10090229 CITY OF CUPERTIN43 BUILDING PERMIT
BUILDING ADDRESS: 11123 CANYON VISTA DR CONTRACTOR.__ iY .jn,�< �f''i PERMIT NO: 10090229
OWNER'S NAME: GEOFFREY SHERMAN ! >��(3 C�~C � Ll DATE ISSUED:09/23/2010
1ER'S PHONE: 4082557603 ( ✓1 L r �__ PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT r- PLUMB
License Class q1-1 c( 3N D Lic.# 3Q MECH r- RESIDENTIAL r- COMMERCIAL
Contractor'S�.o..,SGs:,t Kmr-r takc c Date Q !y
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:RE-ROOF OVERLAY WITH SINGLE PLY DURO-LAST
MEMBRANE
(commencing with Section 7000)of Division 3 of the Business&Professions '-LASS A 13SQ
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 which Sq.Ft Floor Area: Valuation:$6924
permit is issued.
APPLICANT CERTIFICATION APN Number:35628030.00 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 PENT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. �� Date:
-'� Issuey
Signature --� V Date c1'�3- ITN
V 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
I,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, �
Business&Professions Code) Signature of Applicant: Date:
I,as owner of the property,am exclusively contracting with licensed contractors to _L5- 10
construct
L 5- 10construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS 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 in
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. I 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&
Safety 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 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 Owner or a t r agent:
become subject to the Worker's Compensation provisions of the Labor Code,_I Date: -, --
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is I hereby 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
mify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
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 understand my plans shall be used as public records.
9.18.
Signature Date Licensed Professional
CITY OF CUPERTINO
3 ITEMS OF 13 PERM"T RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: B:-k: Lot:
APN . . . . . . . . : 35628030 .00
DATE ISSUED. . . . . . . : 09/23/2010
RECEIPT #. . . . . . . . . : B:3000011547
REFERENCE ID # . . . : 10090229
SITE ADDRESS . . . . . : 1:-123 CANYON VISTA DR
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : GEOFFREY SHERMAN
ADDRESS . . . . . . . . . . : 1:-123 CANYON VISTA DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : SORENSON & ASSOC
CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096
COMPANY . . . . . . . . . . : TBD - 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 VOICE ID DESCRIPTION
-------- ----------------------------- -------- ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
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: 'Y PHONE# c ' SS `7c.C
GENERAL CONTRACTOR: 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 1NSPECTION(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
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
CITY OF CUPERTINO
FEE ESTIMATOR--BUILDING DIVISION
its ADDRESS: DATE: REVIEWED BY:
APN: BP#: "VALUATION: 1$6,924
PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY /0 PENTAMATION 1SFDWLR00F
USE: SFD or Duplex 10 PERMIT TYPE:
WORK
SCOPE
FEE ID ROOF AREA
;.f.
1 REROOFFRES 1,300
f�l�'C'1. hCYiIt7 f'C'i';
"b"o'?. 1", r2/1l'e't: 7,ir'C. P"riPJf1
i�artb. to
NOTE. These ees are based on the preliminaty in ormation zvailable and are only an estimate. Contact the De t or addn'1 info.
FEE ITEMS (Fee Resolution 09-051 Ef. 7!I%70) FEE QTY/FEE MISC ITEMS
Plan C7,c'cA! kc((
Strp171. 1't,'
Plan Chcck:
Permit Fee: $169.00
Sapp1. I17.S'l ]''Ce
F'Itnrtf�.,'_tleth.:�1:1c� C nif 1'ec=:
l'Itarrrh.i;1 t�ch.i7:Ic�c� 1'cnnit 1 cif:
t wz.sIrtwiion 1'ax
,l coustfcOl
Work Without Permit? 0 Yes E) No $).00
111annin,<>Vilcs
7 i-en cel I)oc lonfIntution Fee's
Strong,Motion Fee: IBSEISMICR $3.69 Select an Administrative Item
Bldg;Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $173.69 $0.00 TOTAL FEE: $170.69
Revised: 9/22/2010
M.Indoor Air Quality and Finishes
1. 1 IAQ/Heah pts yeses p
2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Hsalth pts yeses p
3.,Usebvig#4VOGAdia6wes 31AQ/Health pts y=yes p
4.Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes D
5.Use Engineered Sheet Goods with no added Urea
Formaldehyde 61AQ/Health pts y=yes p
6.Use Exterior Grade Piywood for Interior Uses 1 IAQ/Hsalth pts y=yes p
7.S8dqOiaf dgrUDF - 4 IAQ/Health pts Y=Ye 0
B.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 MWE601im
1.Select FSC Certified Wood Flooring a Resource pts y=yes D
life f3pd i Rer;te le J9wdng 1�lafsraajs 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/Healthpts yeses p
5.Use Exposed Concrete as Finished Floor 4 Resource pts y=yes 0
S.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes 0
Total Points Availabl.e:j 1 701 1301 57
Total Points Project Received: 0 -OL 0
rkdatalprogslgr:enbutldingguidelinseremodelers/greenpointsfina121204proteotedxls
CITY OF PL01' PLAn�
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CITY OF CUPERTINO
91 RER.00F °AW
CUPERTINO
PERMIT APPLICATION PLANNI Df_-.PT.
MATE
APN # Dater
h '
Building Address:
Owner's Phone #:
ptO,Kf_\A-c
HOA: Yes [ No ❑ [f es, provide letter from HOA H o � � 11 G 0
Contractor: Phone
Fax#:
Cupertino Business License #:
Contractor License #:
K
Type of Roof Covering:
Existing: Proposed:
J Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other (Specify) ❑ Other (Specify) 5
Number of existing coverings ❑ Provide I.C.C.E.S. Rep rt#
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description:
Residential -
Commercial
Green Building: Please complete relevant por:ion of the Con-fumed 2ith_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:
� r
I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
4l
Signature
Revised 02/05/09