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10090227CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 11103 CANYON VISTA DR OWNER'S NAME: GREG LAFFEN iER'S PHONE: 4082531857 ❑ LICENSED CONTRACTOR'S DECLARATION License Classes I % Lic. # 4A qq I q in Contractor Date --q 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. 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 whicb 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 12errmt. Additionally, the applicant understands and will comply with all non-po t s e egu•L lations per the Cupertino Municipal Code, Section 9.18. Signature_l �_t — Date el —13 L.J '`633'NER-BCIILDER DECLARA11UN I 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). I 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, I 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 •nnify and keep harmless the City of Cupertino against liabilities, judgments, , 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. Signature Date CONTRACTOR D-r-�('P—�V\,:f-x-�, � f--' PERMIT NO: 10090227 DATE ISSUED: 09/23/2010 PHONE NO: BUILDING PERMIT INFO: BLDG r— ELECT r PLUMB r MECH r RESIDENTIAL r COMMERCIAL [_ JOB DESCRIPTION: RE -ROOF INSTALL A SINGLE PLY MEMBRANE OVER EXISTING ROOF CLASS A 13SQ Sq. Ft Floor Area: I Valuation: $6924 APN Number: 35628029.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. f Z Issued by 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. Signature of Applica3r Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I 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 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 Health & Safety Code, Sections 25505, 25533, and 25534. yen . Date: L --f 6 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 Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional 3 ITEMS OF 13 CITY OF CUPERTINO PERMIT' RECEIPT Sec: Twp: Rng: Sub: Elk: Lot: APN ........: 35628029.00 DATE ISSUED.......: 09/23/2010 RECEIPT #.........: BS000011547 REFERENCE ID # ...: 10090227 SITE ADDRESS .....: 11103 CANYON VISTA DR SUBDIVISION ...... CITY CUPERTINO IMPACT AREA ...... OWNER GREG LAFFEN ADDRESS ..........: 11103 CANYON VISTA DR CITY/STATE/ZIP ...: CUPERTINO, CA 95014 OPERATOR: patg COPY # : 1 RECEIVED FROM ....: SCRENSON & ASSOC CONTRACTOR .......: TPD - TO BE DETERMINED LIC # 00096 COMPANY ..........: TPD - TO BE DETERMINED ADDRESS .......... CITY/STATE/ZIP ...: , TELEPHONE ........ FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL ---------- ----------------------- 1BCBSC VALUATION ---------- 6,924.00 ---------- 1.00 ---------- 0.00 ---------- 1.00 0.00 1BSEISMICR VALUATION 6,924.00 0.70 0.00 0.70 0.00 1REROOFRES SQ FEET 13.00 169.00 0.00 169.00 ---------- 0.00 ---------- TOTAL PERMIT ---------- 170.70 ---------- 0.00 170.70 0.00 VOICE ID DESCRIPTION -------- ---------------------------- 601 ROOF TEAR OFF VOICE ID DESCRIPTION -------- ---------------------------- 602 ROOF PLYWOOD NAIL 604 ROOF IN -PROGRESS 605 FINAL REROOF 1. Use iLmuffilo-VOG Feint 1 IAQ/Health pts y --yes 2. Use Low VOC, Water -Based Wood Finishes 2 IAQ/Health pts y --yes 3.UsoW?Ajo'VAG: dliapbes 31AQ/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 ; aaj iof x�r#AiIDF 4 IAQ/Health -pts y=yes B. 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/Hsalth pts y=yes N. Flooring 1. Select FSC Certified Wood Flooring B Resource pts y=yes Ilse 33apicjiener�atleoori �ylaferaajs 4 Resource pts y=yes 3. Use Recycled Content Ceramic Tiles 4 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 4 Resource pts y=yes 6. Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes Total Points Avails le: Total Points Project Received: 1401 1301 57 1 0 0 0 G:datdprmjdgr senbufldingguidelinedrL-modelers/greenpointsfinal212o4proleded.-4s CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: k 0:3 PERMIT # OWNER'S NAME: - PHONE # LAc!�4 I.S-3 IS GENERAL CONTRAC BUSINESS LICENSE # ADDRESS: CITY/ZIPCODE: *Our municipal code requires all businesses working in the city to nave a 9,,iy u, -upul t„■., .,,.�._.. �� ._��.-��• NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONT� CTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. __-- - _..._�.. _ 1 am not using any subcontrac�_ Si€,3 Date PlPnCP ehPek annlicable subcontractors and complete the following information: Owner / Contractor Signature Date SUBCONTRACTOR BUSINE 3S 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 / Contractor Signature Date CITY OF2- - � iw, : .� CITY OF CUPERTINO DAM RF,ROOF CUPERTINO PERMIT APPLICATION PLAN-, DATE APN # �`,-r C �y(� �� Date:" -M" o` -i Building Addrej�; r, ��L e �� n Owner's Name: Phone #: tley Roj."e_\,A, b-c-cp C �- HOA: Yes No ❑ If Yes, provide letter from HOA Contractor: Phone #: c{ •�5 , �, �,� • Z Sor e Fax #: t Cupertino Business License #: Contractor License #: Type of Roof Covering: Existing: Proposed: 'g, Built -Up Roof ❑ 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. Repo # ❑ To be Removed ❑ Provide Mfgr. Installation Specs. Job Description: Ctuss Residential - Commercial Green Building: Please complete relevant portion of the Cori. --firmed 2gith_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: t I Have Read, Understand and Will Comply with Cupertino's Tear -Off Policy: Signature Revised 02/05/09