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, BUIUDIN,G DIVISION PERMIT
BUILDING ADDRESS:
10826 LINDA VISTA DR
-IVNER'S NAME:
PHONE:
U0 hl\TTrT TTT
ARCHITEC (ENGINEER:
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of dee Business and Professions Code, and my license is
in full fora and effect
119
License Lie. t
Date Contracts
ARCHITECTS DEC RATION
1 understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm that 1 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
prior 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
(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
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars (5500).
❑ 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
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.).
❑ 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-
ccnse 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
`wner 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 Compcn-
sation, as provided for by Section 3700 of the Labor Code, for the performance of the
work for which this permit is issued.
14115ve and will maintain Worker's Compensation Insurance, as required by Section
3700 of the Labor Code, for the performance of she work for which this permit is issued.
My Worker's Compensation Insurance carrier and Polity number are: DO
Carrier �► Policy No.: A Q 62
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(chis section need not be completed if the permit is formic hundred dollars ($100)
or less)
I certify that in she 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
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.)
Lender's Name
Lender's Address
I certify that 1 have read this application and state that the above information is
cora I 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
(We) agree to save, indemnify and keep harmless the City of Cupertino against
liabilities, judgments, costs and expenses which may in any way accrue against said City
in consequeA of the granting of this permit.
APPLICJW UNDERSTANDS AND WILL COMPLY WITH ALL NON-POJAT
HAZAROWA MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Cod hapter 9.12, and the Health and Safety
Code, Section 25532(a)?
❑ Yes
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminantsas defined h e Bay Area Air Quality Management
District?
❑ Yes
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health & Safct , Sections 25505.25533 and 25534.1 understand that if the building
does not c�a tenant Uwe it is my responsihi ' notify Use occupanlrtsf the
mouimme ich must be metDdsrr to issltaace of c ate of Occhancy.,)
or authorized
RATTS C(
( 650) 961-1544
Job Description
RE -ROOF REMOVE AND REPLACE 19 SQUARES OF METAL
OVER SHAKE ROOFING. SHEET WITH 5/8/ RADIANT
BARRIER OSB
Sq. Ft. Floor Area
i We
APN Number Occupancy Type
3561405:L . 00
r
Issued by
Re -roofs
Type of Roof
Required Inspections
OF i
All roofs Shall be inspected prior to any roofing material being installed.
If a roof i 3 installed without first obtaining an inspection, I agree to remove
all new mate ' is for inspection.
Signature of Appllct to
roof coverings to be Class','.`' or better
PERMIT NO.
09070089
PERMIT ISSUE DATE
AN A O.
CONTROL NO.
BUILDING PERMIT INFO
BLDG
ELECT
PLUMB
Job Description
RE -ROOF REMOVE AND REPLACE 19 SQUARES OF METAL
OVER SHAKE ROOFING. SHEET WITH 5/8/ RADIANT
BARRIER OSB
Sq. Ft. Floor Area
i We
APN Number Occupancy Type
3561405:L . 00
r
Issued by
Re -roofs
Type of Roof
Required Inspections
OF i
All roofs Shall be inspected prior to any roofing material being installed.
If a roof i 3 installed without first obtaining an inspection, I agree to remove
all new mate ' is for inspection.
Signature of Appllct to
roof coverings to be Class','.`' or better
3 ITEMS OF 3
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: B11: Lot:
APN ........: 35614051.00
DATE ISSUED.......: 07/08/2009
RECEIPT #......... BS000008156
REFERENCE ID # ...: 09070089
SITE ADDRESS .....: 1O426 LINDA VISTA DR
SUBDIVISION ......
CITY CUPERTINO
IMPACT AREA ......
