ESS 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