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09080007. CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10500 N DE ANZA OWNER'S NAME: APPLE ER'S PHONE: 4089744155 ❑ LICENSED CONTRACTOR'S DECLARATION License Class C_-3 Lic. # 'SOJ W-9 Contractor ��CA)tDate '31-00, 1 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: 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. APPLICANT CERTIFICATION I certify that 1 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 non -point source regulatio s pe a upertino Municipal Code, Section 9.18. Signature y I d OWNER -BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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 & Professions Code) I, 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, 1 become subject to the Worker's Compensation provisions of the Labor Code, I must 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 i ify and keep harmless the City of Cupertino against liabilities, judgments, c ,, ,nd 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. Signature Date CONTRACTOR: STATEWIDE ROOFING INC PERMIT NO: 09080007 5542 MONTEREY RD DATE ISSUED: 08/03/2009 SAN JOSE, CA 95138 PHONE NO: (408)288-8680 BUILDING PERMIT INFO: BLDG T_ ELECT r PLUMB r MECH r RESIDENTIAL r COMMERCIAL I— JOB DESCRIPTION: RE -ROOF REMOVE EXISTING GRAVEL & TAR ROOF & INSTALL NEW CA T24 CAPSHEET BUR CLS A 565 SQ; I.C.C.E.S. REPORT # TO BE MADE AVAILABLE ON SITE, Sq. Ft Floor Area: APN Number: 31622017.ALL Valuation: $203021 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued b ; Date: RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. if a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signatur of A plicant: 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. ldditionally, 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 Ifealth & Safety Code, Sections 25505, 25533, and 25534. Ow auth 'zj f Date: 7 CONSTRUCTION LENDING AGENCY hereby affirm that there is a construction lending agency for the performance of work's .or which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION understand my plans shall be used as public records. Licensed Professiona t - CITY Of CUPEkTINO CITY OF CUPERTINO REROOF PERMIT APPLICATION 0�',4 oc"I APN # 1 A O �� • XL—' Date: �) �� Building Address: 10 j U- &, �)e Owner's Name: f) J j Phone #: Cq HOA: Yes ❑ No M If yes, provide letter from HOA Contractor: �?t N Phone #: Fax #: Cupertino Business License #: Contra or License #: CA02-�A'Z 2 3!771 G Type of Roo f Covering: Existing: Proposed: ❑ 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 ❑ Provide I.C.C.E.S. Report #� *,_To be Removed ❑ Provide Mfgr. Installation Specs. Job Description: 6 r� C, ve Residential Commercial Green Building: Please complete relevant portio n of the Confirmed with Planning Dept. if Green Building Checklist & attach it to the application or if there are any restrictions: ❑ applicable, incl de in plan set & the sheet index. Valuation: V2 0,31C L I I Have Read, Understand and Will Comply with Cupertino's Tear -Off Policy: Signature a(( --, CITY OF CUPEkT1NO CITY OF CUPERTINO RI;ROOF FEE SCHEDULE Number of Squares Fee ID Fee Description Fee Group Permit Type 1REROOFCOM Re -roof Commercial B 1COMMLROOF I 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICO Seismic Commercial B IREROOFRES Re -roof Residential B 1SFDWLR00F 1BCBSC Cal Bldg Standards CommisE ion Fee B ALL PERMIT TYPES 1BSEISMICRE Seismic Residential B 1REROOFMRES Re -roof Multi -Family B 1MFDWLROOF 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 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 z e -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 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 Ci .y, 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 nai', 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 z/E " per foot slope and demonstrate that there is no ponding. 2. An I.C.B.O. report is required to be o ri the job site at the time on inspection. I understand and will comply with the above stated policy on re -roofing. Homeowner's Name: A&410 Job Site Address: C,&)z - Roofing Company Name: i , G' Applicant's Signature ate: Greg Casteel Building Official Revised 07/30/08 I' 14911LOWAto-VOC Pant 1 IAQ/Health pts y=yes 2. Use Low VOC, Water -Based Wood Finishes 2 IAQ/Health pts y=yes 3. Use Lowift 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 5 IAQ/Health pts y=yes Formaldehyde 61AQ/Health pts y=yes 6. Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 7.SOW 4.E)peosill r6deboardf or#JDF 41AQ/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/Healthis P y=yes. Y -Y N. Flooring 1. Select FSC Certified Wood Flooring 3 Resource pts y=yes 2. Use Rey Renewable Fioonng Materials 4 Resource pts y=yes 3. Use Recycled Content Ceramic Tiles 1 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 t Resource pts y=yes 6. Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes Total Points Available: Total Points Project Received: 140 1301 57 G:data/progs/greer huildingguidelines/remodelers/greenpointsfinal2.12.04protected.zls CITY OF XPEkTiNO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Buildin De artment JOB ADDRESS: PERMIT # OWNER'S NAME: fV4 PHONE # GENERAL CONTRACTOR FAX # I am not using any subcontractors: 8 Signature ate the following information: Please ::U]SUBCONTRACTOR Cnecx 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 /� TTIul', ' x/) /�c CITY O:? CUPERTINO ITEM 1 OF 1 PERM::T RECEIPT Sec: Twp: Rng: Sub: B:.k: Lot: APN ........: 3:.622017.ALL DATE ISSUED.......: 0£4/19/2009 RECEIPT #.........: BS000008472 REFERENCE ID # ...: 09080007 { x ��o fs> '? fs& - 7� � /747x -e-, «`c c-1 SITE ADDRESS 10500 N DE ANZA SUBDIVISION ...... CITY CUPERTINO IMPACT AREA ...... OPERATOR: suew COPY # : 1 OWNER APPLE ADDRESS 1(500 N DE ANZA BLVD CITY/STATE/ZIP ...: CUPERTINO CA, 95014-2102 RECEIVED FROM ....: KP.THY ROBERTSON CONTRACTOR KALE HYPES LIC # 23509 COMPANY S'T'ATEWIDE ROOFING INC ADDRESS 5542 MONTEREY RD CITY/STATE/ZIP ...: SAN JOSE, CA 95138 TELEPHONE (408)288-8680 FEE ID ---------- UNIT ------------- QUANTITY ---------- AMOUNT PD -TO -DT THIS REC NEW BAL 1BCBSC VALUATION 203,021.00 ---------- 9.00 ---------- 9.00 ---------- 0.00 ---------- 0.00 1BSEISMICO VALUATION 203,021.00 42.84 42.84 0.00 0.00 IINSP<=2HR HOURS 2.00 379.00 0.00 379.00 0.00 1REROOFCOM SQUARES 565.00 3666.00 3666.00 0.00 0.00 TOTAL PERMIT ---------- 4096.84 ---------- 3717.84 ---------- 379.00 ---------- 0.00 METHOD OF PAYMENT ----------------- CREDIT CARD TOTAL RECEIPT : AMOUNT --------------- 379.00 --------------- 379.00 VOICE ID DESCRIPTION -------- ---------------------------- 601 ROOF TEAR OFF 604 ROOF IN -PROGRESS m T REFERENCE NUMBER -------------------- VISA VOICE 602 605 10388 TORRE AVE CUPERTINO, CA 95814 DAL I0: 8808166 ;RANT 3241101629 'A ALExxxxxxxxx2149 ITCH: 800252 I NUOI CE: 85240101 aTE: AUG 18, 89 TIME: 16: 0: 081 RUTH NO: 01"`_•9 TOTAL $379.0