09120053 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10055 CRESCENT RD CONTRACTOR:ARMSTRONG PERMIT NO:09120053
INSTALLATION
''NER'S NAME: ELERATH JON G AND DEBRA A 4575 SAN PABLO AVE DATE ISSUED: 12/09/2009
OWNER'S PHONE: 4082522366 EMERYVILLE,CA 94608 PHONE NO:(510)777-1234
1k LICENSED CONTRACTOR'S DECLARATIONf—
�] Q BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class C3�C3� Lic.#t /-< // MECH RESIDENTIAL� COMMERCIAL
Contractor zhmV Date L O�
I hereby affirm that I am licensed unly
der the provisions of Chapter 9 JOB DESCRIPTION: RE-ROOF FOAM OVERLAY 2400 SQFT CLASS A,24
(commencing with Section 7000)of Division 3 of the Business&Professions SQUARES
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,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 provided for by Sq.Ft Floor Area: Valuation:$21000
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
APN Number:32616070.00 Occupancy Type:
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
correct.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 PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes. (We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION.
granting of this permit. Additionally,the applicant understands and will comply
with all non-point sour a regulations th u ertino Municipal Code,Section
9.18. Issued by: Date:
ature Date_,-
❑ OWNER-BUILDER DECLARATION RE-ROOFS:
All roofs shall be inspected prior to any roofing material eing installed.If a roof is
hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining inspection,I agreo move all new materials for
the following two reasons: inspection.
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, Sin r Applicant: Date:
Business&Professions Code) I6
1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1 hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the
Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material.
Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505, 3,and 25534/
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California. If,after making this certificate of exemption,I Owner or an orized agent: g
become subject to the Worker's Compensation provisions of the Labor Code,I must Date:
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION I hereby affirm that there is a constriction lending agency for the performance of work's
I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.)
correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name
to building construction,and hereby authorize representatives of this city to enter
,he above mentioned property for inspection purposes.(We)agree to save Lender's Address
anify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records.
9.18.
Licensed Professional
Signature Date
CITY OF CUPERTINO
REROOF
CUPEkTINO PERMIT APPLICATION
APN #� C J Date:/Z D Q
Building Address:
Owner's Name: 6,h � 1 Phone #:
HOA: Yes ❑
No LN If yes, provide letter from HOA
Contractor: 1 J Phone #: 71r 12
.G�s—� Fax #: S/v /
Cupertino Business Lic nse #: Contractor License #:
Z-yS
Type of Roof Covering:
Existing: Proposed:
N Built-Up Roof X, Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other (Specify) Other (Specify)
Number of existing coverings J Provide I.C.C.E.S. Report#
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description: lrrocrr ��a w. u vv Zy0" c/G,ss
Z
Residential'Y Commercial Ej
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, Under nd and Will Com ly itt Cupertino's Tear-Off Policy:
Signature
Revised 02/05/09
CITY OF CUPERTINO
RERDOF
CUPEkjJNO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1REROOFCOM Re-roof Cor-unercial B 1COMMLROOF
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
1BSEISMICO Seismic Commercial B
2`I 1REROOFRES Re-roof Residential B 1SFDWLR00F
/ 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
j 1BSEISMICRE Seismic Residential B
1 REROOFMRES Re-roof Mu:ti-Family B 1MFDWLROOF
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commissior. Fee
1BSEISMICRE Seismic Residential 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:-e-roofing.All roofs are Class "A"per Cupertino
municipal code 16.04.080.
2. New roof coverings shall not be appLed 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 a1y roofing installation.
4. To receive a final sign off from the City,the following steps are
required:
1) Pre-inspection and/or tear off apFroval.
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 pe 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 con 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: Z% r7,` 1
Job Site Address: / y c7 ss �rCc
Roofing Company Name: �rvkxol -A,411 Cei i 01)
Applicant's Signature: Date:
Greg Casteel
Building Official
Revi;;ed 07/30/08
M.Indoor Air ua ity and Finishes-
1.Use tOtll+lo-VOC P*t 1 IAQ/Health pts y=yes 0
2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes 0
3.Use Lowlb VM Adams 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 61AQ/Health pts y=yes D
0
6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes
7.Seal all Exposed Path an_m 41AQ/Health pts y=yes D
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 D
1 1
10.Install Whole House Vacuum System 3 IAQ/Health pts y=yes 0
N.Flooring
1,Select FSC Certified Wood Flooring 3 Resource pts y=yes 0
2.Use Rapidly Renewable Flooring Materials I Resource pts y=yes 0
3.Use Recycled Content Ceramic Tiles I 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 I Resource pts y=yes 0
6.Install Recycled Content Carpet with Low VOCs I Resource pts y=yes 0
Total Points Available: 401 1301 57
Total Points Project Received:
G:data/progs/grer nbuildingguidelines/remodelers/greenpointsfinal2.12.o4protarted.xls
Community Development
` 10300 Torre Avenue
7
;s Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
,;UPEkTINO
Building Department
JOB ADDRESS: PERMIT #
er�se..,4 ))r 0q 'Z 0<::�2S-3
OWNER'S NAME: h £I coj�% PHONE # 7 77-/232?
GENERAL CONTRACTOR: A r Yn s
I am not using any subcontractors:
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
Owner/Contractor Signature Date