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10080125CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10631 GLENVIEW AVE ANNER'S NAME: GREGORY S & PATRICIA MARVIN NER'S PHONE: 4089738772 LICENSED CONTRACTOR'S DECLARATION License Class Lic. # Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 (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. 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 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 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 indemnify 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 with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Date I0/vc OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: I, as owner of the property, or my employees with wages as their sole compensation, 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 construct the project (Sec.7044, Business & Professions Code). C, /1,-N I hereby affirm under penalty of perjury one of the following three 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 permit is issued. 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 Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoke 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 relating to building construction, and hereby authorize representatives of this city to enter r- ~ the above mentioned property for inspection purposes. (We) agree to save nify and keep harmless the City of Cupertino against liabilities, judgments, c.,....,, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature j! L Date CONTR ACTOR: GREGORY S & PATRICIA PERMIT NO: 10080125 MARV Il I 10631 G LENVIEW AVE DATE ISSUED: 08/18/2010 CUPER'rINO, CA 95014 PHONE NO: BUILDING PERMIT INFO: BLDG r ELECT r PLUMB F MECH I— RESIDENTIAL r COMMERCIAL F JOB D.:SCRIPTION: RE -ROOF REMOVE EXISTING SHAKE ROOF. PLYWOOD OVER 1 XSKP c HEATING WITH 7/16 OR BETTER OSB PLYWOOD OR 3/8 OR E ETTER LAMINATED PLYWOOD, INSTALL 40YR Sq. Ft Floor Area: APN Nr tuber: 36926027.00 Valuation: $5000 Occupancy Type: PE RMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued Date: ����" ( C) RE -ROOFS: All roof s shall be inspected prior to any roofing material being installed. If a roof is installer l without first obtaining an inspection, I agree to remove all new materials for mspectr m. Signatu -e of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have •ead the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compli ince with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety --ode, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contan inants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Own or authorized agent: n/' Z �'Lit _,r,.,Date:� CONSTRUCTION LENDING AGENCY I hereb ✓ affirm that there is a construction lending agency for the performance of work's for whi ch this permit is issued (Sec. 3097, Civ C.) Lendei •'s Name Lender's ARCHITECT'S DECLARATION I undej stand my plans shall be used as public records. Licensed Professional 3 ITEMS OF 3 CITY OF CUPE 2TINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 36926027.00 DATE ISSUED.......: 08/18/2010 RECEIPT #.........: BS000011213 REFERENCE ID # ...: 10080125 SITE ADDRESS .....: 10631 GLENVIEW AVE SUBDIVISION ...... CITY CUPERTINO IMPACT AREA ...... OPERATOR: patg COPY # : 1 OWNER GREGORY S & PATRICIA MARVIN ADDRESS ..........: 10631 CLENVIEW AVE CITY/STATE/ZIP ...: CUPERTINO, CA 95014 RECEIVED FROM ....: GREGORY S MARVIN CONTRACTOR LIC # *OWNER* COMPANY GREGORY S & PATRICIA MARVIN ADDRESS ..........: 10631 CLENVIEW AVE CITY/STATE/ZIP ...: CUPERTINO, CA 95014 TELEPHONE ......... FEE ID UNIT QUANTITY AMOUVT PD -TO -DT THIS REC ---------- NEW BAL ---------- ----------------------- 1BCBSC VALUATION ---------- 5,000.00 ---------- 1.00 ---------- 0.00 1.00 0.00 1BSEISMICR VALUATION 5,000.00 0.50 0.00 0.50 0.00 1REROOFRES SQ FEET 25.00 3 5.00 0.00 325.00 ---------- 0.00 ---------- TOTAL PERMIT ---------- 3 6.50 ---------- 0.00 326.50 0.00 METHOD OF PAYMENT ----------------- CREDIT CARD TOTAL RECEIPT : AMOUNT --------------- 326.50 --------------- 326.50 VOICE ID DESCRIPTION -------- ---------------------------- 601 ROOF TEAR OFF DEFERENCE NUMBER -------------------- VISA VOICE ID DESCRIPTION -------- ---------------------------- 602 ROOF PLYWOOD NAIL 604 