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10120118 r CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10374 S TANTAU AVE CONTRACTOR:J B CONSTRUCTION PERMIT NO: 10120118 OWNER'S NAME: FALCO FORBRICH 4532 MORNING BROOK LN DATE ISSUED: 12/16/2010 OWNER'S PHONE: 4087771213 TRACY,CA 95377 PHONE NO:(408)595-5471 L. LICENSED CONTRACTOR'S DECLARATIONF BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class /LJ Lic.# e-ZG s-3F MECH RESIDENTIAL COMMERCIAL Contractor �:)_is . (ni ft 57"kv(,ria bate 12, �' �G I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:TEAR OFF EXISITNG ASPHALT SHINGLES,EXISTING (commencing with Section 7000)of Division 3 of the Business&Professions SHEATHING STAYS,30#FELT,INSTALL SQUARES Code and that my license is in full force and effect. CLASS A ASPHALT SHINGLES OVER EXISITNG HOUSE 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 Sq.Ft Floor Area: Valuation:$7000 permit is issued. APPLICANT CERTIFICATION APN Number:37508032.00 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point source]egu a ons per the Cupertino Municipal Code,Section 9.18. / Signature Date '\6 Issued by: ���..a.__....��... Date: OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for 1,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, `G Business&Professions Code) Signature of Applicant: l Date: I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF VERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE 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 I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534. 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 aut ori d agent: t forthwith comply with such provisions or this permit shall be deemed revoked. Date: \ APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I ereby affirm that there is a construction lending agency for the performance of work's correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address r^ s,and expenses which may accrue against said City in consequence of the ing of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION ....,i all non-point source regulations per the Cupertino Municipal Code,Section 9.18. I understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO I V FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10374 s.tantau ave. DATE: 12/16/2010 REVIEWED BY: bobs. APN: 3 -75— - BP#: *VALUATION: $7,000 xPERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof PRIMARY SFD or Duplex `t7-7 PENTAMATION 1SFDWLR00F USE: .1 _ PERMIT TYPE: WORK tear off, existing roof sheathing stays, 30#felt 30 squares. SCOPE FEE ID ROOF AREA s.f. 1 REROOFFRES ,309eft Lj Li NOTE: Thesefees are based on the preliminarV information available and are only an estimate. Contact the De t or addn'l info, FEE ITEMS (Fee Resoliition 09-051 Eff. 7,'1.%70FEE QTY/FEE MISC ITEMS slipPl. PC 11 t t FA Permit Fee: $390.00 Satpp/, 11rp Fc T'itold), Fi`c� t` it} " Pj117%i!t).- §at'L' f`1ci. Pt`"I7?tt /'cc, Work Without Permit? 0 Yes No $0.00 Strong Motion Motion Fee: IBSEISMICR $0.70 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $3 . 0 $0.00 TOTAL FEE: $,391'70 Revised,-'12/07/201 0 CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: TraciC COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot: APN 37508032 . 00 DATE ISSUED. . . . . . . : 12/16/2010 RECEIPT #. . . . . . . . . BS000012276 REFERENCE ID # . . . : 10120118 SITE ADDRESS 10374 S TANTAU AVE SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER FALCO FORBRICH ADDRESS . . . . . . . . . . : 10374 TANTAU AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : J B CONSTRUCTION CONTRACTOR JORGE BARRIGA LIC # 28131 COMPANY J B CONSTRUCTION ADDRESS 4532 MORNING BROOK LN CITY/STATE/ZIP . . . : TRACY, CA 95377 TELEPHONE (408) 595-5471 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 7, 000. 00 1 . 00 0 . 00 1. 00 0 . 00 1BSEISMICR VALUATION 7, 000 . 00 0 .70 0 .00 0 . 70 0 .00 1REROOFRES SQ FEET 25. 00 325 . 00 0 . 00 325. 00 0 .00 ---------- ---------- ---------- ---------- TOTAL PERMIT 326 .70 0. 