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09060138 7777-7777777 i i i:. CITY OF CUPERTINO �T BUILDING DIVISION PERMIT PERMIT NO. BUILDING ADDRESS: 1015 NOVEMBER DR KEVIN PERMIT ISSUE DATE OWNER' (lE)RSA R #t. 2089 CONTROL NO. INE: (408) 842-1057 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECTPLUMB MECH Q (� 0 0 a p O LICENSED CON'TRACTOR'S DECLARATION Job Description uI hereby affirm that I am licensed under provisions of Chapter 9(commencing w with Section7000)ofDivision3oftheBusinessandprofessionsCode,andmylicenseis in full force and effectRE—ROOF TEAR OFF 2 LAYERS OF EXISTING ROOF. e y 0 ?1 Licens�,a a Lr x INSTALL SHEATHING AND LANDMARK PREMIUM ASPHALT 'F Datc t=-Zt��Contracwr ARCHITECTS DECLARATION I understand my plans shall be used as public records SHINGLES INSTALL SEAMLESS GUTTERS. 2 9 SQUARE �yU L.WO I- Licensed Professional OWNER-BUILDER DECLARATION eI hereby affirm that 1 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 which requires a permit to construct,alter.improve,demolish,or repair any structure y"y prior to its issuance,also requires the applicant for such permit to file a signed statement Sq.Ft.Floor Area Valuation Z< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Y t=- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $11600 E R E 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). 3 6 213 0 E 3 . 0 0 I,as owner of the property,or my employees with wages as their sole compensation, win 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 thecon,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.). ❑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 themon,and, who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law. Q 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 Worker's Compen- ,ation,as provided for by Section 3700 of the Labor Code.for the performance of the work for which this permit is issued. fI have and will maintain Worker's Compensation insurance,as required by Section 0 of the Labor Code,for the performance of the work for which this permit is issued. My Workkee+es Compensation Insurance carrier and Policy number are: Carrier. Ylik� Ad PolicyNo.: 60oo{R7y �� 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 Z forthwith comply with such provisions or this permit shall be deemed revoked Z, CONSTRUCTION LENDING AGENCY E~•t r�-i 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 QL.endces Name 0 z Lender's Address I certify that I have ad this application and state that the above information is LUL" re correct.l agree to comply with all city and county ordinances and state laws relating to 0 U building construction,and herby authorize representatives of this city to enter upon the m W above- entioned property for inspection purposes a (We)agree to save,indemnify and keep harmless the City of Cupertino against CA liabilities,judgm is,costs and expenses which may in anyway accrue against said City V Z in consequence f e granting of this permit. Date t--t APPL NT N ERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Conuactor Date T of RoofARDOUS MATERIALS DISCLOSURE Type Will the cap 'c t 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)? f All roofs shall be inspected prior to any roofing material being installed. Yes L7 No If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which t hazardous air contaminants defined by the Bay Area Air Quality Management all w R L for inspection. .strict? / Yes u I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 75505.25533 and 25534.1 understand that if the building lC� does not currently tenant that it is my responsibility to notify the occupant of the Date -,, CITY OF CUPERTINO ► ` REEZOOF CUPEkTINO PERMIT APPLICATION OgOCo�l � APN # Date: - 2 Y_ 5(vz )5-3 :DO Building Address: j0 1 , r b( Owner's Name: Phone #: os�zoq --qg,? 1 HOA: Yes ❑ No If yes, provide letter from HOA Contractor: RR Phone #• qO g`� ._� ' 7 12,64 fJ R-OA, S Fax #: 600 9L 7-6 9 Cupertino Business License #: Contractor License #: �3g/0 9©37/ Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles ;' Asphalt Shingles A Wood Shakes ❑ Wood Shakes 9 Wood Shingles ❑ Wood Shingles ❑ Other (Specify) ❑ Other (Specify) Number of existing coverings o`Z ❑ Provide I.C.C.E.S. Report# ❑ To be Removed ❑ Provide Mfgr. Installation Specs. Job Description: .-fir 'zed' -�wao� Skgk� *5.5;0 j1f). 1,1541t 9 51 nt, CosT�it 6vc�.00 Residential �] �^ � � Commercial ❑ gs Q agP�k� S � ,�• �' 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 nderstand and Will Comply with Cupertino's Tear-Off Policy: Signa re Revised 02/05/09 -� CITY OF CUPERTINO REROOF CUPEkTiNO FEE SCHEDULE Number of Fee ID Fee Description Fee Permit Type Squares Group 1REROOFCOM Re-roof Commercial B 1COMMLROOF 1BCBSC Cal Bldg Stz.ndards B ALL PERMIT TYPES Commission Fee 1BSEISMICO Seismic Cor.-imercial B 1 REROOFRES Re-roof Residential B 1 SFDWLROOF 1BCBSC Cal Bldg St�mdards B ALL PERMIT TYPES Commission Fee 1BSEISMICRE Seismic Residential B 1 REROOFMRES Re-roof Mu'.ti-Family B 1MFDWLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICRE Seismic Residential B 1BUSLIC Business Lixnse 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 agl 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 buildirg 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 ar 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 app oval. 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 miiterial 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 fe 2 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 the above stated policy on re-roofing. Homeowner's Name: -` job Site Address: 16tS Nave4y, P r. 9s- 01 L/ Roofing Company Nam • � Applicant's Signature: Date: Greg Casteel Building Official Revi:ed 07/30/08 INPUT Resources Energy AQ.,�Pfth indoor Air Quality and Finishes 1.Use Low/No-VOC Paint 1 IAQ/Health pts y=yes 0 2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes D 3.Use Lowly 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.Seat.all Exposed Particleboard or MDF 4 IAQ/Health pts y=yes 0 B.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 B Resource pts y=yes 0 2.Use Raody Renewable Flooring Materials t 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 5 IAQ/Health pts y=yes 0 5.Use Exposed Concrete as Finished Floor t Resource pts y=yes 0 6.Install Recycled Content Carpet with Low VOCs }Resource pts y=yesl D Total Points Available: 1401 130f---571 Total Points Project Received] X 01 O= G:data/progslgrei nbuildinoguidelines/remodelers/greenpointsfinal2.12.04protected.xls Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 '.UPERTINO Building Department JOB ADDRESS: lois N ovemW- Ljr, PERMIT # 0(p ^ C)`3(�pm G., w i- S DI q `� OWNER'S NAME: PHONE # -c(8 Z10 GENERAL CONTRACTOR orel-6&. I am not using any subcontractors: ~� ' ',;nature Date Please check applicable subcontractors d co llete 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