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09070130 CITY OF CUPERTINO BUILDING DIVISION PERMIT + � TR�. +D I } , TI(�Nr ;» BUILDING ADDRESS: PERMIT NO. 908 BROOKGROVE LN CD ROOF-ING OWNER'S NAME: PERMIT ISSUE DATE GTW 7 JNE: A O. 9 9 9 CONTROL NO. (408) 89:3-6605 ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH u O p LICENSED CONTRACTOR'S DECLARATION Job Description m I hereby affirm that I am licensed under provisions of Chapter 9(commencing Zwith Section 7000)of Division 3 of the Business and Professions Code.and my license is =y in full force and eff RE-RF T/0 ASPHLT SHNGLS INSTL NEW ASPHALT SHNGLS j ? License Clasa —Lic.M 9�2 T ±F- Date — Contfactor _�rtfAt6t�.� BASE & TORCH MAX 25SQ CLS A AR ITECPS DECLARATION 19-, 1 understand my plans shall be used as public records 7yU io Licensed Professional y 3 OWNER-BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the 00 following reason.(Section 7031.5,Business and Professions Code:Any city or county K a ff which requires a permit to construct.alter,improve,demolish,or repair any structure u Z prior to its issuance,also requires We applicant for such permit to file a signed statement =2c F that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 3q.Ft.Floor Area Valuation yH$ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or 6 O O 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($500). 37539037 . 00 ❑I,as owner of the property,or my employees with wages as their solo compensation, will 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 docs 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.). ❑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 thereon,and who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law. ❑1 am exempt under Sec B&P C for this reason Owner 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-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. ❑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 Workers Compensation Insurance carrier and Policy number are: Carrier. : 'f Tr C,,%v-- Policy No.: C262 CERTIFICATEO OF EXEMPTION FRO WRER KS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or Icsa) 1 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 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 Er r�-m 1 hereby affirm that there is a constructinn lending agency for the performance of (Y, the work for which this permit is issued(Sec.3097,Civ.Q W Q Lender's Name Z Lender's Address U O l certify that I have read this application and state that the above information is V.t" correct I agree to comply with all city and county ordinances and state laws relating to 0 V building construction.and hereby authorise representatives of this city to enter upon the W above-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against rA liabilities,judgments,costs and expenses which may in anyway accrue against said City lJ z inconsequence of the granting of this permit. Date APPLICANT UND ST DS OMPLY WITH ALL NON-POINT Issued by: wit SOURCE REG J - - Re-roofs erre ofApplicant/Congkdror Dale HAZARDOUS MATERIALS DISCLOSURE Type of R)of Will the applicant or future building occupant store or handle hazardous material as defined bythe Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Code,Section 25532(a)? All roofs:hall be inspected prior to any roofing material being installed. ❑Yes N_ Will the applicant or future 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 materials for insp %flon. District? ❑Yes � / > l havc read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building does not currently havea that it is my responsibility to notify the occupant of the / 7 requiremems whit st et tom uance of a Certificate of occupancy. Signature A Applicant Date All roof coverings to be Class'n'or better 04wer or authorized f9ent Dale CITY OF CUPERTINO 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec : Twp: Rng: Sub: Blk : Lot : APN . . . . . . . . : 37539037 . 00 DATE ISSUED. . . . . . . : 07/16/2009 RECEIPT # . . . . . . . . . BSC00008208 REFERENCE ID # . . . : 09C70130 SITE ADDRESS . . . . . : 90E BROOKGROVE LN SUBDIVISION . . . . . . CITY CUFERTINO IMPACT AREA . . . . . . OWNER GIF GIAO ADDRESS 90E BROOKGROVE LN CITY/STATE/ZIP . . . : CUFERTINO, CA 95014 RECEIVED FROM . . . . : CHFRLIE DUONG CONTRACTOR . . . . . . . : CHF.RLIE DUONG LIC # 28245 COMPANY . . . . . . . . . . : CD ROOFING ADDRESS 29C9 WILBUR AVE CITY/STATE/ZIP . . . : SAT JOSE, CA 95127 TELEPHONE . . . . . . . . : (4C8) 898-6605 FEE ID UNIT QUANTITY FMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- -- -------- ---------- ---------- ---------- 1BCBSC VALUATION 6, 000 . 