OPERATOR: SylviaM
COPY # : 1
OWNER SWIiNSON BEVERLY J AND FRANKLIN
ADDRESS 10826 LINDA VISTA DR
CITY/STATE/ZIP ...: CUPERTINO CA, 95014-4749
RECEIVED FROM ....: TON WAUGH
CONTRACTOR .......: FFJ�NK RATTS LIC # 30785
COMPANY RAFTS CONSTRUCTION
ADDRESS 250 E EDITH AVE
CITY/STATE/ZIP ...: LOS ALTOS, CA 94022
TELEPHONE (650) 941-1544
FEE ID UNIT
QUANTITY
2NOUNT
PD -TO -DT
THIS REC
NEW BAL
----------
-----------------------
1BCBSC VALUATION
----------
9,800.00
--•--------
1.00
----------
0.00
----------
1.00
0.00
1BSEISMICR VALUATION
9,800.00
1.00
0.00
1.00
0.00
1REROOFRES SQ FEET
19.00
247.00
0.00
247.00
----------
0.00
----------
TOTAL PERMIT
-----------
249.00
----------
0.00
249.00
0.00
METHOD OF PAYMENT
-----------------
CREDIT CARD
TOTAL RECEIPT :
AMOUNT
---------------
249.00
---------------
249.00
VOICE ID DESCRIPTION
-------- ----------------------------
601 ROOF TEAR OFF
REFERENCE NUMBER
--------------------
master card
VOICE ID DESCRIPTION
-------- ----------------------------
602 ROOF PLYWOOD NAIL
604 ROOF IN -PROGRESS 605 FINAL REROOF
CITY OF
,.,UPEkTINO
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Building Department
JOB ADDRESS:
)0??- Li j t, 4 -V,4,
PERMIT #
o
OWNER'S NAME: Tz,cog �
PHONE # (o o--Z`� /r iSlo
GENERAL CONTRACTOR: e
FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and comn:)lete the following information:
7
1S � lo
Owner/Con ctor Signature Date
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
ile
7
1S � lo
Owner/Con ctor Signature Date
--�, CITY OF CUPERTINO
: f REROOF
CUPEkT1NO PERMIT APPLICATION
APN # 3 _ O S/
Date: /
Building Address: /
1 Z6 (..'� w "t 4t,)44 `DrL .F,d
Owner'sarae:
F�.ulr- tet% NgO�
Phone
2
HOA: Yes ❑ No If yes, provide letter from HOA
Contractor: C NS -f a
Phone #: (o �1p •Z9/- 9�(0
Fax #:
Cupertino Business License #:
Contractor License #:
�j'Z$(olg
Type of Roof Covering:
Existing: Proposed:
❑ Built -Up Roof ❑ Built -Up roof
❑ Asphalt Shingles phalt Shingles
a- Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
q/Other (Specify) r,e�r. ROW- wne�w � ❑ Other (Specify)
Number of existing coverings Z ❑ Provide I.C.C.E.S. Report #
be Removed ❑ Provide Mfgr. Installation Specs.
PAA 644 ) X7 UL4%
----u_
Job Description: e",e w.,, .rh _ 14 S°� �0-ak o W%el�
np,��
ove-a -sle& osh
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: af
�' S
I Have Read, erstand and Will Comply with Cupertino's Tear -Off Policy:
Signature
Revised 02/05/09
a((,--
CITY OF
CUPEkTINO
CITY OF C'UPERTINO
REROOF
FEE SCHEDULE
Number of
Squares
Fee ID
Fee Description
Fee
Group
Permit Type
1REROOFCOM
Re -roof Co:-nmercial
B
1COMMLROOF
1 BCBSC
Cal Bldg Sl andards
Commission Fee
B
ALL PERMIT TYPES
1 BSEISMICO
Seismic Commercial
B
1RER00FRES
Re -roof Reiidential
B
1SFDWLR00F
I
1BCBSC
Cal Bldg Standards
Commission Fee
B
ALL PERMIT TYPES
/
1BSEISMICRE
Seismic Re3idential
B
1 REROOFMRES
Re -roof ML lti-Family
B
1MFDWLROOF
1BCBSC
Cal Bldg Standards
Commissio i Fee
B
ALL PERMIT TYPES
1BSEISMICRE
Seismic Re.3idential
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 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 building inspector. A final inspection and
approval shall be obtained from the b-lilding 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 nail inspection is required.
6. Any roofing which is applied without first obtaining an inspection,
will require the removal of all new mz terial down to the sheathing,
so a proper City inspection can be per Formed.
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 cagi 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: Fe -P, m� eV 75u)`&r J %'a AJ
Job Site Address: �� Z� L' �'�A l/ �, S �Q-) •�-Q_
Roofing Company Name: 'Z _
Applicant's Signature: 1 - Date:9)
U *D
Greg Casteel
Building Official
Revised 07/30/08
M. Indoor it Quality an "Finis
1. Use LowMo-VOC Paint
1 IAQ/Health pts
y=yes
2. Use Low VOC, Water -Based Wood Finishes
2 IAQ/Health pts
y=yes
3. Use Low/No VOC Adhesives
3 IAQ/Health pts
y=yes
4. Use Salvaged Materials for Interior Finishes
3 Resource pts
y=yes
5. Use Engineered Sheet Goods with no added Urea
Formaldehyde
61AQ/Health pts
y=yes
6. Use Exterior Grade Plywood for Interior Uses
1 IAQ/Health pts
y=yes
7. Seal all Exposed Particleboard or MDF
4 IAQ/Health pts
y=yes
8. Use FSC Certified Materials for Interior Finish
4 Resource pts
y=yes
9. Use Finger -Jointed or Recycled -Content Trim
1 Resource pts
y=yes
10. Install Whole House Vacuum System
3 IAQ/Health pts
y=yes
N. Flooring
1. Select FSC Certified Wood Flooring
13 Resource pts
y=yes
2. Use Rapidly Renewable Flooring Materials
4 Resource pts
y=yes
3. Use Recycled Content Ceramic Tiles
4 Resource pts
y=yes
4. Install Natural Linoleum in Place of Vinyl
5 IAQ/Health pts
y=yes
5. Use Exposed Concrete as Finished Floor
4 Resource pts
y=yes
6. Install Recycled Content Carpet with Low VOCs
4 Resource pts
y=yes
Total Points Available:
Total Points Project Received:
1401 130 57
�+ 1 01 01 0
% 8 "/
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