09060030 CITY OF CUPERTINO
BUILDING DIVISION PERMIT
Cd1TR�►C0R II �t
r
BUILDING ADDRESS: PERMIT NO.
21631 RE ER
PERMIT ISSUE DATE
OWNER'S NAME:
209) 471-8292
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
a 0 o a
u p p LICENSED CONTRACTOR'S DECLARATION Job Description
U C I hereby affirm that I am licensed under provisions of Chapter 9(commencing
U 5 with Section 7000)of Division 3 of the Business and Professions Code,and my license is
R. L enull forceandeffeet 4' ? RE—RF T/0 EXT SHKRF RESHEET OSB, 30# FLT PRESDTL
z License s Lam• J
+t,� Date Contractor COMP CLS A 36SQ— SUMMERFIELD ROOFING RENWD BUS
ARCHITECrS DECLARATION
a< I understand my plans shall be used as public recordsL I C
Daav
.
S.0
th Licensed Professional
n 3 OWNER-BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractors License Law for the
p O following mason.(Section 7031.5,Business and Professions Code:Any city or county
K (ii which requires a permit to constructalter,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
Z< that he is licensed pursuant to the provisions of the Contractor's license Law(Chapter 9 Sq
I=- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or 7
y that he is exempt therefrom and the basis for the alleged exemption.Any violation of Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number
not more than five hundred dollars(5500). 35622013 . 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 Conuactoes License Law docs 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.).
[11.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-
ccnse 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.
0 I am exempt under Sec. B&P C for this mason
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-
_.ton,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
rI have and will maintain Workers Compensation Insurance,as required by Section
700 of the Labor Code,for the performance of the work for which this permit is issued.
My Worker's Compensation Insurance carrier and Polity number are:
Carrier, S i��t� .�sJ�llK) Policy No.: ��;— D/17V .5
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(chis section need not be completed if the permit is for one hundred dollars($100)
or less)
1 cerufv 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
,J O forthwith comply with such provisions or this permit shall be deemed revoked.
Z''' CONSTRUCTION LENDING AGENCY
Fes-. I hereby affirm that there is a construction lending agency for the performance of
p; the work for which this permit is issued(Sec.3097,Civ.C.)
W 0Lender's Name
az Lender's Address
I certify that 1 have read this application and state that the above information is
LUL" correct.I agree to comply with all city and county ordinances and state laws relating to
0 building construction,and hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes
Oa (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 (�
U Z in consequence of the granting of this permit. Date y l
APP
Dare T of Roof
HAZARDOUS MA ALS 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 YesNo
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
it hazardous air contaminants as defined by the Bay Area Air Quality Management all new r laterials for inspection.
strict?
0 Yes N
1 have read the hoz txism aterials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sections 25505.25533 and 25534.1 understand that if the building
docs not currently have a tenant,that it is my responsibility to notify the occupant M the
Date
CITY OF C UPERTINO
REROOF
CUPS TINO PERMIT APPLICATION
APN # Dater
D go C7 U
Building Address: Zl 6 3 ,1
PI a
Owner's Name: Phone #:
Contractor: Phone #: Z
U ,�e r � ld �,,,7�c
Fax#: Z o 9 - Zs'/
Cupertino Business License #: Contractor License #:
� 7-� 7 �6o a3 y
Type of Rc of Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
Asphalt Shingles
❑ Asphalt Shingles `�r�
?4+Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other (Specify) ❑ Other(Specify)
Number of existing coverings I ❑ Provide I.C.B.O. Report#
To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description:
ys
Commercial
Residential ❑
Green Building: Please complete relevant port ion of the Confirmed with Planning De
Green Building Checklist & attach it to the application if
or if there are any restrictions:
applicable, include in plan set & the sheet index.
Valuation: ` X73
Revised 6/16/08
CITY OF (;
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 agi 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 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 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 on the job site at the time on inspection.
I understand and will policy on re-roofing.
Homeowner's Name:
Job Site Address:
Roofing Company Name: �y m r-e r t"I G
Applicant's Signature:
Date: _y 2X q
Greg Casteel
Building Official
Revi;ed 07/30/08
Green Building Plan Check
Index of Green Building Points/Categories
A. Category Example of an Index or Table of Green Plan Sheet or Page Points
Building Points Categories that must be
shown and referenced on the Project
Plans ISee below
ENRON MIN
B. Site 9. Install H.E. Irrigation, (details/spec)" L-1 2 points
11. Permeable Paving, Note L-1 2 points
C. Foundation 1. Use 15 % Flyash Concrete, (nose) S-1 5 points
D. Structural 3. Uses Wood I-Joist, (See Spec.) S-2 2 points
5. Use Truss with heels, (detail) S-2 2 points
6. B. OSB Sheathing, detail S-2 2 points
E. Ext. Finish 1. Composite Decking, (Note/Spec:.) A-3 2 points
4. B. Fiber Cement Siding, (Note/Spec. A-4 2 points
F. Plumbing 1. Insulate all H.W. pipes, (Note/Spec.) P-1 2 points
5. Tankless W.H., (Note/Spec.) A-2 2 points
11. A 2500 Gal.Tank, (Note/Spec L-1 10 points
G. Electrical 4. E. Ceiling Fans, (Note/Spec.) A-3 4 points
H. Appliances 1. Energy Star Dishwasher, (NoteiSpec.) A-3 1 point
3. Energy Star Refrigerator, Note Spec.) A-3 1 point
P. Other 1. List Green Features on Plans A-1 1 point
TOTAL POINTS1 40 points
IL5
1_C4 I-
Plan Review Process Work Book Page-12-Revised 3/25/08
+!
