09080179 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7496 DE LA FARGE DR CONTRACTOR:ROOF ROOFING PERMIT NO:09080179
OWNER'S NAME: COX CHARLES L AND JOAN M 5577 VASSAR DR DATE ISSUED:08/19/2009
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R'S PHONE: 4085407924 SAN JOSE,CA 95118 PHONE NO:(408)265-9270
❑ LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO: BLDG r ELECT F_ PLUMB
License Class li• `Y Lic.# V 7
j� (-MECH RESIDENTIAL ^ COMMERCIAL
Contractor _X- Date
I hereby affirm that l am licensed under the provisions of Chapter 9 JOB DESCRIPTION:RE-ROOF REMOVE SHAKE ROOF& INSTALL
(commencing with Section 7000)of Division 3 of the Business&Professions 40YR COMP OSB
Code and that my license is in full force and effect. PLYWOOD CLS A 28SQ
1 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.
1 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 �q Ft Floor Area: Valuation:$9200
permit is issued
APPLICANT CERTIFICATION %PN Number:35926035.00 Occupancy Type:
I certify that I have read this application and state that the above information is
correct. 1 agree to comply with all city and county ordinances and state laws relating
to building construction,and hereby authorize representatives of this city I enter PERMIT EXPIRES IF WORK IS NOT STARTED upon the ai.e�.e mentioned property for inspection purposes. (We)agree too save
indemnify and keep harmleas the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs, expenses which may accrue against said City rconsequence the 180 DAYS FROM LAST CALLED INSPECTION.
granting,of this permit. Additionally,t applicant understands and will comply
with all non-point source regulatio r the Cupertino Municipal Code,Section
9.lti�
Issued by: - Date:
Signature Date lEr-f
Li OWNER-BUILDER DECLARATION RE-ROOFS:
idl roofs shall be inspected prior to any roofing material being installed. If a root'is
I hereby affirm that I am exempt from the Contractor's License Law for one of
i iswithout first obtaining an inspection,1 agree to remove all new materials for
I the following two reasons: i ispectipection.
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, Signature of Applicant: Date:
Business&Professions Code) t;./:2,c.-t -
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
declarations: HAZARDOUS MATERIALS DISCLOSURE
1 have and will maintain a Certificate of Consent to self-insure for Worker's 1 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 C alifornia Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
performance of the work for which this permit is issued. a►mpliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
I have and will maintain Worker's Compensation Insurance,as provided for by S ifety 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
permit iz issued. contaminants as defined by the Bay Area Air Quality Management District 1 will
tr aintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
I certify that in:he performance of the work for which this permit is issued,1 shall Health&Safety Code,Sections 25505,25533,and 25534.
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of Califomia. If,after making this certificate of exemption,I Owner or a nt:
become subject to the Worker's Compensation provisions of the Labor Code,I must _ Date: 1!1�1`l'�qC�f
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION I Hereby affirm that there is a construction lending agency for the performance of work's
I certify that 1 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
union the above mentioned property for inspection purposes.(We)agree to save Lender's Address
:iify and keep harmless the City of Cupertino against liat:ilities,judgments, -
and expenses which may accrue against said City in consequence of the
granting of this permit Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
with all non-point source regulations per the Cupertino Municipal Code,Section I t nderstand my plans shall be used as public records.
19.18.
Signature Date
Licensed Professional
__
-�, CITY OF CUPERTINO Oq 0� 0 17
REROOF
CUPEkT1NO PERMIT APPLICATION
APN # Date:
_?�t_�q CP o c)
Building Address:
L,a 0. �i
Owner's Name: CV )L U Phone #:
�-Oy
HOA: Yes ❑ No If yes, provide letter from HOA
Contractor: Phone #:4lv�s= 14 S ri Z i b
Fax #: g�,;
Cupertino Business License #: Contractor License #:
Type of R c)of Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles �e'"`' ' Asphalt Shingles
`5w:� 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:
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:
>Have d, U d r t d and Will Comply with Cupertino's Tear-Off Policy:
Revised 02/05/09
i CITY OF C UPERTINO
REROOF
CUPEl�T1NO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1REROOFCOM Re-roof Commercial B 1COMMLROOF
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
1BSEISMICO Seismic Commercial B
1REROOFRES Re-roof Residential B 1SFDWLR00F
2�
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commissioa Fee
1BSEISMICRE Seismic Re3idential B
1 REROOFMRES Re-roof Multi-Family B 1MFDWLROOF
1BCBSC Cal Bldg S,:andards B ALL PERMIT TYPES
Commission 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 i 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 b wilding 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 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 nai.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 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/ '•per foot slope and demonstrate
that there is no ponding.
2. An I.C.B.O.report is required to be on he job site at the time on inspection.
I understand and will comply with the above stated policy on re-roofing.
Homeowner's Name: N rZ- r o<
Job Site Address: Q
Roofing Company Name: € �`�
Applicant's Signature: Date:�+l�'-O
Greg Casteel
Building Official
Revised 07/30/08
.Indoor Air Quality and Finishes INPUT RLscurces Energ� IAD/Health
1-UseLowJtwo-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 LowM VOC Adheiives 3 IAQ/Health pts y=yes p
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 p
6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 0
7.Seal aU ErpDSW Parbclei3oard 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 p
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 5 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 t t
Total Points Available: 1401 130 57
Total Points Project Received: 0 0
c.,.C)
G:data/progs/gre enbuildngguiderines/remodelers/greenpointsfinal2.12.04protected.xls
Community Development
' 10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CIV OF Fax(408)777-3333
�UPEkTINO
Buildi.ng Department
JOB ADDRESS: PERMIT #
e.
OWNER'S NAME: �L V o X. PHONE # qO,, ` 5'1to� 7
GENERAL CONTRACTOR: f .i FAX#
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and con. lete the following information:
SUBCONTRACTOR BUSIvESS 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
1---' Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date