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09070146Z w ds. U< wE 0( FG ►� F U� CITY OF CUPERTINO PERMIT �� � T fi BUILDING DIVISION BUILDING ADDRESS: PERMIT NO. 864 KIM ST WILLIAM RINEY (1W NER'S NAME: PERMIT ISSUE DATE i A CONTROL NO. ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description ► hereby 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 RE—RF HJ RCVD ALL INSPECTIONS ON PREV in full force and effect License Class Lle• 8 Dale Contractor PERMIT (7050094) r NEED FINAL INSPECTION CLS A ARCHITECTS DECLARATION 16 S Q 1 understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the 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 Sq. Ft. Floor Area Valuation prior to its issuance, also requires the applicant for such permit to file a signed statement License Law (Chapter 9 that he is licensed pursuant to the provisions of the Contractor's (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 10 0 that he is exempt therefrom and the basis for the alleged exemption. Any violation of APN Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (3500). 35919036 .00 ❑ I, as owner of the property, or my employees with wages as their sok compensation, Required Inspections q 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 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.). �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 contractors) licensed pursuant to the Contractor's License Law. ❑ 1 am exempt under Sec B & P C for this reason Owner ' `7 Dare WORKER'S COMPEN TION 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. ❑ 1 have and will maintain Workers 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 Compensation Insurance carrier and Policy number arc: Carrier. Polity No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is forone hundred dollars ($100) or lass.) I certifv that in the performance of the work for which this permit is issued, l shall not employ any person in any man r g c act to the Workcrs' Compensation Laws of Califq% DUe_ 77// YY1 Applicant NOTICE TO APPLICANT: If, after making this qartificatc of Exemption, you should become subject to the Worker's Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. " CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.) Lendces Name Lender's Address 1 certify that I have read this application and state that the above information is " correct 1 agree to comply with all city and county ordinances and state laws relating to " building construction, and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. 4 (We) agree to save, indemnify and keep harmless the City of Cupertino against F) liabilities, judgments, costs and expenses which may in any way accrue against said City in consequence of the granting of this permiL t APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by Date )OURCEREGULATIONS (1-1 1119 Re -roofs Type of Roof Signature of Applicant/CionActor Cate HAZARDOUS MA RIALS DISCLOSURE 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 .11 Code, Section 25532(a)?All roofs ;hall be inspected prior to any roofing material being installed. ❑Yes If a roof i; installed without first obtaining an inspection, I agree to remove Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? _ ❑ Yes L'^u 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 does not currently have a ant, that it is my responsibility to notify the occupant of the issuance Certificate Occa er. Date rcquircme which m met prior to of a Signature of Applicant 77 2f a All roof coverings to be Class'n" or better Owner or authorized agent Date CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT.' RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 35919036.00 DATE ISSUED.......: 07/21/2009 RECEIPT #......... BS000008233 REFERENCE ID # ... 09070146 SITE ADDRESS .....: 864 KIM ST SUBDIVISION ...... CITY .............. CUPERTINO IMPACT AREA ...... OWNER ............: WILLIAM RINEY ADDRESS ..........: 864 KIM ST CITY/STATE/ZIP ...: CUPERTINO CA, OPERATOR: patg COPY # : 1 95014-4323 RECEIVED FROM ....: WILLIAM M RINEY CONTRACTOR .......: LIC # *OWNER* COMPANY ..........: WILLIAM RINEY ADDRESS 864 KIM ST CITY/STATE/ZIP ...: CUPERTINO CA, 95014-4323 TELEPHONE ........ FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL ----------------------- 1BCBSC VALUATION ---------- 100.00 ---------- 1.00 ---------- 0.00 -------------------- 1.00 0.00 1BSEISMICR VALUATION 100.00 0.50 0.00 0.50 0.00 1REROOFRES SQ FEET 16.00 208.00 0.00 208.00 ---------- 0.00 TOTAL PERMIT ---------- 209.50 ---------- 0.00 ---------- 209.50 0.00 METHOD OF PAYMENT ----------------- CHECK TOTAL RECEIPT AMOUNT --------------- 209.50 --------------- 209.50 VOICE ID DESCRIPTION -------- ---------------------------- 601 ROOF TEAR OFF REFERENCE NUMBER -------------------- #1253 VOICE ID DESCRIPTION -------- ---------------------------- 602 ROOF PLYWOOD NAIL 604 ROOF IN -PROGRESS 605 FINAL REROOF c 0-7 c) r T(e CITY OF CUPERTINO =- REROOF CUPEi�TiNO PERMIT APPLICATION APN # i ` O J Date: C) _' Z © g Building Address. Owner's Name: t li /v(, °� p Phone #: HOA: Yes ❑ Noes rovide leiter from HOA C4 �'g `- 4 (� Contractor: Phone #: Fax #: Cupertino Business License #: Contractor License #: Type of Roof Covering: Existing: Proposed: ❑ Built -Up Roof ❑ Built -Up roof ❑ Asphalt Shingles a--'-A-sphalt Shingles w' 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. Job Description: ,� ,� C E ��� (,� ��� �va,S • YIN115C Qpm '-� Residential Commercial 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 index. Valuation: 0. I Have Read, Understand and Will C ply with Cupertino's Tear -Off Policy: 07 F Signature Revised 02/05/09 CITY OF C'UPERTINO REF:OOF CITY Of CUPEkTiNO FEE SCHEDULE Number of Squares Fee ID Fee Description Fee Group Permit Type 1 REROOFCOM Re -roof Commercial B 1COMMLROOF 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICO Seismic Commercial B / IREROOFRES Re -roof Re;>idential B 1SFDWLR00F 1BCBSC Cal Bldg Standards Commissio n Fee B ALL PERMIT TYPES / 1 BSEISMICRE Seismic Re ;idential B 1 REROOFMRES Re -roof W lti-Family B 1MFDWLROOF 1BCBSC Cal Bldg Standards Commissio l Fee B ALL PERMIT TYPES 1BSEISMICRE Seismic Re;;idential B 1BUSLIC Business License 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 re -roofing. All roofs are Class "A" per Cupertino municipal code 16.04.080. 2. New roof coverings shall not be apphad 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 Ciiy, 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 fe a 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 1/4 " 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 abov a stated policy on re -roofing. Homeowner's Name: / - • , QQ � Job Site Address: & Roofing Company Name: Applicant's Signature: Greg Casteel Building Official Revisad 07/30/08 1. Use L,Dw/NO-VOG Pmt 2. Use Low VOC, Water -Based Wood Finishes 3. Use Lo* No VOC Adhesives 4. Use Salvaged Materials for Interior Finishes 5. Use Engineered Sheet Goods with no added Urea Formaldehyde S. Use Exterior Grade Plywoodfor Interior Uses 7. Seal ail dosed Parf deboard or WF 8. Use FSC Certified Materials for Interior Finish 9. Use Finger -Jointed or Recycled -Content Trim 10. Install Whole House Vacuum System N. Flooring 1. Select FSC Certified Wood Flooring ?.:Use Rapidly Renewable Flooring Materials 3. Use Recycled Content Ceramic Tiles 4. Install Natural Linoleum in Place of Vinyl 5. Use Exposed Concrete as Finished Floor 6. Install Recycled Content Carpet with Low VOCs Total Points Available: Total Points Project Received: 1 IAQ/Health pts y --yes 21AQ/Health pts y=yes 3IAQ/Health pts y=yes 3 Resource pts y=yes 61AQ/Health pts y=yes 1 IAQ/Health pts y=yes 41AQ/Health. pts y=yes 4 Resource pts y=yes 1 Resource pts y=yes 3 IAQ/Health pts y=yes 8 Resource pts 4 Resource pts 4 Resource pts 5 IAQ/Health pts 4 Resource pts 4 Resource pts y=yes y=yes y=yes y=yes y=yes 1401 130 57 C7— 01 01 0 t "7 12-/ /72 9 G:data/progs/gre enbuildngguidelines/remodelers/greenpointsfinal212.04protected.xls OWNER -BUILDER VERIFICATION 1. (Check one) I or my immediate family (parent, spouse or child) will perform A. ill the work authorized by this permit B. A portion of the work C. — None of the work If B or C is checked, complete 2 or 3 below. 2 A state licensed contractor will be hired to do: A. All of the work B. A portion of the work (complete section below) Phone # State License # Type of work to 3. I will utilize unlicensed person(s) other than my immediate family to perform all or portions of the authorized work. I understand that I may be an employer (see reverse side). A Certificate of Insurance covering workers' compensation must be on file at the City of Cupertino Building Department office. PersorVFirm Address/City. . [Phone Number I Type of work to be Performed I declare under penalty of perjury that the above is true and correct. I have read and understand the Owner -Builder Information (reverse side). Property Owner's Signature: �'�.� Date: (07 Z( /2-609 Job Address: Permit # 0917 t �' Any changes to the information Provided on this form shall be submitted to the City of Cupertino Build Department.