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09120020CITY OF CUPERTIP O BUILDING PERMIT BUILDING ADDRESS: 20875 VALLEY GREEN DR CONTRACTOR: FIVE STAR ROOFING PERMIT NO: 09120020 OWNER'S NAME: WOODMONT CORP 387-A UMBARGER RD DATE ISSUED: 12/02/2009 VER'S PHONE: 6505923960 SAN JOSE, CA 95111 PHONE NO: (408)972-7855 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic. # Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: 1 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 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 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 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 accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all - nt source regulations per the Cupertino Municipal Code, Section 9.18. Sign Datel�� d4 CJ OWNER -BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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 & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). 1 hereby affirm under penalty of perjury one of the following three 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 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 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 Worker's Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I rut forthwith comply with such provisions or this permit shall be deemed revoked. 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 upon the above mentioned property for inspection purposes. (We) agree to save nify and keep harmless the City of Cupertino against liabilities, judgments, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. MECH r- RESIDENTIAL f- COMMERCIAL f— JOB DESCRIPTION: RE -ROOF REMOVE EXISTING 1 -LAYER BUR SYSTEM REPAIR DECK AS NEEDED, INSTALL NEW 3PKG (ROSIN,BASE,2 GLASS & GRAVEL)SYSTEM CLASS A 16SQ Sq. Ft Floor Area: Valuation: $53963 APN Number: 32609064.CARPRTS I Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 D YS FROM ST CALLED INSPECTION. �- • 6 Issued by: � Date: RE -ROOFS: All roofs shall bei rior to any roofing material being installed. If a roof is installed witt rrst obtaining inspection, I agree to remove all new materials for inspection. Signature of Applican . Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE 1 have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the -Uc#lth & Safety Code, Sections 25505, 25533, and 25534. ne or authorized agent: Date: CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Signature_ Date Licensed Professional -� CITY OF CUPERTINO 2, 0 C ->A# REROOF CUPEkT1NO PERMIT APPLICATION APN # // f ��(_P V 2(� 4-' �t _ U K- Date: sal GAP Building Address: - VG�S7 _ ���� �� An Owner's Name: Phone #: �f q6 O HOA: Yes ❑ No es, rovide leiter from HOA Contractor: Phone #: 4,10 s q �,;Z Fax #: (x/69) %7_-� - ?� Cupertino Business License #:f/�J 1 d g #: Contractoor License1-(17-717 Type of Roof Covering: Existin Propose -- Built-Up Roof Built -Up roof ❑ Asphalt Shingles ❑ 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 # �o be Removed ❑ Provide Mfgr. Installation Specs. Job Description:��,., „� c� X� f� % - /� y e.^ u ✓� s s 7.' �ti=- (a g -y Q A-' C1( +� J c ✓ 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: o c� ead, Understand and Will Comply with Cupertino's Tear -Off Policy: Signature Revised 02/05/09 i CITY OF C UPERTINO '' RE1�.00F CUPEkT]NO FEE SCHEDULE Number of Squares Fee ID Fee Description Fee Group Permit Type 1REROOFCOM Re -roof Coinmercial B 1COMMLROOF 1BEBSC Cal Bldg Standards Commissio 1 Fee B ALL PERMIT TYPES 1BSEISMICO Seismic Commercial B 1RER00FRES Re -roof Residential B 1SFDWLROOF 1BCBSC Cal Bldg Standards Commissio 1 Fee B ALL PERMIT TYPES 1BSEISMICRE Seismic Residential B 1 b 1 REROOFMRES Re -roof ML lti-Family B 1MFDWLROOF / 1BCBSC Cal Bldg Standards Commissio l Fee B ALL PERMIT TYPES J 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 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-.iilding 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 app: -oval. 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 me.terial 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 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. Homeowner's Name: Job Site Address: 2 U RTS Roofing Company Name: Applicant's Signa = ti Date: - A v 9 Greg Casteel Building Official Revised 07/30/08 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 gilding 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 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,� of $176.18. The re -inspection fee must be paid before another inspection cal 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 above stated policy on re -roofing. Homeowner's Name: r` Ar Job Site Address: 2c) i 7S A77 Roofing Compand�o e: A1 L — r-eZA Applicant's Signa - Date: Greg Casteel Building Official Revis !d 07/30/08 SO CITY OF �MkTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department OB ADDRESS: - _ j' PERMIT # OWNER'S NAME: PHONE GENERAL CONTRACTOR: FAX # I am not using any subcontractor3' Si;nature Date Please check avvlicable subcontractors and complete the following information: Owner/ Contractor 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 Tile Owner/ Contractor Signature Date