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10090181 CITY OF CUPERTI NO BUILDING PERMIT BUILDING ADDRESS: 22424 MCCLELLAN RD CONTRACTOR:BECKS ROOFING PERMIT NO: 10090181 OWNER'S NAME: JEFFREY WIDMAN 6191 OCHO RIOS DR DATE ISSUED:09/20/2010 PER'S PHONE: 6509482831 SAN JOSE,CA 95123 PHONE NO:(408)365-8979 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT F PLUMB r License Class / Lic.# / ' F r MECH RESIDENTIAL COMMERCIAL Contractor �:(JC.J Date UJ V I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: RE-ROOF T/O,OSB,#40YR,30LB FELT CLASS A 34SQ (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. Sq.Ft Floor Area: Valuation:$13000 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 APN Number:35604023 Occupancy Type: 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 relatin€ PERMIT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION. costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionall ,the applicant understands and will comply with all non-point so a regulaf per the Cupertino Municipal Code,Section Issued bxt'' — Date: U � . 9.18. Signature v Date U RE-ROOFS: OWNER-BUILDER DECLARATION All roofs shall be inspected prior to any roofing material being installed.If a roof is installed without first obtaining an inspection,I ay4ee to remove all new materials for I hereby affirm that I am exempt from the Contractor's License Law for one of inspection. the following two reasons: �/ 1,as owner of the property,or my employees with wages as their sole compensation,, Signature of Applicant: �-/ Date: 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 ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this 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 permit is issued. Health&Safety Code,Sections 25 05,25 ,and 25534. 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 Owner or authorized agent. Compensation laws of California. If,after making this certificate of exemption,I Date: become subject to the Worker's Compensation provisions of the Labor Code,I mu it forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.) I certify that I have read this application and state that the above information is Lender's Name correct.I agree to comply with all city and county ordinances and state laws relatir Lg to building construction,and hereby authorize representatives of this city to enter Lender's Address upon the above mentioned property for inspection purposes.(We)agree to save '-mnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION ,and expenses which may accrue against said City in consequence of the g.anting of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Licensed Professional Signature Nate CITY OE' CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: B]k: Lot: APN . . . . . . . . . 3E.604023 DATE ISSUED. . . . . . . : 09/20/2010 RECEIPT #. . . . . . . . . : BE;000011496 REFERENCE ID # . . . : 10090181 SITE ADDRESS . . . . . : 22424 MCCLELLAN RD SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER JEFFREY WIDMAN ADDRESS . . . . . . . . . . : 22424 MCCLELLAN RD CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : CARL A BECKS CONTRACTOR . . . . . . . : BECKS, CARL LIC # 21908 COMPANY . . . . . . . . . . : BECKS ROOFING ADDRESS . . . . . . . . . . : 6:-91 OCHO RIOS DR CITY/STATE/ZIP . . . : S]iN JOSE, CA 95123 TELEPHONE . . . . . . . . : (1:08) 365-8979 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ----------- ---------- ---------- ---------- 1BCBSC VALUATION 13, 000. 00 1 .00 0. 00 1. 00 0 . 00 1BSEISMICR VALUATION 13, 000 . 00 1 .30 0 .00 1.30 0 .00 1REROOFRES SQ FEET 34 . 00 442 . 00 0 .00 442 . 00 0 .00 ----------- ---------- ---------- ---------- TOTAL PERMIT 444 .30 0. 00 444 .30 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 444 .30 VISA --------------- TOTAL RECEIPT 444 .30 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- --------------------------- - -------- ---------------------------- 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 604 ROOF IN-PROGRESS 605 FINAL REROOF M.Indoor Air Quality and Finishes 1.Use Low/No-VbG Paint 1 IAQ/Hsalth pts y=yes 0 2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes 0 3.Use Low/go V,OC Adhesives 3 IAQ/Health pts y=yes 0 4.Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes 0 5.Use Engineered Sheet Goods with no added Urea Formaldehyde 61AQ/Health pts y=yes 0 6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 0 7 Sed all EVw9d ftrOWebmdorUDF 41AQ/Health pts y=yes 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 0 1 1 1 N.Flooring 1.Select FSC Certified Wood Flooring B Resource pts y=yes 0 2 Use Rapidly Renewable Flooring MatWajs 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 0 I1 1 1 Total Points Avails le: 1 1401 1301 57 Total Points Project Received:1 1, 01 01 0 G:datalprogsr)reenbuildingguidelineslremodelerstgreenp6intsfina1212 04proteatedxis CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: I DATE: REVIEWED BY: APN: BP#: *VALUATION: 1$13,000 R*PERMITTYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof PRIMARY <o,, 11 PENTAMATION 1 SFDWLROOF USE: SFD or Duplex 1 1_{)<> . . -f PERMIT TYPE: WORK SCOPE FEE ID ROOF AREA s.f. 1REROOFFRES ;1,400 i fc(h M,11), t cc' f'iur�th Tz;;l;_ ?`LV NOTE: Theseees are based on the preliminary in ormation available and are only an estimate. Contact the Dept/or addn'l info. FEE ITEMS(Fee Resolution 09-051 Elf. 7- 10) FEE QTY/FEE MISC ITEMS supp/. 1'('FCC F P/11/_11/7. "11ec°/I. 1e/,,c I laii C/wc L Permit Fee: $412.00 sllpp/ F P/IIInb. lI°r1t. Z fee: t crit f"Cc f'hIalh i/ech 1: REROOF TEAR-OFF POLICY COMMUNITY DEVELOPMENT DEPPRTMENT•BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BJILDING OFFICIAL CUPERTINO 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408)777-3228•FAX(408)777-3333•building(@cupertino.org PROJECT ADDRESS 2, /� j /► APN# OWNER NAME `// Jb�A I^ ` `P•(I- E-MAIL STREET ADDRESS fyZt. / L /v CITY, iTATE,ZIPIl4 /' FAX !�4v e / CONTRACTOR NAME CAr �'1 LICENSE NUN BER /`�I I+l �L� EN PE,� BUS.LIC.# COMPANY NAME ��.- v /'Y�'I/� E-MAIL. / FAX STREET ADDRESS /�" f� CITY,`.TATE,ZIP �� PHON h 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 minimum 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 (all 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 ins>G ection 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 approximatel,l 25% of the roofing material. 6. New roof coverings shall not be applied withot t first obtaining all inspections and written approvals from the building inspector. Any roofing whic i 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 obtainl;d 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"per 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 nailing 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 following is true: I am the property owner or authorized agent to act on the property owner's behalf. I undrtapr and agr,-e to comply with the re-roof policy stated above. ` Signature of Applicant/Agent: Date: ( � ReroofPo1icy_2010.doc revised 05/17/10 CITY OF L961 CITY OF CUPERTINO c-� :,1 REROOF CUPERTINO PERMIT APPLICATION FBuildingAdd��,�, N# 2,0 0 L� CI) Date: Sj 4 s L Mc le1 e= - Owner's Name: J t , Phone #: HOA: Yes ❑ No If i/es, rovide lets er from HOA- S Contractor: C� j'C'CK-� t� PhoneI/V 1 2 ?> `_ Fax#: Cupertino Business License #: Contractor i ense #: Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles Asphalt Shingles Wood Shakes (❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles c3 Other (Specify) ❑ Other(Specify) Number of existing coverings ❑ Provide I.C.C.E.S. Report# ❑ To be Removed ❑ Provide Mfgr. Installation Specs. Job Description: , f-ell Residential - Commercial Green Building: Please complete relevant portioa of the Confirmed 1_46th_Planning Dept. if Green Building Checklist & attach it to the application or if there are any restrictions: ❑ applicable, include in Man set & the sheet index. Valuation: 1,3 a Cg D I Have Read, Understand and Will Comply with Cu,)ertino's Tear-Off Policy: Signature Revised 02/05/09