10090193 CITY OF CUPERTI NO BUILDING PERMIT
BUILDING ADDRESS: 11090 SANTA TERESA DR CONTRACTOR:CASTILLO'S ROOFING PERMIT NO: 10090193
OWNER'S NAME: AKEMI MAEDA 1703 CATHAY DR DATE ISSUED:09/20/2010
1ER'S PHONE: 4084465149 SAN JOSE,CA 95122 PHONE NO:(408)251-3565
❑ LICENSED CONTRACTOR'S DECLARATION�� Y5045&
��& r
/ BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic.# / MECH r RESIDENTIAL F COMMERCIAL r
Cont a Date -�0!/ 0
I hereby affirm tha I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:RE-ROOF TEAR OFF EXISTING WOOD SHAKES,INSTALL
(commencing with Section 7000)of Division 3 of the Business&Professions 7/16"OSB INSTALL A 40YR COMP SHINGLES 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:$10000
permit is issued.
APPLICANT CERTIFICATION APN Number:35617029.00 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 relatin€
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
9.18. �-� -
igm ?�U
7/) _/D Issued bya-' , - Date:
Date
V WNER-BUILDER DECLARATION
RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one oAll 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) Signatu of App _Date:
1,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
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. 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&
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 Cod<,I=M- Owner or autho ized agent:
forthwith comply with such provisions or this permit shall be deemed revoked. — Date: C/
APPLICANT CERTIFICATION CONSTRUCTION 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 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
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. I understand my plans shall be used as public records.
Signature Date Licensed Professional
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk : Lot:
APN 35E17029 .00
DATE ISSUED. . . . . . . : 09/20/2010
RECEIPT #. . . . . . . . . BSC00011511
REFERENCE ID # . . . : JOC90193
SITE ADDRESS 11090 SANTA TERESA DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : AKEMI MAEDA
ADDRESS 11090 SANTA TERESA DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : CASTILLO'S ROOFING
CONTRACTOR . . . . . . . : J0;3E CASTILLO LIC # 25850
COMPANY . . . . . . . . . . : CA3TILL0'S ROOFING
ADDRESS . . . . . . . . . . : 17 )3 CATHAY DR
CITY/STATE/ZIP . . . : SA:J JOSE, CA 95122
TELEPHONE . . . . . . . . : (4)8) 251-3565
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- -------------
---------- ---------- ---------
1BCBSC VALUATION 10, 000 . 00 1 .00 0. 00 1 .00 0 .00
1BSEISMICR VALUATION 10, 000 .00 1. 00 0 . 00 1. 00 0 .00
1REROOFRES SQ FEET 22 . 00 286 .00 0 .00 286 . 00 ------0_00
---------- ---------- ----------
TOTAL PERMIT 288 .00 0 . 00 288 . 00 0 .00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- -----------
CHECK 288 .00 #16637
---------------
TOTAL RECEIPT 288 .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: j DATE: REVIEWED BY:
APN: BP#: 'VALUATION: $10,000
P*PERIMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARYj(11 tl. PENTAMATION 1SFDWLR00F
USE: SFD or Duplex � �C)t10� tf�°:��: PERMIT TYPE:
WORK
SCOPE
FEE ID ROOF AREA
s1
1REROOFFRES 2,200
"I" olit 1'c c, ,iiii I`c'y..
Li
NOTE. These fees are based on the preliminary in ormation zvailable and are only an estimate. Contact the Dept for addn'l info,
FEE ITEMS (Fee Resolution 09-051 Elf.' 7/U10) FEE QTY/FEE MISC ITEMS
P1U71 �flf'L 1� Fk't'
s Jp1d, PC F<,
f'ltrmh.ialecTr.i7;lec /11,ni C hcuk,
Permit Fee: $283-00
Stpp/. 111sp FA,
Phfillb. 1f1;.=`l:k`E, larit F�cc,
1'1tr7r1h.IJlcch. Flc`c� 1,crinliI FCC.
