09080122CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10415 PLUM TREE LN CONTRACTOR: LOS GATOS ROOFING PERMIT NO: 09080122
OWNER'S NAME: SAMPSON GURNEY E AND THELMA D P O BOX 1726 DATE ISSUED: 08/14/2009
O%VNER'S PHONE: 4082574574 LOS GATOS, CA 95031 PHONE NO: (408)298-9399
L LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r—
License Class Lic. #
Contractor
Date
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.
1 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.
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
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 non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Date
OWNER -BUILDER DECLARATION
1 hereby affirm that 1 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)
1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sce.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.
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
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 must Owner jauthori A agent:
forthwith comply with such provisions or this permit shall be deemed revoked. �-�( /.t I Y 1 ti Date: Y `7t v
MECH RESIDENTIAL✓ COMMERCIAL
JOB DESCRIPTION: RE -ROOF REMOVE EXISTING SHAKE ROOF.
INSTALL
7/16"OSB, FIBERGLASS REINFORCED FELT AND DURATION
PREMIUM COMP SHINGLES BY OWENS CORNING CLS A 21 SQ
Sq. Ft Floor Area:
APN Number: 31633118.00
Valuation: $6216
Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by:
Date:
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtainin an inspection, I agree to remove all new materials for
inspection.
Signature f A plicant: Date:
c
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 1 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
Health & Safety Code, Sections 25505, 25533, and 25534.
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,
co -id expenses which may accrue against said City in consequence of the
gi of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18. 1
�j
Signature--r-X) Date �y d
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
ARCHITECT'S DECLARATION
1 understand my plans shall be used as public records.
Licensed Professional
CITY OF
CUPS ]NO
CITE' OF CUPERTINO
RE,ROOF
PERMIT APPLICATION
APN #
Date:
Building Address:
/04//S
Owner's Name:
Phone #:
., Da��s Ste,s
wog �2,52-z1s7y
Contractor: f _ s�� y ��`
Phone #:
Fax #: °i
Cupertino Business LicenseContratc�tor
2 '�'
License #: `
;l%'
f- i77
Cif(% �-7 •'
Type of ]Zoof Covering:
Existing: Proposed:
❑ Built -Up Roof ❑ Built -Up roof
❑ Asphalt Shingles �11_ Asphalt Shingles
`et� Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other (Specify) ❑ Other (Specify)
Number of existing coverings j ❑ Provide I.C.B.O. Report #
To be Removed Provide Mfg. Installation Specs.
Job Des ription: " /1e "o
J
Residential Commercial ❑
Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if
Green Building Checklist & attach it to the application El�n or if there are any restrictions:
applicable, i elude in plan set & the sheet index. -
Valuation:
I Have Read, Understand and Will Comply with Cupertino's Tear -Off Policy;
Sieare
Revised 6/16/08
CITY OF
CUPEINO
CITY OF CUPERTINO
RERO OF
FEE S+CHE DULE
Number of
Squares
Fee ID
Fee Descriptic u
Fee
Group
Permit Type
1REROOFCOM
Re -roof Commcrcial
B
1COMMLROOF
1BSEISMICO
Seismic Commercial
B
2
1REROOFRES '
Re -roof Residential
B
1SFDWLR00F
/
1BSEISMICRE
Seismic Residential
B
1REROOFMRES
Re -roof Multi -Family
B
1MFDWLR00F
1BSEISMICRE
Seismic Resi&ntial
B
1BUSLIC Business License
B
Revised 6/16/08
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 agee 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 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 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 nz it 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 cen 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.
t y
Homeowner's Name: .
/)&L
ob Site Address:
Roofing Company Name:
� r
Applicant's Signature:
Greg Casteel
Building Official
Revis:d 07/30/08
1. Ins i_II Er, Hoy-Eiiciant
a. Doubt -P_nad 1 Energy pt y=yes
b. (1 -cm -E) 2 Energy pts y=yes
c. Loi;,. ConUu--joty FF -=M ---Z 2 Energy pts y=yes
2. Install Low Heat Transmission Glazing 1 Energy pt y=yes
J. Heating Ventil=tion and Air Conditioning
1. Us=- Duct Miastic on All Duct Joints
2 Energy pts
yges
2. Install Ductwork within Conditioned Space
3 Energy pts
y=yes
3. Vent Range Hood to the Outside
1 IAQ/Haalth pt
y=yes
4. Clean all Ducts Before Occupancy
2 IAQ/Health pis
y=yes
5. Install Solar Attic Fan
2 Energy pts
y=yes
6. Install Attic Ventilation Systems
1 Energy pt
y=yes
7. Install Whole House Fan
4 Energy pts
y=yes
8. Install Sealed Combustion Units
5 IAOJHealth pts
y=yes
a. Furnaces
3 IAQ/Health pts
y=yes
J. Water Heaters
3 IAQ/Health pts
y=yes
9. Replace Wall -Mounted Electric and Gas Heaters with