00 326 .70 0 .00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT- CARD 326 .70 981454 --------------- TOTAL RECEIPT 326 .70 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 309 EXTERIOR LATH 311 SCRATCH COAT 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 604 ROOF IN-PROGRESS 605 FINAL REROOF .In oor Air ua11 an Finishes INPUT R�sDatres EnLrgy AD'Health 1.Use Low/No-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 Low/No VOC Adhesives 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 p p 6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 7.Seal all EVosed Partiolaboard or MY 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 0 1 1 1 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 1 1 Total Points Available: 1 1401 130 57 Total Points Project Received: 01 01 0 G:data/props/greenbufldngguidelines/remodelers/greenpbotsfina1212D4protected.xis REROOF TEAR-OFF POLICY COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE-CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228 FAX(408)777-3333•building(abcupertino.org PROJECT ADDRESS IO -] ` T /v�/� Vp,C APN# OWNERNAME FA'L-K (D /^,04 ;/e 0 A4 ", PHONEY©D E-MAIL STREET ADDRESS l ,1 � CITY, STATE,ZIP ��Al r/v �j.� FAX C'ONTRAC'TOR NAME LICENSE NUMBER /v 19 Q Q O S-�' NS6E�TYtPq BUS.LIC. COMPANY NAME E-MAIL 00FAX 0#D 01p y :P/0" C"o STREET ADDRESS CITY,STATE,ZIP PHONE I UNDERSTAND AND AGREE TO THE FOLLOWING: 1. The re-roof project shall comply with all applicable provisions of the 2007 California Building Code. 2. You must schedule all needed inspections a minimum of one day before the requested inspection date. Please schedule inspections online or call (408)777-3228 between 7:30-3:30 (Mon-Fri). 3. Tear-off roof inspection is required. Please call for tear-off inspection after the roof is torn off and all the nails/fasteners have been removed. Any and all dry-rotted wood shall be replaced prior to this inspection. A building inspector will be available within one hour. There are special hours for this service: 7:30 — 10:30am and 1:00—3:30pm (Mon—Thurs); 7:30 — 10:30am and 1:00—2:30pm (Friday). 4. If plywood is installed, a plywood nailing inspection is required. 5. In-Progress roof inspection is required. Call for an in-progress roof inspection to verify building is weather tight after installation of approximately 25% of the roofing material. 6. New roof coverings shall not be applied without first obtaining all inspections and written approvals from the building inspector. Any roofing which is applied without first obtaining an approved inspection will require the removal of all new material down to the sheathing so a proper inspection can be performed. 7. A final inspection and approval shall be obtained from the building inspector when the re-roofing is complete. To receive a final sign-off, the following items will be verified: a. Flat roofs shall have a minimum of per foot of slope and must demonstrate there is no ponding. b. Listings from approved testing agencies for all pre-manufactured products used shall be available on-site to review at the time of the inspection. c. Proper spark arrestor installation. 8. NOTE: If you call for a tear-off or plywood nailing inspection and the work is not complete, you will be charged a re-inspection fee of$126.00. The re-inspection fee shall be paid before another inspection can be scheduled. By my signing below, I certify each of the following is true: I am the property owner or authorized agent to act on the property owner's beha f. I understan nd agree to comply with the re-roof policy stat bo e. Signature of Applicant/Agent: Date: 2 d ReroofPo1icy_2010.doc revised 05/17/10 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: PERMIT# OWNER'S NAME: PHONE # GENERAL CONTRACTOR: C!T7 6(° BUSINESS LICENSE# ADDRESS: CITY/ZIPCODE: � *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. 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 Painting/Wallpaper Paving Plastering Plumbing Roofing W-7 Septic Tank Sheet Metal Sheet Rock F—ITile Owner/Contr r Si nature Date CITY OF CITY OF CUPERTINO REROOF (3II t CUPERTINO PERMIT APPLICATION APN # 37 Date: If residential, is house an Eichler? Yes ❑ No ZK If yes, needs planning approval. Building Address: Owner's Name: � � ���� ��� Phone #: HOA: Yes ❑ No If yes, provide letter from HOA Contractor: Phone #: Fax#: Y rg ?v y fVX / 0 Cupertino Business License #: Contractor License #: Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof Z Asphalt Shingles ` Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood ShinglesZ c� ❑ Other (Specify) ❑ Other (Specify) C ss t,N£r Number of existing coverings ( ❑ Provide I.C.C.E.S. Report# XTo be Removed ❑ Provide Mfgr. Installation Specs. Job Description: 7TH OFF 0 FO-eF Residential Commercial El Green Building: Please complete rete rtion 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, rst d ill Comply with Cupertino's Tear-Off Policy: