09060061 CITY OF CUPERTINO T �t
BUILDING DIVISION PERMIT � � N- FTl�ll.
BUILDING ADDRESS: PERMIT NO.
M114 PA IFI A DR M C R007ING
PERMIT ISSUE DATE
OWNER'S NAME:
A O. CONTROL NO.
t0
(4 08) 72 a-3436
BUILDING PERMIT INFO
ARCHITEC IENGINEER:
BLDG ELECT PLUMB MECH
u O p LICENSED CONTRACTOR'S DECLARATION Job Description
m p 1 hereby affirm that
t I a�mplicensed under provisions of Chapter 9(commencing
ICU
Zd ntfullforeeandw)ofLDtG�o�n �daeBusiness and Professions Code,and mylicense is RE—ROOF TEAR OFF SHAKES INSTALL 7/16 OSB WITH
z Licettae Class— ! Lie.s
Dat3 0 LB
n F- e.;_/�...�, l Contract"r-�.- _if i.:Rs _
ARCHITECTS DECLARAMON FELT & 30 YR SHINGLES
—t I understand my plans shall be used as public records
JyU
U.in Licensed Professional
0,
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
p OcG following mason.(Section 703 1.5,Business and Professions Code:Any city or county
which requires a permit to construct,alter,improve,demolish,or repair any structure
Zy prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation
2 G that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area
Y.H (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $9500
y .. that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not more than five hundred dollars(5500). 36928023 . 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 q p
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements ate 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 Contactors 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 Contractors
License Law.
❑1 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-
..etion,as provided for by Section 3700 of the Labor Code,for the performance of the
workk lb ich this permit is issued.
�j
have and will maintain Workces Compensation Insurance,as required by Section
3700 of the Labor Cook:,for the performance of the work for which this permit is issued.
My Workers Compensation insurance carrier and Policy number am:
Carrier.` . ` PolicyNo.:
IFICA EE OPTION FROM ORKERS'
COMPENSATION INSURANCE
(This section need not be completed 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,1 shall not
employ any person in any manner so as to become subject to the Workcrs'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"" CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
tx > the work for which this permit is issued(Sec.3097,Civ.C.)
QLender's Name
Z
Lenders Address
U O 1 certify that 1 have rad this application and state that the above information is
V.► 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
a above-mentioned property for inspection purposes
(We)agree to save,indemnify and keep harmless the City of Cupertino against
Hto liabilities,judgments,toss and expenses which may in any way accrue against said City
U Z in consequence of the granting of this permit. Date
APPLICANT UIQ ERSTANDS AN WI CO LY WITH ALL NON-POINT Issued b)
SOUR ELATION
Re-roofs
ignsture etant/C Date Type of Roof
MATERIALS DISCLOSURE yP
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.
❑Yes ISO
Will the applicant or future building occupant use equipment or devices which
If a roof .s installed without first obtaining an inspection,I agree to remove
it hazardous air contaminantsas define by the Bay Area Air Quality Management all new r laterials for inspection.
.strict?
❑Yes [ o
1 have read the hazardous materials requimments under Chaptcr6.95 of the Califor-
nia Health&SafctyCodc,Sections 25505.25533 and 25534.1 understand that if the building
toes not currently have a tenant that it is my responsibility to notify the occupant of the
ertifieaearOccupanty. Signature Applicant Date
Owner or au zed agent
Dae All roof coverings to be Class'n"or better
CITY OF CUPERTINO
REROOF
CUPEkTINO PERMIT APPLICATION
APN # 0 2_3 Date: 10 V
Bu' ding Address:
Owner's Name: Phone #:
HOA: Yes ❑ No Ifes rovide letter from HOA
#:
/' - Fax #:
Cupertino Business License #: Contractor License #:
Type of]goof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles Asphalt Shingles
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: - t_
Residential Commercial
Green Building: Please complete relevant po rtion 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 witli Cupertino's Tear-Off Policy:
Signature a
Revised 02/05/09
a( --
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 Standards B ALL PERMIT TYPES
Commission Fee
1BSEISMICO Seismic Co:nmercial B
1RER00FRES Re-roof Residential B 1SFDWLR00F
r
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commissio z Fee
1BSEISMICRE Seismic Re,,,idential B
1REROOFMRES Re-roof Mi.1ti-Family B 1MFDWLROOF
1BCBSC Cal Bldg Slandards B ALL PERMIT TYPES
Commission Fee
1BSEISMICRE Seismic Re3idential B
1 BUSLIC 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 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 appli:!d 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 arty 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 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 ort the job site at the time on inspection.
I understand and will comply with the above stated policy on re-roofing.
Homeowner's Name:
Greg Casteel
Building Official
Revi:ed 07/30/08
M.Indoor Air Quality and Finishes
1.Use Low/tJo-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*to 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
0
6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes
7.Seal AN Exxposea Parbdeboard 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
1 1
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
1 1 !
Total Points Available: 1 1401 1301 57
Total Points Project Received: 01 0 0
G:data/progs/grerb, nngguidelineshemodelers/greenpointsfinal2.12.D4protected.xis
Community Development
10300 Torre Avenue
.:. Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
1'UPEkTINO
BuildingDe artment
JOB ADDRESS: PERMIT # .�t
L
OWNER'S NAME: IPHONE #
GENERAL CONTRACTOR: }'� - E- tj # 7; �'- -.3
I am not using any subcontractors:
Si;nature 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