10090271 CITY OF CUPERTIN43 BUILDING PERMIT
BUILDING ADDRESS: 22322 CUPERTINO RD CONTRACTOR:GATEWAY ROOFING& PERMIT NO: 10090271
WATERPROOFING
dER'S NAME: PON LEE 191 VIENNA ST DATE ISSUED:09/29/2010
OWNER'S PHONE: 4153346008 SAN FRANCISCO,CA 94112 PHONE NO:(415)3346008
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG F ELECT r PLUMB
License Class Lic.# ��q(0`-(' MECH F RESIDENTIAL r COMMERCIAL r
Contractor Date
JOB DESCRIPTION:REMOVE OLD WATERPROOFING MATERIAL&APPLY 3
I hereby affirm that I am licensed under the provisions of Chapter 9 'LY OF
(commencing with Section 7000)of Division 3 of the Business&Professions :LASTOMERIC WATERPROOFING COATING
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 this Sq.Ft Floor Area: Valuation:$11000
permit is issued.
APPLICANT CERTIFICATION APN Number:32650061.00 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::'rove 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, 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:� 2�
e
Date � Z � Issued b �
atu
❑ 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, Date:
Business&Professions Code) Signature of Applicant:
I,as owner of the property,am exclusively contracting with licensed contractors to
construct 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
I have read the hazardous materials requirements under Chapter 6.95 of the
Compensation,as provided for by Section 3700 of the Labor Code,for 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 ner or author d ut
become subject to the Worker's Compensation provisions of the Labor Code,I must Date: Z�7
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
the above mentioned property for inspection purposes.(We)agree to save Lender's Address
..mnify 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 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
Building Department
City Of Cupertino
Is 10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
CUPERTINO Fax: 408-777-3333
CONTRACTOR / SUBCONTRACTOR LIST
JOB ADDRESS: ?, 6"#40 PERMIT# Z
OWNER'S NAME: 10014,44PHONE #
GENERAL CONTRACTOR: jULSINESS LICENSE#
ADDRESS: CITY/ZIPCODE: G4 /`L
*Our municipal code requires all businesses working it 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 SUBC FACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE. q6ql
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
caner/Contracto Signature Dat
Nl.Indoor Air Quality an Finishes ;•
I.Use LDVV/fdo-VpC Pairit
2.Use Low VOC,Water-Based Wood Finishes 1 IAD/Health pts y=yes
es D
3.Use Low/t�o VOC Adhesives 21AQ/Health pts y=yes
D
4.Use Salvaged Materials for Interior Finishes 3 IAD/Health pts y=yes
D
5.Use Engineered Sheet Goods with no added Urea 3 Resource pts y=yes D
Formaldehyde
B.Use Exterior Grade Plywood for Interior Uses 6 IAQ/Health pts y=yes
11AQ/Health is D
7.Seala"Ex{iosed P�oleboard Dr MQF p y=yes p
B.Use FSC Certified Materials for Interior Finish — 4 IAQ/Health s = es
4 Resource pts D
9.Use Finger-Jointed orRecycled-Cony=yes
tent Trim D --
1D.Install Whole House Vacuum System i Resource pts y=yes D
3 IAQ/Health pts y=yes
D
N.Flooring
1.Select FSC Certified Wood Flooring
(I Resource pts y=yes
2.Use R D
apidly Renewable Flooring Materials
3.Use Recycled Content Ceramic Tiles Resource pts y=yes D
4.Install Natural Linoleum in Place of Vinyl Resource pts y=yes D
5.Use Exposed Concrete as Finished Floor *IAQ/Health pts y=yes
D
6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes D
4 Resource pts y=yes D
E=�� Total Points Available:
140 130 57
Total Points Project Received:
0 0 0
G:datalpmgs/greenbu Idingguidelines/remodelers/greenpointdna1212D4prMecled rJs
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPART MENT•BUILDING DIVISION
ALBERT SALVADOR, P.E.,C.B.O., BUILDING OFFICIAL
CUPERTINO 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228•FAX(408)777-3333•tuilding(a)cupertino.org
PROJECT ADDRESS . J APN#
OWNER NAME PHONE Y3 - F2_6 E-MAIL /' n' f #„J• ^O ft-Al-
STREET ADDRESSA 21' h0 Z 1 CITY, STA TE,ZIP O� FAX
CONTRA OR NA E a� LICENSE NUMBEI.� LICENSE TYPE BUS.LIC.#
a*A
qft
C MPA Y NAME E-MAIL ,� FAX
tea xwl
STREET A D ESS i CITY, TA-E,ZIP �� A PHO E ' O
CMa
I UNDERSTAND AND AGREE TO THE FOLLOWING:
1. The re-roof project shall comply with all applicatle provisions of the 2007 California Building Code.
2. You must schedule all needed inspections a minitaum of one day before the requested inspection date.
Please schedule inspections online or call (408)7 7-3228 between 7:30-3:30 (Mon-Fri).
3. Tear-off roof inspection is required. Please cal l 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 followi ig items will be verified:
a. Flat roofs shall have a minimum of 1/4"per Rot of slope and must demonstrate there is no ponding.
b. Listings from approved testing agencies for z 11 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 nail,ng 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 ing is rue: I am the property owner or authorized agent to act
on the property owner's behalf. I unde and and a ee t ply with t e-roof policy stated above.
Signature of Applicant/Agent: Date: !i12V
ReroofPolicy_2010.doc revised 05/17/10
1001 (0 2-1
3
CITY OF
CITY OF C'UPERTINO
CUPEKTINO GENERA-, BUILDING
PERINMT APPLICATION FORM
APN# 0 o� ` Date: Z D
Building Address:
CLMailing Address (if different om building address):
Are Hazardous Materials being used as part of this project? Yes No
25
HOA: (Exterior work only) Yes ❑ No If es, provide letter from HOA
Owner's Name- Phone#:
F0 n 4az
Contractor: Phone:
W roe Fax: (S-s-2Z-��6J
Contractor License : 7 q IO�- t
Cupertino Business License#:
Contact: JJ// Phone:
,W?vlfit/l, Fax:
Residential Commercial ❑
Job Description: oV
Building Permit Info:
' Bldg ❑ Elect ❑ P!umb ❑ Mech ❑
Type of Construction (Usage Class): Occupancy Type: (2---
1-A, 1-B ❑ U/=-A ❑ II/VI B, IV-HT, V-B ❑�—
Valuation: y� Square Footage:
000 � 12-
Project Size: Express 2�tandard ❑ Large ❑ Major ❑
Green Building: Please complete relevant portion of the Green Building/LEED Checklist& attach it
to the application or if applicable, iiclude in plan set& the sheet index.
pints Achieved:
L For help, contact Build it Green at www.builditgreen.or ,(
Revised 07/14/09
3