1.Windows
1.Install Energy-Efficient Windows
a.Double-Paned Energy pt Y=yes 0
b.Low-SSsWvlty(LOaa E) Energy pts Y=Yes 0
c.Low.Conductivity Fmrnes Energy pts Y=yes 0
2,Install Low Heat Transmission Glazing Energy pt y=yes 0
■ 1 1 1
J.Heating Ventilation and Air Conditioning
1.Use Duct Mastic on Ail Duct Joints ?Energy pts Y=yes 0
2.Install Ductwork within Conditioned Space 3 Energy pts y=yes 0
3.Vent Range Hood to the Outside I IAQ/Health pt y=yes 0
4.Clean all Ducts Before Occupancy ?IAQ/Health pts y=yes 0
5.Install Solar Attic Fan 2 Energy pts y=yes
0
6.Install Attic Ventilation Systems 1 Energy pt y=yes 0
7.Install Whole House Fan 4 Energy pts Y=yes 0
8.Install Sealed Combustion Units
a.Furnaces 3 IAQ/Health pts y=yes 0
b.Water Heaters 3 IAQ/Health pts y=yes 0
9.Replace Wall-Mounted Electric and Gas Heaters with
Through-the-Wall Heat Pumps 3 Energy pts y=yes 0
10.Install 13 SEER111 EER or higher AC with a TXV 3 Energy pts y=yes 0
11.Install AC with Non-HCFC Refrigerants 2 Resource pts y=yes 0
12.Install 90%Annual Fuel Utilization Efficiency(AFUE)Furnace 2 Energy pts y=yes 0
13.Retrofit Wood Burning Fireplaces
a.Install EPA certified wood stoves/inserts 1 IAQ/Health pt y=yes 0
b. Install/Replace Dampers 1 Energy pt y=yes 0
c.Install Airtight Doors 1 Energy pt Y=yes 0
14.Install Zoned,Hydronic Radiant Heating 3 Energy pts y=yes 0
15.Install High Efficiency Filter 4 IAQ/Health pts y=yes 0
16.Install Heat Recovery Ventilation Unit(HRV) 5 IAQ/Health pts y=yes 0
17.Install Separate Garage Exhaust Fan 3 IAQ/Health pts yges 0
1 1 1
K.Renewable Energy and Roofing
1.Pre-Plumb for Solar Water Heating 4 Energy pts y=yes 0
2.Install Solar Water Heating System 10 Energy pts y=yes 0
3.PreAkfire for Future Photovoltaic(PV)Installation 4 Energy pts y=yes 0
4.Install Photovoltaic(PV)System
(1.2 kw=6 points,2.4 kw=12 points,3.6 kw=18 points) Up to 18 Energy pts 0
6.Select Safe and Durable Roofing Materials 1 Resource pt Y=yes E 0
7.Install Radiant Barrier 3 Energy pts y=yes 0
' 1 1 1
L.Natural Heating and Cooling
1.Incorporate Passive Solar Heating 5 Energy pts y=yes 0
2.Install Overhangs or Awnings over South Facing Windows 3 Energy pts y=yes 0
3.Plant Deciduous Trees on the West and South Sides 3 Energy pts y-yes 0
INPUT Resources Energy 14'blHeafth
M.Indoor Air Quality and Finishes
1.Use Low/No-VOC Paint IAQ/Health pts y=yes 0
2.Use Low VOC,Water-Based Wood Finishes IAQ/Health pts y=yes. 0
3.Use Low/No VOC Adhesives :s 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 i IAQ/Health pts y=yes 0
6.Use Exterior Grade Plywood for Interior Uses IAQ/Health pts y=yes 0
7.Seal all Exposed Particleboard or MDF I IAQ/Health. pts y=yes 0
8.Use FSC Certified Materials for Interior Finish 1 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 E Resource pts y=yes 0
2.Use Rapidly Renewable Flooring Materials 4 Resource pts y=yes 0
3.Use Recycled Content Ceramic Tiles z Resource pts y=yes 0
4.Install Natural Linoleum in Place of Vinyl IAQ/Health pts y=yes 0
5.Use Exposed Concrete as Finished Floor Resource pts y=yes 0
6.Install Recycled Content Carpet with Low VOCs Resource pts y=yes 0
Total Points Available: 1 1401 1351 57
Total Points Project Received: j ��- 1 01 0 0
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u - Community Development
10300 Torre Avenue
�' ;• Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
1'UPEI�TINO
BuildingDe artment
JOB ADDRESS: �' PERMIT #
916,51 �Ce4 n w � 69a06'00 �
OWNER'S NAME:
,,,� / �, FAX #
I am not using any subcontractors. Q
Si.:,natureU 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/Co tra Signature Date