ROOF IN -PROGRESS 605 FINAL REROOF CITY OF CUP ERTINO REROOF PERMIT APPL [CATION APN #Date: C) /V4-- ICI Building Address: /(� G 3 / &/-e- n � ,� � � �tg v Owner's Name: Phone #: *-eq 7-7 3_ 5 7.2 -2— HOA: Yes r No If yes, provide letter from HOA c el< `' ,jg 3 1 G 7 `00 Contractor: c Phone #: Fax #: Cupertino Business License #: Contractor License #: Type of Roof Covering: Existing: Proposed: ❑ Built -Up Roof ❑ Built -Up roof ❑ Asphalt Shingles )a- Asphalt Shingles p- Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood 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: �' e -l-; d Q j< s jaf- 1 t o r 4 5)7,j<_ fr Residential - Commercial Green Building: Please complete relevant portion oi' 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 Cupeitino's Tear -Off Policy: 1 Signature Revised 02/05/09 ITT O CITY OF CUPERTINO RERO OF CUPER'T NO FEE SCHEDULE Number of Squares Fee ID Fee Description Fee Group Permit Type 1REROOFCOM Re -roof ConuTercial B 1COMMLROOF 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICO Seismic Commercial B 1REROOFRES Re -roof Residential B 1SFDWLR00F 1BCBSC Cal Bldg Standards Commission F -.e B ALL PERMIT TYPES 1BSEISMICRE Seismic Residential B 1RER00FMRES Re -roof Multi -Family B 1MFDWLROOF 1BCBSC Cal Bldg Standards Commission F -,e B ALL PERMIT TYPES 1BSEISMICRE Seismic Residential B 1BUSLIC Business Licer. se B 1. Use i owft-YbC fall 2. Use Low VOC, Water Based Wood Finishes 3. Use Lovd1jo VOC Adhesives 4. Use Salvaged Materials for Interior Finishes 5. Use Engineered Sheet Goods with no added Urea Formaldehyde S. Use Exterior Grade Plywood for Interior Uses 7.5;ea1l#�gl�F _ S. Use FSC Certified Materials for Interior Finish 9. Use Finger -Jointed or Recyclad-Content Trim 10. Install Whole House Vacuum System . N. Flooring 1. Select FSC Certified Wood Flooring 2. Ilse t3apidl*figne irahle F]oMpg'(ulatena4s 3. Use Recycled Content Ceramic Tiles 4. Install Natural Linoleum in Place of Vinyl . 5. Use Exposed Concrete as Finished Floor 6. Install Recycled Content Carpet with Low VOCs Total Points Available: Total Points Project Received: 1 IAa Health pts y=yes 21AQ,Health pts y=yes 3 IAO, Health pts y=yes 3 Res )urce pts y=yes 5IMHealth pts y=yes 1 IACs Health pts y=yes 41AQ,Healtit •ots v=ves 4 Res wrce pts y=yes 1 Res)urce pts y=yes 3 IAC /Health pts y=yes B Resojrce pts y=yes 4 Resolrce pts y=yes 4 Resoirce pts y=yes 5 IAQ1-lealth pts yeses 4 Resoirce pts y=yes 4 Resoirce. pts y=yes L_1401 1301 57 01 11 0 /g s9-, e, /Q Mdatalprpogreenbuildini; guidelineshemodelerslgreenp6intsfina1212Mpmtwledxis REROOF TEAR -OFF POLICY COMMUNITY DEVELOPMENT DEPARTMENT • 13UILDING DIVISION is ALBERT SALVADOR, P.E., C.B.O., BUILDING Of"FICIAL 10300 TORRE AVENUE • CUPERTINO, CA 95011-3255 CUPERTINO (408) 777-3228 •FAX (408) 777-3333 • buildin :upertino.org PROJE TQD E / 0 V Ar V, -e- A'N # OWNER Nr /l PH(Q�NE -(ate_ 7 3 ` E-MAIL STREET ADDRESS G i tip-- CITY, STA , ZIP �.� c v ^�-,=►c� c l FAX o -j ��► v CONTRACTOR NAME D LICENSE NUMBER LICENSE TYPE BUS. LIC. # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE I UNDERSTAND AND AGREE "'O THE FOLLOWING: 1. The re -roof project shall comply with all applicable proN isions 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)777-322,, between 7:30-3:30 (Mon -Fri). 3. Tear -off roof inspection is required. Please call for to it -off inspection after the roof is torn off and all the nails/fasteners have been removed. Any and all diy-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 — 10:30om 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 it -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 1/a" per foot of , lope 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-inspf ction fee shall be paid before another inspection can be scheduled. By my signing below, I certify each of the following is true: 1 am the property owner or authorized agent to act on the property owner's behalf. I understand and agree to comply with the re -roof policy stated above. Signature of Applicant/Agent: a _5z Date: J.9' 11 y-2 ReroofPolicy_2010.doc revised 05/17/10 CUPERTINO OWNER -BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 - buildin c>cupertino.ora Dear Property Owner(s): An application for a building permit has been submitted