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09070045 CITY OF CUPERTINO BUILDING DIVISION PERMIT 00N BUILDING ADDRESS: PERMIT NO. 10647 S BLANEY AVE MBROWN CONS 09070045 "NER'S NAME: PERMIT ISSUE DATE PHONE: surtAIM6.2CONTROL NO. (408) 26 )-1260 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 app LICENSED CONTRACTOR'S DECLARATION Job Description V I hereby a ,zLu affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is y in full force ande£fect ! RE-RFRY1 EXT RF & INSTL APPX 2 8 SQ OF COMP RF 3 ? License lass Lic.0 +F.a Date - -49 7 Contractor/JGl nt,A," W/S H EAT:3I NG CLS A ARCHITECTS DECLARATION 1 understand my plans shall be used as public records �yU `L6 H Licensed Professional N 3 OWNER-BUILDER DECLARATION jt x I hereby affirm that 1 am exempt from the Contractor's License Law for the OO following reason.(Section 7031.5,Business and Professions Code:Any city or county K$ff which requires a permit to construct.alter,improve,demolish,or repair any structure a Zprior to its issuance,also requires the applicant for such permit to file a signed statement _ that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation Y.F$ (commencing with Scction 7000)of Division 3 of do Business and Professions Codc)or 4 6 9 0 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 mem than five hundred dollars(M). 36933003 . 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 ns Required Inspections and Professions Code:The Contractor's License Law dues 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 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. ❑I am exempt under Sec B&P C for this mason vner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑1 have and will maintain a Certificate of Consent to self-insum for Worker's Compen- sation,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 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Worker Compensation Insurance carrier and Policy number am: Carrier. (J�—` Policy No.:0C V940? !J?WO L 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 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 Oforthwith comply with such provisions or this permit shall be deemed revoked. Z' CONSTRUCTION LENDING AGENCY (~- (A I hereby affirm that there is a construction lending agency for the performance of a+> the work for which this permit is issued(Sec.3097,Civ.C.) QLender's Name ►7 Z Lender's Address V 0 1 certify that I have mad this application and sate that the above information is VL correct.I agree to comply with all city and county ordinances and sate laws relating to 0 V building construction,and hereby authorize representatives of this city to enter upon the W above-mentioned property for inspection purposes LL (We)agree to save,indemnify and keep harmless the City of Cupertino against Hcol liabilities,judgments,costs and expenses which may in any way accrue against said City !� V Z in consequence of the granting of this permit. y Date —7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued b SOURCE REGULATION Gam' -7-6-orf Re-roofs Signature of Applicant/Contractor Date HAZARDOUS MATERIALS DISCLOSURE Type of R sof Will the applicant or future building occupant stom or handle hazardous material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety -de,Section 25532(a)? All roofs:;hall be inspected prior to any roofing material being installed. ❑Yes Will the applicant or forum building occupant use equipment or devices which If a roof i:;installed without first obtaining an inspection,I agree to remove emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new m iterials for inspection. District? ❑Yes 1 have read the harardcws materials requirements under Chapter 6.95 of due Califor- nia Health&Safcty Codc,Sections 25505.25533 and 25534.I understand that if dtc building does not currently have a tenant,that it is my responsibility to notify the occupant of the requirements which must et ito issuance ofa certificate of Occupancy. Signature A Applicant Date All roof coverings to be Class's `'or better Owner orauthorized agent Date CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 36933008 . 00 DATE ISSUED. . . . . . . : 07/06/2009 RECEIPT #. . . . . . . . - : BS000008136 REFERENCE ID # . . . : 09070045 SITE ADDRESS . . . . . : 10647 S BLANEY AVE SUBDIVISION . . . . . . CITY CUFERTINO IMPACT AREA . . . . . . . OWNER JANE ASHER ADDRESS . . . . . . . . . . : 10647 S BLANEY AVE CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4542 RECEIVED FROM . . . . : CHRIS BROWN CONTRACTOR . . . . . . . : CHRIS BROWN LIC # 25108 COMPANY . . . . . . . . . . : MBROWN CONSTRUCTION, INC ADDRESS . . . . . . . . . . : 702 S DANIEL WAY CITY/STATE/ZIP . . . : SAN JOSE, CA 95128 TELEPHONE . . . . . . . . : (4C8) 260-1260 FEE ID UNIT QUANTITY PMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 4 , 690 .00 1 . 00 0 . 00 1 . 00 0 .00 1BSEISMICR VALUATION 4, 690 . 00 0 .50 0 .00 0 . 50 0 .00 1REROOFRES SQ FEET 28 . 00 364 . 00 0 . 00 364 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 365 . 50 0 . 00 365 .50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 365 . 50 VISA --------------- TOTAL RECEIPT 365 .50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 604 ROOF IN-PROGRESS 605 FINAL REROOF Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 CUPERTINO Building Department JOB ADDRESS: PERMIT# OWNER'S NAME: c Gr PHONE # 1v,(--A( la'd GENERAL CONTRACTOR: FAX# I am not using any subcontractors: Signature Date Please check applicable subcontractors and com-Aete 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 7 y Owner/Contractor Signature Date Dct0-� 0� CITY OF CUPERTINO I a-]TyF:d REROOF CUPEkTINO PERMIT APPLICATION APN # -- T----- -3--3 0 F7 D7 Date: ,3 (a 9 Building Address: D-049 Spy+i, bc��vKy_ Ave, Owner's Name: Phone #: 5ohc, Contractor: _ Phone #- �� r�� N1l'jirow►� C,c��1C�-�c.�' ,Tr�G, C ------- -- - Fax #: 0 • 12-L0 Cupertino Business License #: C ntract—or License #: - --- '► _ _-------- --_ 0S2Z Type of R)of Covering: Existing: Proposed: ❑ Built-Up Roof ❑ uilt-Up roof 1D Asphalt Shingles V Asphalt Shingles Wood Shakes ❑ Wood Shakes j ❑ Wood Shingles ❑ Wood Shingles ❑ Other(Specify) ❑ Other (Specify) [V tuber of existing coverings _1 _ ❑ Provide I.C.B.O. Report # To be Removed ❑ Provide Mfgr. Installation Specs. Job Description:i mDDt)(I rs" Ql nstt (_l G_pes'oY_ - Std, . Residential fu —� Commercial Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if Green Building Checklist & attach it to the apr lication or if there are any restrictions: ❑ applicable, include in plan set & the sheet index:. Valuation: --- ----- ----------- Have Read, Understand and Will Comply with C upertino's hear-Off Policy: Signature Revised 6/16/08 aU -1 CITY OF CUPERTINO REROOF CUPEkT1NO 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 Commission Fee 1BSEISMICO Seismic Commercial B 1RER00FRES Re-roof Residential B 1SFDWLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICRE Seismic Residential B 1 REROOFMRES Re-roof Mu''Lti-Family B 1MFDWLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICRE Seismic Residential B 1 BUSLIC Business Li,;ense 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 agr:e to comply with 2007 IBC Standards and manufacturers specifications on rc-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 any 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 3f$176.18. The re-inspection fee must be paid before another inspection can be scheduled. IMPORTANT: 1. Flat roofs must have a minimum of 1/4 "per foot slope and demonstrate that there is no ponding. 2. An I.C.B.O. report is required to be on t-ie job site at the time on inspection. I understand and will comply with the above stated policy on re-roofing. Homeowner's Name: �� Ask(Pr Job Site Address: 64- Roofing Company Name:M RA" 0QG:!!t2d4Z,91 . D-) (' . Applicant's Signature: Date: �- v Greg Casteel Building Official Revised )7/30/08 M.lndOor Air Quality and Finishes 1.Use LOW No-VOC Pairt 1 IAQ/Health pts y=yes 0 2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes 0 3.Use LowNo 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 Plywoodfor Interior Uses 1 IAQ/Health pts y=yes 7.Seaial;�osed�'�deboard or WF 4[AD/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 1 ! 1 N.Flooring 1.Select FSC Certified Wood Flooring 6 Resource pts y=yes 0 2 Lise Rapidly Renewable Flooring MaWals 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 i ! Total Points Available: 1 1401 130 57 Total Points Project Received: 0 0 0 G:data/progs/gre:nbuildingguidelines/remodelers/greenpointsfinal2.12.04protected.xls