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09070016 CITY OF CUPERTINO f BUILDING DIVISION PERMIT �*:� � X .': BUILDING ADDRESS: PERMIT NO. 943 BLAZINGW OD AVE KEITH Rf� FIN _"NER'S NAME: PERMIT ISSUE DATE 2009 PHONE: S A CONTROL NO. (408) 29 -)-8616 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH app LICENSED CONTRACTOR'S DECLARATION Job Description U C I hereby affirm that I am licensed under provisions of Chapter 9(commencing (J with Section 7000)of Division 3 of the Business and Professions Code,and my license is : y in full force and est.. RE-RF R'4V COMP RF INSTL 3 0LB FLT&4 0YR COMP CLS A o ? License Class — Loc•0 2 3 S Q F p Dato Contractor ARCHITECTS DECLARA ON I understand my plans shall be used as public records �yU L OH Licensed Professional y 1 OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the COO following reason.(Section 7031.5,Business and Professions Code:Any city or county K which requires a permit to construct.alter,improve,demolish,or repair any structure Z >< prior to is issuance,also requires the applicant for such permit to file a signed statement =cthat he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 3q.Ft.Floor Area Valuation %t-$ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or 7 2 0 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 more than five hundred dollars(5500). 36920019 . 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:Ilse Conuactoes License Law does not apply to an owner of q 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 U. 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 See. B&P C for this reason ,mer 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- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑1 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's Cgmpe�uon l��rricr and Policy number am: Cartier �L/}�"� t Policy No.: 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 OCONSTRUCTION LENDING AGENCY [-r ham. I hereby affirm that there is a construction lending agency for the performance of 5 the work for which this permit is issued(Sec.3097,Civ.C.) QLender's Name Z LendefsAddress U 0 I certify that I have read this application and state that the above information is LL r� correct.I agree to comply with all city and county ordinances and state laws relating to Vbuilding construction,and hereby authorize representatives of this city to enter upon the Uabove-mentioned property for inspection purposes. (Wc)agree to save,indemnify and keep harmless the City of Cupertino against ►F.h OZ 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 h"h APPLICANT ERSTANDS AND WILL COMPLY WITH ALL ON- DINT Issued by: SOURCE AnONS. Re-roofs SeYA of Applicant/Contractor bate HAZARDOUS MATERIALS DISCLOSURE Type of R)of / 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 -'de,Section 25532(a)? All roofs:,hall be inspected prior to any roofing material being installed. ❑Yes o Will the applicant or uture building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove Will the applicantolutu.b emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new In Is for inspection. District? j ❑Yes I J�f6- 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Heahh&Sof Sectors 25505.25533 and 25534.1 understan�LhaL2th�cbufldi ndocs not c only ve a tenant.that it is my responsibility to notify fh must be met prior to issuance of a Certificate of Ocg a 2�73f Applic Date All roof coverings to be Class's"or better wa hnrizedagent Date ,0 t Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 CUPEKTINO Building Department JOB ADDRESS- PERMIT # —z1C?zir� �70oz� OWNER'S NAME: PHONE # -� GENERAL CONTRACTOR: r jtj FAX # ZqS-0 /'7 I am not using any subcontract o �64, 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 CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT' RECEIPT OPERATOR: patg COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 36920019 . 00 DATE ISSUED. . . . . . . : 07/06/2009 RECEIPT #. . . . . . . . . : BS000008121 REFERENCE ID # . . . 09070016 SITE ADDRESS . . . . . : 94.3 BLAZINGWOOD AVE SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : WYANDT DAVID A ADDRESS . . . . . . . . . . : 94:3 BLAZINGWOOD CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : ROGER BRIGHT CONTRACTOR . . . . . . . : BRnGHT, ROGER LIC # 21477 COMPANY . . . . . . . . . . : KE::TH ROOFING CO INC ADDRESS . . . . . . . . . . : 920 LINCOLN AVE CITY/STATE/ZIP . . . : SAN JOSE, CA 95126 TELEPHONE . . . . . . . . : (408) 295-8616 FEE ID UNIT QUANTITY �UMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 7,200 . 00 1 . 00 0 . 00 1 . 00 0 .00 1BSEISMICR VALUATION 7, 200 . 00 0 . 80 0 . 00 0 . 80 0 .00 1REROOFRES SQ FEET 23 .00 299 . 00 0 . 00 299 . 00 0 .00 - --------- ---------- ---------- ---------- TOTAL PERMIT 300 . 80 0 . 00 300 . 80 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 300 . 80 VISA --------------- TOTAL RECEIPT 300 . 80 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 604 ROOF IN-PROGRESS 605 FINAL REROOF J 0`7 0,3 I ff CITY OF CUPERTINO REROOF COF CUPERTINO PERMIT APPLICATION APN # i���� o O r � � � Date: -7 Building Address: `� (GIZih Owner's Name: _j,_),4ivi6( Phone #: HOA: Yes ❑ No If es provide lel ter from HOA �gg— Contractor: e Phone #: Fax #: "Z,q = G/7 Cupertino Business License #:a 1,/� Contractor License #: Type of F.00f Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles Asphalt Shingles qOV )�54_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. i ,00-09 Job Description nom{ F, T C s - Residential Commercial El 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 ind ex. Valuation: I Have Read, erstand and Will Comply with Cupertino's Tear-Off Policy: Sign 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 Conunercial B 1COMMLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1 BSEISMICO Seismic Commercial B _ 1 REROOFRES Re-roof Residential B 1SFDWLR00F 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee ' 1 BSEISMICRE Seismic ReE idential B 1RER00FMRES Re-roof Multi-Family B 1MFDWLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICRE Seismic Re,.idential B 1BUSLIC 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 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 apph ad without first obtaining all inspection and written approval from the building inspector. A final inspection and approval shall be obtained from the b gilding 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 cast 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 or the job site at the time on inspection. I understand and will comply with the above stated �oliicy on re-roofing. Homeowner's Name: DM Cf J Job Site Address: 0/T/ Roofing Company Name: f,l 1 k �Vi h j e-6 -J4_4_ Applicant's Signa e: Date: / t Greg Casteel Building Official Revis!d 07/30/08 M.Indoor Air Quality and Finishes 1•Use iowWVOC 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 Lowl%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 p 6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 0 7.Seal aJExposed Paffcl boa or MDF 41AQ/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 IAQMealth pts y=yes 0 1 D D N.Flooring 1.Select FSC Certified Wood Flooring B Resource pts y=yes 0 2'0se fitly 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 D 1 D D Total Points Available: r 140 1301 57 Total Points Project Received: 01 91 0 G:data/progslgref nbuildingguidelines/n;modelers/greenpointsfina12.12.D4protected.xls