09060041 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CC1TQR I ` } E� I� '
PERMIT NO.
BUILDING ADDRESS:
21960 MCCLELTAN ED BAY 101
PERMIT ISSUE DATE
OWNER'S NAME:
S A CONTROL NO.
PHON
408) 957-0531
BUILDING PERMIT INFO
nRCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
u O O LICENSED CONTRACTOR'S DECLARATION Job Description
jm E I hereby affirm that I am licensed under provisions of Chapter 9(commencing
Zm with Section 7000)of Division 3 of the Business and Professions Code,and my license is
=y in full force and eff�ct_ J�( p ; RE-RF T/0 2 LYRS W/SHNGLS&SHKS PUT OSB .BOARD& 30#
j ? License Clan L1C.g
-Ep Date 42-t..- Conl w,. V 40 r FLT& 30 YR COMP CLS A 12 SQ
ARCHITECTS DECLACATION
I understand my plans shall be used as public records
e,
4 C y Licensed Professional
a 3 OWNER-BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the
p O following reason.(Section 7031.5,Business and Professions Code:Any city or county
y^ which requires a permit to construct alter,improve,demolish,or repair any structure
41 Z m its issuance,also requires the applicant for such permit to file a signed statement Valuation
that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area
%I-.a $5
(commencing with Section 7000)of Division 3 of the Business and Professions Code)or 800
e g— 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(5500). 35608033 . 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 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 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.).
❑I,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.
❑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:
I have and will maintain a Certificate of Consent to self-insure for worker's compen-
an,as provided for by Section 3700 of the Labor Code,for the performance of the
.,rk 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 Workepes Compensation Insurance carrier and Policy number arc:
Carrier. J 40(/ �Policy No.:10h 0:32.22-2-10
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars($100)
or Icss)
I certif!v 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 workers Compensation provisions of the Labor Code,you must
Z forthwith comply with such provisions or this permit shall be deemed revoked.
Z O CONSTRUCTION LENDING AGENCY
F~-r I hereby affirm that there is a construction lending agency for the performance of
[y,> the work for which this permit is issued(Sec.3097,Civ.C.)
W Q Lenders Name
aLenders Address
U C) I certify that I have read this application and state that the above information is
IL 1-1 correct.I agree to comply with all city and county ordinances and state laws relating to
0 V 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
04
V) liabilities,judgments,costs and expenses which may in any way accrue against said City
U Z in consequence of the granting of this permit. Date '� V
APPLICANT UNDERSTAND
Deeh ��—
HAZARDOUS MATERIALS DISCLOSURE Type Of Roof
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Mu icipal 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.
❑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
-mit hazardous air contaminants as defined by the Bay Area Air Quality Management all new r.laterials for inspection.
;uict?
❑Y°s °
1 have read the hazard materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Cade,Sections 25505, 533 pld 534.I understand that if the building •— 5 ,
docs not currently have a tenant that it y Aposibilfty to notify the occupant of the
requirements which must be m or ss cc f a Cenificate of Occupancy. Signaturc Of pl' ant Date
'C All roof coverings to be Class'n"or better
Owner or authorized Date
CITY OF CUPERTINO Ct (D
I,aeK RE ROOF
CUPEF�TINO PERMIT APPLICATION
APN # 3 5 (e ()�- 5 :� Date: 0
Building Address:
_,O� / 96 D 6LF, L6 J
Owner's Name: � Phone #:
HOA: Yes ❑ No es provide le Iter from HOA
/6 &n Fax #:
upe ino Business License #: Contractor License #:
? / 14
Type of hoof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
Asphalt Shingles �( Asphalt Shingles 3C y icWL
Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other (Specify) ❑ Other (Specify)
Number of existing coverings -7 J,Zo _ ❑ Provide I.C.C.E.S. Report#
f To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description: v Z �ij
p r�r OF _ y -
��i T c7 /� �021� �1�-') 3 6
Residential -. Commercial ❑
Cf e-ff
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 Compl w' 'qCupertino's Tear-Off Policy:
Signature
Revised 02/05/09
a�TK.
CITY OF CUPERTINO
RER13OF
CM OF
CUPEkTINO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1REROOFCOM Re-roof Conunercial B 1COMMLROOF
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commissior. Fee
1BSEISMICO Seismic Corrunercial B
1REROOFRES Re-roof Residential B 1SFDWLR00F
1BCBSC Cal Bldg Strndards 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
Commissiu-1 Fee
1BSEISMICRE Seismic Re;>idential 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 (:ity 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 applied without first obtaining all inspection
and written approval from the buildin;inspector. A final inspection and
approval shall be obtained from the bt.ilding inspector when the re-roofing
is completed.
3. All roofs shall be inspected prior to an y 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 me terial down to the sheathing,
so a proper City inspection can be per Formed.
7. NOTE: If you call for a plywood nail inspection and the job is not ready,
you will be charged a re-inspection fei! of$176.18. The re-inspection fee must
be paid before another insyection ca:l be 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 ori 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: l 921 / L�LL�i& L2
Roofing Company Name: gA Y 6 1206r4 le -7ti, �
Applicant's Signature: -^� Date: k? - Y-6
Greg Casteel
Building Official
Reviled 07/30/08
M.Indoor Air Quality and Finishes
1.Use Leo-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 Lov*Wo VOC Ad esi>,+es 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 allxposed9?au# lebaard ar MDF 4 IAQ/Health. pts y=yes 0
S.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 !
N.Flooring
1.Select FSC Certified Wood Flooring 6 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
i t !
Total Points Available: 1401 130 57
Total Points Project Received: 0 0 0
rte.
G:datalprogslgre enbuildinggu nnWre delers/greenp6,ntsfinal2.12.04protected.xls
Community Development
i 10300 Torre Avenue
` Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
-UPEkTINO
Building Department
JOB ADDRESS: PERMIT # Q O ��H I
6 0 e G,�I
Al
OWNER'S NAME: Z ' I 1IZ= 2 PHONE # Z10 Y OS_
0
GENERAL CONTRACTOR: N!J p C, AX #
I am not using any subcontractors: ,
Sign e 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/CordTaior Signature Date