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10110079 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22442 CARNOUSTIE CT CONTRACTOR:JOSEPH SEGNA PERMIT NO: 10110079 OWNER'S NAME: JOSEPH SEGNA 22442 CARNOUSTIE CT DATE ISSUED: 11/12/2010 OWNER'S PHONE: 4082533979 CUPERTINO CA, 95014-3949 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIAL License Class Lic.# RE-ROOF 28 SQ,REMOVE EXISTING SHAKES&SKIP SHEETING CLASS A 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: 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. Sq.Ft Floor Area: Valuation:$8400 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 APN Number:35603028.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 D LAX511 CALLED INSPECTION. 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 Issued by: Date: �� Z with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature Date 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. OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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 HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the / California Health&Safety Code,Sections 25505,25533,and 25534. I will I hereby affirm under penalty of perjury one of the following threg� maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: v Health&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sechop 25505,25533,and 25134. l 1 Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: « ` Z L D 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 CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed re ked. work's for which this permit is issued(Sec.3097,Civ C.) /L Lender's Name APPLICANT CERTIFICATION Lender's Address 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, ARCHITECT'S DECLARATION s,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. sting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. 1 Signature Date Z12-0 t 0 July 17, 2010 To Whom It May Concern: I, Isabella B. Segna, am unwilling to continue to serve as Agent for Joseph J. Segna under the Limited Durable Power of Attorney for Management and Disposition of Assets dated December 20, 2000. Sincerely, ,4�,-�� a- Isabella B. Segna 22442 Carnoustie Court Cupertino, CA 95014 (408)253-3979 �� G ITIV 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(d_)cupertino.org PROJECT ADDRESS 221ty�f �� ���S I �� C� APN# OWNER NAME SC)S �('�� SL ✓�¢�' PHONE&06 �3 -Gr E-MAIL STREETADDRESS �f LIYZ_ / �.,P CITY, STATE, � ryn` o GSSG/ FAX VA L)V CONTRACTOR NAME L • �1l► LICENSE NUMBER LICENSE TYPE BUS.LIC.# COMPANY NAME � E-MAIL FAX 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 1/4"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 behalf.,I understand a d agree to comply with the re-roof policy//stated above. Signature of Applicant/Agent: Date: A— wl-n 7 ,V\ 6+ `J os(P k 17 547't V-j 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: 22gq cW.�vc�tS �ePERMIT# _!�T OWNER'S NAME: Tv5 /1 S, wt� PHONE# �� Z� �� GENERAL CONTRACTOR: - d 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 HAVEPBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. �y� V— I am not using any subcontractors: Sign ure 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 Septic Tank Sheet Metal Sheet Rock Tile Owner/ ontractor Signature Date CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 35603028 . 00 DATE ISSUED. . . . . . . : 11/12/2010 RECEIPT #. . . . . . . . . : BS000011989 REFERENCE ID # . . . : 10110079 SITE ADDRESS . . . . . : 22442 CARNOUSTIE CT SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER JOSEPH SEGNA ADDRESS . . . . . . . . . . : 22442 CARNOUSTIE CT CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-3949 RECEIVED FROM . . . . : LARRY SEGNA CONTRACTOR . . . . . . . : LIC # *OWNER* COMPANY . . . . . . . . . . : JOSEPH SEGNA ADDRESS . . . . . . . . . . : 22442 CARNOUSTIE CT CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-3949 TELEPHONE . . . . . . . . FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 8,400 .00 1. 00 0 .00 1. 00 0. 00 1BSEISMICR VALUATION 8,400 . 00 0 . 84 0 .00 0 . 84 0 . 00 1REROOFRES SQ FEET 28 . 00 364 . 00 0 . 00 364 . 00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 365. 84 0 .00 365 . 84 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 365 . 84 VISA --------------- TOTAL RECEIPT 365. 84 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 M.Indoor Air Ouality and Finishes 1.1W L006-�AWN 1 IAQ/Health pts y=yes D 2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes D 3.Usa Loaft VOC Adhadim 3 IAQ/Health pts y=yes D 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 D 6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 0 �; dlltf�lae�6t# 1 41AQ/Health pts y=yes 0 B.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes D 9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y=yes D 10.Install Whole House Vacuum System 3 IAQ/Health pts y=yes D 1 i 1 N.Flooring 1.Select FSC Certified Wood Flooring B Resource pts y=yes 0 �.Use Papdy Plwawawd J90M rag dodos 4 Resource pts y=yes D 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 D 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 Total Points—Mal—lablell 1 1401 1301 57 Total Points Project Received: 01 01 7q G:data/proWgreenbulldngguiderines/remodelers/greenpointsf=12=rDtected.xis CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 22442 carnoustic ct. DATE: 11/12/2010 REVIEWED BY: APN: BP#: "EVALUATION: 1$8,400 xPERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof PRIMARY . PENTAMATION SFD or Duplex 1 SFDWLROOF USE: P �'��( _ -���_ - PERMIT TYPE: WORK SCOPE FEE ID ROOF AREA s.f. 1REROOFFRES 2,800 7-1"", . Plant Ch iP ib Plo; ( / � _ir>t'. P'..Ft C ilc< tii���a,. )rhe r lac ch. Mv) iLv' NOTE: Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addn'1 info, FEE ITEMS (Fee Resolution 09-051 El 7/1,,"10) FEE QTY/FEE MISC ITEMS Pi"'m Clwck FC(l- Sliplrl. PC Fcc Permit Fee: $364.00 Pizrrr�tt.'?1)�t li.-I�'1ec Pc�Fr�rir f�'<°c�: ("onsirw lion 1-ox 'ICOI s iCtll Rcrt'icw Work Without Permit? 0 Yes E) No $0.00 Plr.ztzrtial�, l°�'t:`�: Trtr�c>l l}cx rr�r�<��ztu?ir�rt l�cr.i= Strong Motion Fee: 1BSEISMICR $0.84 Select an Administrative Item Bldp-Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $365.84 $0.00 TOTAL FEE: $365.84 Revised: 11/08/2010 CITY OF T CITY OF CUPERTINO REROOF CUPERTINO PERMIT APPLICATION A - / APN# � Date: Building Address: . 2 2 y y Z C�•��N s} Owner's Name: �To s- f, k S, S-�5►tib Phone #: y08 - ,0,53- 3g7q HOA: Yes ❑ No ® If Yes, provide letter from HOA Contractor: Phone#: Fax#: l Cupertino Business License #: Contractor License #: Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles &Asphalt Shingles q�Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other (Specify) ❑ Other(Specify) Number of existing coverings 1. ❑ Provide I.C.C.E.S. Report# 2,'ro be Removed ❑ Provide Mfgr. Installation Specs. Job Description: i�ew&o ve- TVtS4at1 .nevJ 5L1CC' 4v,_j 4 C_SPjA,j+` '9$ J Residential Commercial Green Building: Please complete relevant portion of the Conf,rmed 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: # 8 I,,Dc) ---- I I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy: Q rtie y- S ,4, J . S! �q Signature Revised 02/05/09