Through -the -Wall Heat Pumps
3 Energy pts
y=yes
10. Install 13 SEER/11 EER or higher AC with a TXV
3 Energy pts
y=yes
11. Install AC with Non -HCFC Refrigerants
2 Resource pis
y=yes
12. Install 90% Annual Fuel Utilization Efficiency (AFUE) Furnace
2 Energy pts
y=yes
13. Retrofit Wood Burning Fireplaces
10 Energy pts
y=yes
a. Install EPA certified wood stovesTinserts
1 IAQ/Health pt
y=yes
b. Install/Replace Dampers
1 Energy pt
y=yes
c. Install Airtight Doors
1 Energy pt
y=yes
14, Install Zoned, Hydronic Radiant Heating
3 Energy pts
y=yes
15. Install High Efficiency Filter
4 IAQ/Health pts
y=yes
16, Install Heat Recovery Ventilation Unit (HRV)
5 IAOJHealth pts
y=yes
17. Install Separate Garage Exhaust Fan
3 IAD/Health pts
y=yes
K. Renewable Energy and Roofing
1. Pre -Plumb for Solar Water Heating
4 Energy pts
y=yes
2. Install Solar Water Heating System
10 Energy pts
y=yes
3. Pre -Wire for Future Photovoltaic (PV) Installation
4 Energy pts
y=yes
4. Install Photovoltaic (PV) System
(1.2 kw = 6 points, 2.4 kw =12 points, 3.6 kw =18 points)
Up to 18 Energy
pts
6. Select Safe and Durable Rooting Materials
1 Resource pt
y=)res
7. Install Radiant Barrier
3 Energy pts
y=yes
L. Natural Heating and Cooling
1, Incorporate Passive Solar Heating 5 Energy pts y=yes
2. Install Overhangs or Awnings over South Facing Windows 3 Energy pts . y=yes
3. Plant Deciduous Trees on the West and South Sides 3 Energy pts y=yes
rlen Points Being System for Remodeling Projects
Due to the diversity of remodeling project types, assigning a "tote points" value to a project to be considered environmentally friendly is
not feasible. However, 25 measures have been highlighted to si,iniy that every eiiort should be made to incorporate them into your
projects. These items have been chosen based upon their impEct on the environment and the health of the home in coordination with
ease of implementation and relative low cost. These measures :an be used as a starting point for "greening" your project.
A. Site
1. Reseda Job Sita Co;�stnuction & Damcli-bon VVasie
651G = 1 point; 5°� = 2 poinis: 80% = ? V-,'nl- up to 4 Resource pts
2. Salvage R=usable Building I`Aaierials 1 Resource pts y=yes
3. Remodel for Mixed Use, Adaptive Reuse, and
Historic Preservation 1 Resource pts y=yes
4. Protect Native Soil Resource pts y=yes
5. Minimize Disruption of Existing Plants & Trees 1 Resource pt y=yes.
6. Implement Construction Site Stormwater Practices )_ Resource pts y=yes
7. Protect Water Quality with Landscape Design 2 Resource pts y=yes
8. Design Resource -Efficient Landscapes and Gardens Resource pts y=yes
9. Reuse Materials/Use Recycled Content Materials
for Landscape Areas 2 Resource pts y=yes
10. Install High -Efficiency Irrigation Systems i Resource pts y=yes
11. Provide for On -Site Water Catchment / Retention )_ Resource pts y=yes
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
-
B. Foundation
1. Incorporate Recycled Flyash in Concrete
25% Recycled Flyash = 2 points; Add 1 point for every 10%
increase of flyash, up to 5 points up to 5 ResouFce pts 0
2. Use Recycled Content Aggregate 2 Resource pts y=yes 0
3. Insulate Foundation/Slab before backfill 3 Energy pts Y --yes
C. Structural Frame
1. Substitute Solid Sawn Lumber k0th Engineered Lumber 3 Resource pts y=yes
2. Use FSC Certified Wood for framing
(For every 10% of FSC lumber used = 2 points, up to 10) up to 10 Resource pts.
3. Use Wood kJoists for Floors and Ceilings ? Resource pts y=yes
4. Use Web Floor Trusses ? Resource pts y=yes
5. Design Energy Heels on Trusses 6" or more 2 Energy pts y=yes
B. Use Finger -Jointed Studs for Vertical Applications ;! Resource.pts y=yes
7, Use Engineered Studs for Vertical Applications ;? Resource pts y=yes
B. Use Recycled Content Steel Studs for Interior Framing Resource pts y=yes
9. Use Structural Insulated Panels (SIPs)
a. Floors 3 Energy pts y=yes
b. Wall 3 Energy pts y=yes
c. Roof 3 Energy pts y=yes
10. Apply Advanced Framing Techniques 4 Resource pis y=yes
11. Use Reclaimed Lumber for Non Structural Applications 3 Resource pts y=yes
12. Use OSB'
a. Subfloors Resource pt y=y2s
b. Sheathing Resource pt y --yes
0
0
0
0
0
0
0
0
0
0
0
-
1
E
C0 musity Development
10300 To e Avenue
Cupeino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Jos ADDRESS: ,D / y PERl'�ITT- �-D Z
1 /�o
OWNER'S NAME:
GENT– RA_L CON 11ZaC T OR
,_ -T
am not using any subcontractors:
Sib nature
Please check ap2acable subcontractors and comp]
�0711 S�CO�T -i�?I-C O� BUS N'
Cabinets eT M'llwork
Cemen�Fih�i hing
I Electrical
(Excavation
Fencing
Flooring: Carpeting
Linoleum / Wood
Glass / Glazing
Heating I
Insulation
Landscaping
Lathing I
Masonry I
Ornamental Sheet Metal I
Painting / WaLipaper I
IPaving
Plastering
urr
PlLbing
Roofing
Septic Tank
Sheet Metal
(-.Sheet Rock
Tile
Owner/ Contractor Signature
PHONE_ ! f, Q4�3e_C
FAX
Da`e