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09070107 CITY OF CUPERTINO A BUILDING DIVISION PERMIT � Llw lllwl Ll+ � -. BUILDING ADDRESS: PERMIT NO. 1162 STAFFORD DR A & B Rt OF `V NER'S NAME: PERMIT ISSUE DATE VADL-MEN C--NTN 234V ARBINS AVE PHONE: SA N CONTROL NO. ARCHLTECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH TEAR CFF ROOF ON HOUSE AND �0 c LICENSED CONTRACTOR'S DECLARATION ATTACHED GARAGE, Job Description U I 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 O y in full force and effec ��� V - Z License Class ` ;1Lie.# —� Date Contractor tz gg ARCHITECTS DECLA A 1 N eC'� l understand my plans shall be used as public records cul C y Licensed Professional. n OWNER-BUILDER DECLARATION g<z 1 hereby affirm that 1 am exempt from the Contractor's License Law for the p O following reason.(Section 7031.5,Business and Professions Code:Any city or county K Qi which requires a permit to construct,alter,improve,demolish,or repair any structure y 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 Liecnsc Law(Chapter 9 >q.Ft.Floor Area Valuation (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 APN Number Occupancy Type not more than five hundred dollars($500). ❑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 trot 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 arc 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.). ❑1,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. ❑I am exempt under Sec. B do P C for this mason mer 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 Workers Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the wa or which this permit is issued. ve 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 C�ompe•ns�nsa-tion calner and Policy number are: Cartier. S�(r�� A44i Policy No.:02-3 3 K 44—LL5 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for ono 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 ,J O forthwith comply with such provisions or this permit shall be deemed revoked. Z" CONSTRUCTION LENDING AGENCY Fr rA I hereby affirm that there is a constriction lending agency for the performance of <Y.✓ the work for which this permit is issued(Sec.3097,Civ.C.) �W Q L.ender'a Name ] Lender's Address U 0 L certify that I have read this application and state that the above information is V.11 cormcL 1 agree to comply with all city and county ordinances and state laws misting to 0 E'° building construction,and hereby authorize representatives of this city to enter upon the Uabove-mentioned property for inspection purposes (We)agree to save,indemnify and keep harmless the City of Cupertino against fn liabilities,judgments,costs and expenses which may in any way accrue against said City U z in consequence of the granting of this permit. ►h APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POIDate rNT Issued by: T�� U SOURCE REGULAT �!'� 3/2 OI / Re-roofs Signature of Applicant/Contractor Onto 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 •le,Section 25532(x)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes ,0`6No If a roof is 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 maerials for inspection. District? ❑Yes _49�ko 1 have read the materials requirements h .95 the Califor- nia Health&SafetyCodc,Sections 25505,25533 and 25534.1 understand hatifthe building ;t✓S+�� /'3 � �- does not currently have a tenant^that it is my responsibility to notify the occupant of the requirements whi t p r ran era certificate or cupan Signature of Applicant Date —211-3/ Owner or authorized agent Date All roof coverings to be Class"A"or better CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk.: Lot: APN . . . . . . . . : 36207004 . 00 DATE ISSUED. . . . . . . : 07/13/2009 RECEIPT #. . . . . . . . . : BSC00008179 REFERENCE ID # . . • : 09C70107 SITE ADDRESS . . . . . : 11E2 STAFFORD DR SUBDIVISION . . . . . . : CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . : OWNER . . . . . . . . . . . . : KAFSTEN CHIN ADDRESS . . . . . . . . . . : 11E2 STAFFORD DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-4969 RECEIVED FROM . . . . : A S B ROOFING CONTRACTOR . . . . . . . : JOFN WORTHINGTON LIC # 28306 COMPANY . . . . . . . . . . : A S B ROOFING, INC ADDRESS . . . . . . . . . . : 2347 HARDING AVE CITY/STATE/ZIP . . . : RELWOOD CITY, CA 94062 TELEPHONE . . . . . . . . : (6E0) 367-9673 FEE ID UNIT QUANTITY FMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 20, 000 . 00 1 . 00 0 .00 1. 00 0 .00 1BSEISMICR VALUATION 20, 000 . 00 2 . 00 0 . 00 2 . 00 0 . 00 1REROOFRES SQ FEET 40 . 00 520 . 00 0 . 00 520 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 523 . 00 0 . 00 523 . 00 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 523 . 00 1750 --------------- TOTAL RECEIPT 523 . 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 604 ROOF IN-PROGRESS 605 FINAL REROOF S�o Community Development 10300 Torre Avenue'N Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 CUPEKTINO Building Department JOB ADDRESS: PERMIT OWNER'S NAME: _ C PHONE # 367 C 7 3 GENERAL CONTRACTOR: FAX # I am not using any subcontractors: �� l3 0 Signature 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 f Owner/Contractor Signature Date CITY OF CUPERTINO ft REROOF aOF CUPEkTINO PERMIT APPLICATION APN # �Z �3 —7 Date: Building Address: Owner's Name: /Z --"-.s CIt r�� Phone #: HOA: Yes ❑ NoK If yes, provide leiter from HOA 4Z_/5 — S Contractor: Phone #: —3G 7— -96 7� Fax #: Cupertino Business License #: .� Contractor License #: Type of Ikoof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof Asphalt Shingles X Asphalt Shingles ❑ 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: F � Gam..... $' �� - � ✓-�.. -�- 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• I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy: Signature Revised 02/05/09 CITY OF C'UPERTINO REROOF CITY of CUPER,TiNO FEE SCHEDULE Number of Fee ID Fee Description Fee Permit Type Squares Group 1REROOFCOM Re-roof Co,-nmercial B 1COMMLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICO Seismic Commercial B 0 1REROOFRES Re-roof Residential B 1SFDWLROOF / 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICRE Seismic Re:,idential B 1 REROOFMRES Re-roof Mu Iti-Family B 1MFDWLROOF 1 BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICRE Seismic Residential B 1 BUSLIC 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 agi 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 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 any roofing installation. 4. To receive a final sign off from the Citi,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 l 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 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 1/4 "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. i Homeowner's Name: Job Site Address: Roofing Company Name: Applicant's Signature: ✓ ^ -'��- Date: 3 a Greg Casteel Building Official Revis,!d 07/30/08 J M.Indoor Air Quality and Finishes- 1.Use Low/No-VOC 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 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 31AQ/Health pts y=yes p 6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 0 7.Seal all Exposed Particleboard or MDF 4 IAQ/Health pts y=yes 0 8.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=yes 0 . 1 1 1 N.Flooring 1.Select FSC Certified Wood Flooring 8 Resource pts y=yes 0 2.Use Rapidly 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 ' 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 ■ 1 i 1 Total Points Available: 1401 130 57 Total Points Project Received: - 0 0 0 G:datalprogs/green)uildingguidelines/remodelers/greenpointsfinal2.12.04protected.xls