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10090225 CITY OF CUPERT(NO BUILDING PERMIT BUILDING ADDRESS: 10921 KESTER DR CONTRACTOR: PERMIT NO: 10090225 OWNER'S NAME: JEAN OLSON - � : X C DATE ISSUED:09/23/2010 BIER'S PHONE: 4084464158 , PHONE NO: ,v LICENSED CONTRACTOR'S DECLARATION BUILDING ERMIT INFO: BLDG r- ELECT r— PLUMB License Class C- 3Lic.# 9'{C( tJc, MECH r RESIDENTIAL COMMERCIAL r ContractorkcPate q ^ ILI I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:RE-ROOF OVERLAY WITH DURO-LAST MEMBRANE (commencing with Section 7000)of Division 3 of the Business&Professions CLASS A Code and that my license is in full force and effect. 22SQ 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:$11451 permit is issued. APPLICANT CERTIFICATION APN Number:35628022.00 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 regulations per the Cupertino Municipal Code,Section Issued b Date: Signature "'" Date y' D LJ 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 licant: Date: I,as owner of the property,am exclusively contracting with licensed contractors to 9 -1 --�, `10 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 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, us f ©Ener or u iz nt: Date forthwith comply with such provisions or this permit shall be deemed revoked. �? _( L APPLICANT CERTIFICATION ONSTRUCTION LENDING AGENCY 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 relatin; 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 unify 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 9.18. 1 understand my plans shall be used as public records. Signature Date Licensed Professional CITY CF CUPERTINO 3 ITEMS OF 13 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Elk: Lot: APN . . . . . . . . : 35628022 . 00 DATE ISSUED. . . . . . . : C9/23/2010 RECEIPT #. . . . . . . . . : ES000011547 REFERENCE ID # . . . : 10090225 SITE ADDRESS . . . . . : 10921 KESTER DR SUBDIVISION . . . . . . : CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER SEAN OLSON ADDRESS . . . . . . . . . . : 10921 KESTER DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : SORENSON & ASSOC CONTRACTOR . . . . . . . : 'IBD - TO BE DETERMINED LIC # 00096 COMPANY . . . . . . . . . . : IBD - TO BE DETERMINED ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : , TELEPHONE . . . . . . . . FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 11, 451. 00 1. 00 0. 00 1. 00 0 . 00 1BSEISMICR VALUATION 11,451. 00 1.20 0 . 00 1.20 0 . 00 1REROOFRES SQ FEET 22 . 00 286 . 00 0 . 00 286 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 288 .20 0 .00 288 .20 0 .00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- --------------------------- - -------- ---------------------------- 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 604 ROOF IN-PROGRESS 605 FINAL REROOF CITY OF CUPERTINO FEE ESTIMATOR.-BUILDING DIVISION ADDRESS: I DATE: REVIEWED BY: APN: BP#: *VALUATION: 1$11,451 q)�PERMITTYPE: Minor Building Permit PIAN CHECK TYPE: Re-roof PRIMARY r >,, 1 PENTAMATION 1 SFDWLROOF USE: SFD or Duplex ���� ,�� PERMIT TYPE: WORK SCOPE FEE ID ROOF AREA s.f. 1 REROOFFRES 2,200 _T7 0,,/w,:11,-,11, fvi"j). -11 iE';' w.r77)T NOTE: Thesefees are based on the prelintinary in ormatio.7 available and are only an estimate. Contact the De t or addn'1 info, FEE ITEMS(Fee Resolution 09-051 Eff. '% Wnoor r Quality and Finishes 1.Use LwIN0 VOC Few 1 IAQ/Health pts yeses 0 2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y--yes 0 3.Usebo?AlpVOGA1il gewas 3 IAQ/Health pts y=yes 0 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 Plywood for Interior Uses 1 IAQ/Health pts y=yes 0 7.,S 4bseel dQr;AOF - 4 IAQ/Healft-pts y--yes 0 S.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 1 D.Install Whole House Vacuum System 3 IAQ/Health pts y=yes 0 1 1 0 N.Flooring 1.Select FSC Certified Wood Flooring 6 Resource pts y=yes 0 Use 33apady f3er+enra4fe floodq M4*als 4 Resource pts y=yes 0 3.Use Recycled Content Ceramic Tiles 4 Resource pts y=yes D 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 yges D 6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes D @ 1 Id l Total Points Available, , 1 1401 13 01071 Total Points Project Received] 0 01 0 Wil ' 3 ^ ) C G:datdproi sigreenbuNiOngguidelines/n:modelers/greenpointsfina121204proleoteEIAS Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 CUPERTINO Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: I OCI 7 PERMIT# D 2Z OWNER'S NAME: PHONE # L{ GENERAL CONTRACTOR:S 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 SUBCON'T'RACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. r I am not using any subcontra�: Y ^� D , Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSIP ESS 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 ! < , X11 � L(If PLAA!!� CITY OI' CUPERTINO C BY a] REROOF °ATE CUPERTINO PERMIT .:APPLICATION p I_FEPT, DATE .. ... APN# V Date: .- --.... a ' -= Building Address: Owner's Name: Phone #: ��- HOA: Yes No ❑ If yes, provide letter from HOA Ko y Contractor: Phone #: `- 7s` : 6 26 • `l(o Fax#: z , Cupertino Business License #: ' Contractor License #: O C40 Type of Roof Covering: Existing: Proposed: k Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles ❑ Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other (Specify) V! Other (Specify) k,, Number of existing coverings _ ❑ Provide I.C.C.E.S. Report# ❑ To be Removed ❑ Provide Mfgr. Installation Specs. Job Description:cl� �s A c Residential U ' - Commercial Green Building: Please complete relevant p,)rtion of the Confirmed 24ith 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, Understand and Will Comply with Cupertino's Tear-Off Policy: Signature Revised 02/05/09