00 1 . 00 0 .00 1 . 00 0 .00 1BSEISMICR VALUATION 6, 000 . 00 0 . 60 0 . 00 0 . 60 0 . 00 1BUSLIC FLAT RATE 1 . 00 114 . 00 0 . 00 114 . 00 0 . 00 1REROOFRES SQ FEET 25 . 00 325 . 00 0 . 00 325 . 00 0 . 00 -- -------- ---------- ---------- ---------- TOTAL PERMIT 440 . 60 0 .00 440 . 60 0 .00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 440 .60 AMEX --------------- TOTAL RECEIPT 440 . 60 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 604 ROOF IN-PROGRESS 605 FINAL REROOF CITY OF CUPERTINO C) REROOF OF CUPEkTINO PERMIT APPLICATION APN # _� Date: Building Address: J Owner's Name: , ,� v Phone#( � � G HOA: Yes ❑ No Ell If yes, provide letter from HOA ) 21 - Contractor: Phone#: ,-2 20 t-o 6- Fax #: Cupertino Business License #: I Contractor License #: �C `t ;q Type of Roof Covering: Existing: Proposed: ❑ . Built-Up Roof ❑ Built-Up roof 'e� Asphalt Shingles 6r Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other (Specify) r�- ( p 4='>�-w, ❑ Other (Specify) Number of existing coverings ❑ Provide I.C.C.E.S. Report# ❑ To be Removed ❑ Provide Mfgr. Installation Specs. Job Description: j f Residential Commercial Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if Green Building Checklist & attach it to the aF plication or if there are any restrictions: ❑ applicable, include in plan set & the sheet index. Valuation-- I Have Read, Understand andLiComply with Cupertino's Tear-Off Policy: Signature Revised 02/05/09 CITY OF ('UPERTINO :. REROOF CUPEkTINO FEE SCHEDULE Number of Fee ID Fee Description Fee Permit Type Squares Group 1 REROOFCOM Re-roof Commercial B 1 COMMLROOF 1 BCBSC Cal Bldg S:andards B ALL PERMIT TYPES Commission Fee 1BSEISMICO Seismic Commercial B �s 1REROOFRES Re-roofRe,;idential B 1SFDWLR00F / 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commissio a Fee 1 BSEISMICRE Seismic Re,-idential B 1RER00FMRES Re-roof Multi-Family B 1MFDWLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1 BSEISMICRE Seismic Residential 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 I.ity of Cupertino 1. Prior to permit issuance,you must agrae 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 apphE d 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 an�roofing installation. 4. To receive a final sign off from the Cit;,,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 ma serial down to the sheathing, so a proper City inspection can be perf c)rmed. 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 car 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 the job site at the time on inspection. I understand and will comply with the above stated policy on re-roofing. Homeowner's Name: 9//'_ ��/ Job Site Address: -Y-R L' 0 C Roofing Company Name: Applicant's Signature: �' '' Date: C Greg Casteel Building Official Revise 107/30/08 M.Indoor Air Quality and Finishes 1.t 9btbiw oc Pan, IAQ/Health pts y=yes 0 2.Use Low VOC,Water-Based Wood Finishes 2.IAQ/Health pts y=yes 0 3 M IAQ/Health pts y=yes 0 4.Use Salvaged Materials for Interior Finishes :I Resource pts y=yes 0 5.Use Engineered Sheet Goods with no added Urea Formaldehyde E,IAQ/H"th pts y=yes 0 6.Use Exterior Grade Plywood for Interior Uses IAQ/Health pts y=yes 0 7._Sejdil Pisl@l+ tldlll IAQ/Health. pts y=yeS 0 8.Use FSC Certified Materials for Interior Finish Resource pts y=yes 0 9.Use Finger-Jointed or Recycled-Content Trim Resource pts y=yes 0 10.Install Whole House Vacuum System 3 IAQ/Health pts y=yes 0 ■ 1 1 1 N.Flooring 1.Select FSC Certified Wood Flooring 8 3esource pts y=yes 0 2.Use Rapidly Renewable Flooring Materials 4 3esource 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 3esource pts y=yes 0 6.Install Recycled Content Carpet with Low VOCs 4 resource pts y=yes 0 ■ 1 i 1 Total Points Available 1 1401 130 57 Total Points Project Received: 01 0 0 G:data/progs/greent uildingguidelines/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: PERMIT # )Q 0-� O ` 3 OWNER'S NAME: � c> PHONE # p s GENERAL CONTRACTOR: L" << FAX # o jg,S I am not using any subcontractors: C 6 © 57- Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSI1',fESS 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/G actor Signature Date