(`ol1,,;tr-1w0"tyz To,
,1col1S/IcL11 ti C'S t('lt I'('c:
Work Without Permit? 0 Yes E) No $0.00
P1cJrJ7tin�> 1'c'c'.i:
/1-a-v l Ooct t acwaiioll 1`etr l:
-7T:=
Strom Motion Fee: IBSEISMICR 91.00 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC ;.1.00
SUBTOTALS: fi8.00 $0.00 TOTAL FEE: $288.00
$2EE
Revised: 9/14/2010
P. n"OOrjAIr ua ity and-Finishes
1.Use iLaw/No VOC;PAird 1 IAQ/Health pts y=yes p
2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes p
3.Use Lvw/:NoVOCAdhesives 3 IAQ/HeaJth pts y=yes p
4.Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes p
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 p
7.S8dall F ed dorMD 4IAQMealth pts y=yes D
6.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes p
9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y=yes p
10.Install Whole House Vacuum System 3 IAQ/Health pts y=yes p
IN.Flooring 1 1 1
1.Select FSC Certified Wood Flooring 8 Resource pts y=yes p
2 Use Rapidly l3enewaWe flooring Maferials 4 Resource pts y=yes p
3.Use Recycled Content Ceramic Tiles 4 Resource pts y=yes p
4.Install Natural Linoleum in Place of Vinyl 5 IAQ/Health pts y=yes p
5.Use Exposed Concrete as Finished Floor 4 Resource pts y=yes p
6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes p
I 1 1 1
Total Points Available: T4-01 130 57
Total Points Project Received: 01 01 0
7_J/6,
G:data/progdY venbuildngguidslineshemodelers/greenpointsfina1212D4P rotectedxls
REROOF TEAR-OFF POJCY
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
ALBERT SALVADOR, P.E.,C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE•CUPERTINO CA 95014-3255
CUPERTINO
(408)777-3228•FAX(408)777-3333• 3uilding(a)cupertino.org
PROJECT ADDRESS 1 � ,�, APN#
OWNERNAME PHO-JE {W-5 iq E-MAIL
STREET ADDRESS D ^ WITY, ST 4T IP
n6
G)C,T' FAX
CONTRACTOR NAME a� � I�� y,n� LICENSE NU LICEN Y BUS.LIC.#
COMPANY NAME r, �)t� E-MAIL FAX
STREET ADDRESS ova C CITY, ATE,ZIP s CA PHON5 CI �3 to
I UNDERSTAND AND AGREE TO THE FOLLOWING:
1. The re-roof project shall comply with all applicaile 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 call for tear-off inspection after the roof is torn off and all
the nails/fasteners have been removed. Any a id 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 ibr 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 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 inspectic n.
c. Proper spark arrestor installation.
8. NOTE: If you call for a tear-off or plywood na-ling inspection and the work is not complete, you will
be charged a re-inspection fee of$126.00. The i-e-inspection fee shall be paid before another
inspection can be scheduled.
By my signing below, I certify each of the following i. true: I am the property owner or authorized agent to act
on the property owner's behalf. nderst and a ;m,-to comply with the re-roof policy stated above.
✓ g- �
Signature of _ n 2<2 Date: -/d
ReroofPolicy_2010.doc revised 05/17/10
CITY OF ^ -,
CITY OF C:UPERTINO
L
REROOF
CUPERTINO PERMIT APPLICATION
APN# ✓-5 Date: Q
Building Address: I
Oqn
� ��J �� •
Owner's Name: �Lei n t , bect F Phone #: �� „1151 q
HOA: Yes ❑ No [�r If yes, provide letter from HOA
Contractor: Phone #: ( _3 S 07
l to 5 P—W Fax#:
Cupertino Business License #: Contractor License #:
s�
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles wf Asphalt Shingles
w"Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other (Specify) ❑ Other (Specify)
�N tuber of existing coverings ❑ Provide I.C.C.E.S. Report#
To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description" _Q ,� �.,�� �5-� G� 1/J(�G a _es ' SA
?D
k k (2t cpwy �22
Residential V - 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: � O
I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
Signature
Revised 02/05/09