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09070147 CITY OF CUPERTINO ^th BUILDING DIVISION PERMIT *� � � MT�� � BUILDING ADDRESS: PERMIT NO. 10856 BR00KWFT,T, DR WESTSHORE ROOF OWNER'S NAME: PERMIT ISSUE DATE .toNJAjES14 SHAH 2245 -A RDREPTRiH DR A O. 8 6 9 CONTROL NO. 408) 694-0060 ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH a O p LICENSED CONTRACTOR'S DECLARATION WI hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description z with Section 7000)of Division 3 of the Business and Professions Code,and my license is <o in full force and effect L RE—RF IVSTL LANDMARK PLUS 40YR COMP CLS A RF 21 z License Clan r' ' Lic.ff nF a Date Contractor SQ ARCHrrECTSDECLAR ee -3 I understand my plans shall be used as public records Y-60 15/32 03B & 30# FLT ?WU 4 Q y Licensed Professional n 0OWNER-BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the C O O following reason.(Section 7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure Z y prior to its issuance,also requires the applicant for such permit to rile a signed statement < that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation y1-0 (commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he is exempt therefrom and the basis for the alleged exemption.Any violation of $9858 Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type not more than rive hundred dollars(5500). 36921026 . 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 and Professions Code:The Contractor's License Law does not apply to an owner of Required Inspections 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 docs 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 reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affumt 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. ❑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 Workees Compensation Insurance carrier and Policy number arc: Cartier. 2f,i 1-4 r m rt aL Policy No.:1 S?- -econ CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is formic 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 Workces Compensation provisions of the Labor Code,you must ,J O forthwith comply with such provisions or this permit shall be deemed revoked. Z 0-4CONSTRUCTION LENDING AGENCY [~i h4. 1 hereby affirm that there is a construction lending agency for the performance of (Y > the work for which this permit is issued(Sec.3097,Civ.C.) 0 Lender's Name Z Lender's Address U O 1 certify that 1 have read this application and state that the above information is VL*- 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 Uabove-mcndoncd property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against „Hy C.41 liabilities,judgments,costs and expenses which may in any way accrue against said City l U Z in consequence of the granting of this permit Date "y APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by SOURCE REG 'IONS. Re-roofs rgnature of Appliean ontractor Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof 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 ihall be inspected prior to any roofing material being installed. ❑Yes 1° 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 inspection. District? ❑Yes No 1 have 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 ` L the occupant of the Q docs not currently have a tenant,that it is my responsibility to notify requirements which must be met prier to issuance of a Certificate of occupancy. Signature of Applicant Date wneror then agent o All roof coverings to be Class's"or better CITY OF CUPERTINO 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec : Twp: Rng: Sub: Bl}:: Lot : APN . . . . . . . . : 36921026 . 00 DATE ISSUED. . . . . . . : 07/21/2009 RECEIPT #. . . . . . . . . : BS(100008234 REFERENCE ID # . . . : 09070147 SITE ADDRESS . . . . . : 10E156 BROOKWELL DR SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER RA�FESH SHAH ADDRESS . . . . . . . . . . : 10E�56 BROOKWELL DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : BEN FOWLER CONTRACTOR . . . . . . . : PATTL FOWLER LIC # 21417 COMPANY . . . . . . . . . . : WESTSHORE ROOFING INC ADDRESS . . . . . . . . . . : 224:5-A FORTUNE DR CITY/STATE/ZIP . . . : SAI JOSE, CA 95131 TELEPHONE . . . . . . . . : (408) 694-0060 FEE ID UNIT QUANTITY liMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- -- -------- ---------- ---------- ---------- 1BCBSC VALUATION 9, 858 . 