10090005 CITY OF CUPERTIvO BUILDING PERMIT
BUIL15ING ADDRESS: 19872 MERRITT DR CONTRACTOR:R A CONSTRUCTION PERMIT NO:10090005
OWNER'S NAME: LAIMA BALTUSIS AND DANIEL IVERSON 3851 R CHARTER PARK DR DATE ISSUED:09/01/2010
ER'S PHONE: 4084462493 SAN JOSE,CA 95136 PHONE NO:(408)559-1877
❑ LICENSED CONTRACTOR'S DECLARATION- BUILDING PERMIT INFO: BLDG ELECT PLUMB r
License Class Lie.# -3 MECH r RESIDENTIAL r COMMERCIAL r
Contractor Date
JOB DESCRIPTION:RE-ROOF TEAR OFF,OSB/PLYWOOD,INSTALL NEW
I hereby affirm that I am licensed under the provisions of Chapter 9
ROOF
(commencing with Section 7000)of Division 3 of the Business&Professions LIFETIME SHINGLE CLASS A 28SQ
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 Valuation:$13950
Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area:
permit is issued.
APPLICANT CERTIFICATION APN Number:31630025.00 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 relatiu,
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, 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.
Issued by,_-_,
y.- ��� ��— Date: 1
Signature Date
L 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 inspe ion,I agree to remove all new materials for
1,as owner of the property,or my employees with wages as their sole compensatic n, inspection. _
will do the work,and the structure is not intended or offered for sale(Sec.7044, Date:
Business&Professions Code) Signature of Applicant:
1,as owner of the property,am exclusively contracting with licensed contractors tc
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 shal 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 agent:
become subject to the Worker's Compensation provisions of the Labor Code,I m ust Date: ! / /0
forthwith comply with such provisions or this permit shall be deemed revoked.
��Kd
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
imnify 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
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE-CUPERTIN D, CA 95014-3255
CUPERTINO
(408)777-3228- FAX(408)777-3333 -building
(cr7cupertino.org
PROJECT ADDRESS A / Qw APN#
OWNER NAME PFONE E-MAIL
STREET ADDRESS ✓' CITY. ;TATE,ZIP FAX
CONTRACTOR NAM LICENSE NUMBER LICENS TYPE BUS.LIC#
COMPANY NAM E-MAI_ FAX
STREET ADDRESSA CITY,:TATE,ZIP �f" / PHONE 569
?65 v
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 mi limum 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 availa)le 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 insiection is required.
5. In-Progress roof inspection is required. Cal 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/4"pe--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 railing inspection and the work is not complete, you will
be charged a re-inspection fee of$126.00. Th�;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 nd ag-ee to comply with the re-roof policy stated above.
Signature of Applicant/Agent:
Date:
ReroofPo1icy_2010.doc revised 05/17/10
M.Indoor Air Quality and Finishes
1.Use LowNo-VOC Paint 1 IAQ/Health pts y=yes 0
2,Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y--yes 0
3.Use Low/No VOC Adhesives 3 IAQ/Health pts y--yes 0
4.Use Salvaged Materials for Interior Finishes 3 Resource pts yeses 0
5.Use Engineered Sheet Goods with no added Urea
Formaldehyde 61AQ1Health pts y=yes 0
6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 0
7.Seal 11 Vesed�P aardor MDF _ 41AQ/Health pis Y-=Yes
0
B.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes0
9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y=yes 0
10.Install Whole House Vacuum System 3 IAQ/Hsalth pts y=yes 7J770
I1 1 D
N.Fiooring
1.Select FSC Certified Wood Flooring 6 Resource pts y=yes0
2.Use#3apidfy Renewable Flooring Materials 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/Health pts y=yes 0
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 01 0
1 1 D
Total Points Availab e:l 140 130 57
Total Points Project Received:) 0 0 0
- -�-1d
G:datalprocslgreenbuiicfingguidelinesln:modslarslgre ointona121LMprdnted.xls
CITY OF CUPERTINO
3 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: B7.k: Lot:
APN . . . . . . . . : 3:.630025 .00
DATE ISSUED. . . . . . . : 00/01/2010
RECEIPT #. . . . . . . . . BS000011351
REFERENCE ID # . . . : 10090005
SITE ADDRESS 19. 872 MERRITT DR
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : L'kIMA BALTUSIS AND DANIEL IVER
ADDRESS . . . . . . . . . . : 13872 MERRITT DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : R A CONSTRUCTION
CONTRACTOR . . . . . . . : AJDREWS, RON LIC # 21382
COMPANY . . . . . . . . . . : R A CONSTRUCTION
ADDRESS . . . . . . . . . . : 3351 R CHARTER PARK DR
CITY/STATE/ZIP . . . : SAN JOSE, CA 95136
TELEPHONE (408) 559-1877
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- -------------
---------- ---------- -----
1BCBSC VALUATION 13, 950. 00 1 .00 0. 00 1. 00 0 .00
1BSEISMICR VALUATION 13, 950 . 00 1 .40 0 . 00 1.40 0 .00
1REROOFRES SQ FEET 28 .00 364 . 00 0 .00 364 . 00 0 .00
---------- ---------- ---------- ----------
TOTAL PERMIT 366 .40 0. 00 366 .40 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
CITY OF CXPERTINO a
REROOF
CUPERTINO PERMIT APPLICATION
APN# _ Date:
Building Address: lel
g
=Owner'sName: PhoneNo ye s, provide lei-ter from HOA
Contractor: /Z Phone #:
Fax#:
Cupertino Business License #: Contractor License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ; Asphalt Shingles
Wood Shakes ❑ Wood Shakes
❑ Wood Shingles c3Wood Shingles
❑ Other (Specify) ❑ Other (Specify)
Number of existing coverings _ ❑ Provide I.C.C.E.S. Report#
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description: C�9
`F fi"'lz- 0 ,-V�tts C -�s
C �4
Residential Commercial ❑
Green Building: Please complete relevant portion of the Confirmed 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: ��
I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
Signature
Revised 02/05/09