in your nar-ie listing yourself as the builder of the property improvements specified at: SITE ADDRESS/-" &,, , c i� V APN 5PI; I i 6- 3 I G- OWNER NAME OWNER ADDRESS � i' .S i� iQ ✓J �L / 0 6 3 DESCRIPTION OF WORK: / e /\ U d 'Yci We are providing you with an Owner -Builder Acknowledgment anc Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder. We will not issue a building permit until you have read, initialed y sur understanding of each provision, signed, and returned this form to us at our official address indicated. An zigent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFCRMATION (DIRECTIONS: Please read and initial each statement below to signify you understand or verify this information.) 6-". 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner - Builder' building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner -Builder, may be held liable and suhiect to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowners insurance may not provide coverage for those injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. 6-A4-2. I understand building permits are not required to be sic ned by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to as 3ume this responsibility. CT '�-3. I understand as an "Owner -Builder" I am the responsitle party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. 6'*^�4.1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. &41 5. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars (:;500), including labor and materials, I may be considered an "employer' under state and federal law. 6i 0l 6. 1 understand if I am considered an "employer" under slate and federal law, I must register with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. G/yL 7. 1 understand under California Contractors' State Licen 5e Law, an Owner -Builder who builds single-family residential structures cannot legally build them with the intent `o offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does nct exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. G-8. I understand as an Owner -Builder if I sell the property For which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. OwnerBuilderForm 2010.doc revised 04/14/10 V"= 9. 1 understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. 6'"'�10. I am aware of and consent to an Owner -Builder buildinc permit applied for in my name, and understand that I am the parry legally and financially responsible for proposed construction activity at the site address listed above. 6- 11. 1 agree that, as the party legally and financially respons ble for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner-Builcers as well as employers. 6,04`12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I have provided on this form. Licensed contractors aie regulated by designed to protect the public. If you contract with someone who does not have a license, the Co itractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of it complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner -Builder and wish to hire Contracto,s, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. CONSTRUCTION LENDING AGENCY (DIRECTIONS: Please complete the following construction lending agency information.) I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) Lender Name: Lender Address: Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's si natur . Property Owner's Signature: Date: 19 AL16- - -- -- ------ --- --------- ------ ---- ----- ----------------------------- (NOTE: The followi-ng Authorization- Form is required to be complete d by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner -Builder). AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I unc erstand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner -Builder Permit for my project. Scope of Construction Project (or Description of Work): Project Location or Address: Name of Authorized Agent: Address of Authorized Agent: Tel No I declare under penalty of perjury that I am the property owner for thE! address listed above and I personally filled out the above information and certify its accuracy. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented w wen the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: OwnerBuilderForm 2010.doc revised 04/14/10