00 1 . 00 0 .00 1 . 00 0 .00 1BSEISMICR VALUATION 9, 858 . 00 1 . 00 0 .00 1 . 00 0 . 00 1BUSLIC FLAT RATE 1 .00 114 . 00 0 .00 114 . 00 0 . 00 1REROOFRES SQ FEET 21 .00 273 . 00 0 .00 273 . 00 0 . 00 ----------- ---------- ---------- ---------- TOTAL PERMIT 389 . 00 0 .00 389 . 00 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 389 . 00 MC --------------- TOTAL RECEIPT 389 . 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 604 ROOF IN-PROGRESS 605 FINAL REROOF CITY OF CUPERTIN0q 01 Lf O RE ROOF CUPEkT1NO PERMIT APPLICATION APN # 3 �e- -( Date: (/Opt Building Address: jp$ 56 9(voif we ti c'r, Owner's Name: F Aj e 5 h 5 kArih Phone #: HOA: Yes ❑ No M If Yes, provide letter from HOA Contractor: Phone #: X156 - bZ a v Fax #: '/5-6 - CZ- 3_? Cupertino Business License #: Contractor License #: 7, z 2_ Type of I:oof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof X Asphalt Shingles * Asphalt Shingles )w,,. Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other (Specify) ❑ Other (Specify) Number of existing coverings 2- ❑ Provide I.C.C.E.S. Report# ` To be Removed ❑ Provide Mfgr. Installation Specs. Job Description: k4c Al G Oki d VN0 k k -rL,ILA 15 1/0 yr_ co Mr. c-16455 A �Zn�f �- � X6/31 �Sa ; 30 fe Residential Commercial Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if Green Building Checklist & attach it to the aliplication or if there are any restrictions: ❑ applicable, include in plan set & the sheet index. Valuation: I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy: Signature Revised 02/05/09 CITY OF C'UPERTINO :.. REROOF CUPERTINO FEE SCHEDULE Number of Fee ID Fee Description Fee Permit Type Squares Group 1REROOFCOM Re-roof Commercial B 1COMMLROOF 1 BCBSC Cal Bldg S1 andards B ALL PERMIT TYPES Commission Fee 1 BSEISMICO Seismic Commercial B 2 J 1REROOFRES Re-roof Residential B 1SFDWLR00F / 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commissio:l Fee 1BSEISMICRE Seismic Re:;idential B 1REROOFMRES Re-roof Multi-Family B 1MFDWLROOF IBCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1 BSEISMICRE 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 agree to comply with 2007 IBC Standards and manufacturers specifications on r,!-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 buildir.g 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 nai I inspection is required. 6. Any roofing which is applied without first obtaining an inspection, will require the removal of all new me terial down to the sheathing, so a proper City inspection can be per..=ormed. 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 comply with the above stated policy on re-roofing. Homeowner's Name: I�� P�j'1 S�1 u;1 Job Site Address: /0 $�- (D 13rn c r we Q� Roofing Company Name: 1N V0S fS N (Y' C_ 7 Applicant's Signature: Date: Greg Casteel Building Official Revised 07/30/08 Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 ;,UPEkTINO Building Department JOB ADDRESS: p $5-6 �rdo we l, or. PERMIT# Oda-70 ( L--(-% OWNER'S NAME: Rc.N,e 5 k Sha,h . PHONE # Y3-6- v v GENERAL CONTRACTOR: W e5t5ho e-e tz FAX # 47,r ? I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSI14ESS 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 Dale M.Indoor Air Quality and Finishes 1.Use LowMo-VOC PaFnt 1 IAQ/Health pts y=yes 0 2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes 7 0 3.Use Low/No 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 6IAQ/Health pts y=yes 0 6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 0 7.°sal el Paribclabowd or MDF 4 IAQ/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=yesi 0 1 ! 0 N.Flooring 1= 1.Select FSC Certified Wood Flooring B Resource pts y=yes 0 ?—.Use Rapidly Renewable Flooring Nfaterials 4 Resource pts y=yes 0 3.Use Recycled Content Ceramic Tiles 4 Resource pis 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 F E Total Points Available: 1401 1301 57 Total Points Project Recelved: 1 01 0 0 I /eel G:daWprogslgre:nbuildingguidelines/remodelerslgreenpointsfinaf2.12.D4protected.xls