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10080015 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21850 SAN FERNANDO AVE CONTR4CTOR:R E ROOFING& PERMIT NO: 10080015 CONSTRUCTION INC -'NER'S NAME: MARGARET KOPF 15230 C LYDELLE AVE DATE ISSUED:08/02/2010 OWNER'S PHONE: 4082570103 SAN JOSE,CA 95032 PHONE NO:(408)626-9320 ❑ LICENSED CONTRACTOR'S DECCLARATION BUILDING PERMIT INFO: BLDG ELECT[_ PLUMB F icen Class Lic.# ��� 1 y MECH RESIDENTIAL COMMERCIAL Concto Date 1 here '� ffnrm tkla[am licensed under the provisions of Chapter 9 JOB D:SCRIPTION:RE-ROOF REMV EXISTING 2 LAYERS OF ROOF,ON SFDWL 4c (commencing with Section 7000)of Division 3 of the Business&Professions DETACI[ED GARAGE INSTALL NEW 1/2"CDX,30#ASTM Code and that my license is in full force and effect. FELT& 30YR COMP CLASS A 38.55 I hereby affirm under penalty of perjury one of the following two declarations: j� �(J! N •� �j` I have and will maintain a certificate of consent to self-insure for Worker's 1 _ Compensation,as provided for by Section 3700 of the Labor Code,for the Q ( ` performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance,as provided for by c)AiJ rl�Z;1)L Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area: Valuation:$22000 permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is APN Number:35715057.00 Occupancy Type: 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, PERMIT EXPIRES IF WORK IS NOT STARTED costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply V�ITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non-point source regulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION. 9 'aturr Date 22 10 Issued by: Date: J Z- ❑ -'"'--OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS: the following two reasons: _A]l_rogl s shall be inspected prior to any roofing material being installed.If a roof is I,as owner of the property,or my employees with wages as their sole compens ori, installee 'heut t ob ng an ins tion,I agree to remove all ne mat rials for will do the work,and the structure is not intended or offered for sale(Sec.70 4, igalfecti3 a Business&Professions Code) , [ as owner of the roe ,am exclusively contracting with licensed contractors to Signature of i ` Date: `0 t `-' P P rtY 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: I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE 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 •ead the hazardous materials requirements under Chapter 6.95 of the I have and will maintain Worker's Compensation Insurance,as provided for by Califon nia Health&Safety Code,Sections 25505,25533,and 25534. I will maintain comply rice 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. permit is issued. Additionally,should I use equipment or devices which emit hazardous air I certify that in the performance of the work for which this permit is issued,I shall contan inants as defined by the Bay Area Air Quality Management District I will not employ any person in any manner so as to become subject to the Worker' maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Compensation laws of California. If,after making this certificate of exe ption,I alth&Safety Code Sections 25505,25533,and 25534. become subject to the Worker's Compensation provisions of the Labo Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. ne or u riz ^ Il Date: L V APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY 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 I hereb affirm that there is a construction lending agency for the performance of work's to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.) the above mentioned property for inspection purposes.(We)agree to save Lende•'s Name .mify and keep harmless the City of Cupertino against liabilities,judgments, costs,and a nses which may accrue against said City in consequence of the Lende•'s Address gra It of this p it.Additionally,the applicant understands and will comply with al non-point s r latipm perlike Cupertino Municipal Code,Section ARCHITECT'S DECLARATION 9.18. r 2 I under stand my plans shall be used as public records. Signature Date_ _.___ Licensed Professional CITY OF CUPErRTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 35715057 .00 DATE ISSUED. . . . . . . : 08/02/2010 RECEIPT #. . . . . . . . . BS000011056 REFERENCE ID # . . . : 10080015 SITE ADDRESS 21850 .SAN FERNANDO AVE SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER MARGARET KOPF ADDRESS . . . . . . . . . . : 21850 EAN FERNANDO CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM R E ROOFING & CONST CONTRACTOR PROCTOR, PAUL LIC # 20615 COMPANY R E ROOFING & CONSTRUCTION INC ADDRESS 15230 C'LYDELLE AVE CITY/STATE/ZIP . . . : SAN JOSE, CA 95032 TELEPHONE (408) 626-9320 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- -----• ---- ---------- ---------- ---- 1BCBSC VALUATION 22, 000 . 00 1 . 00 0 . 00 1. 00 0 .00 1BSEISMICR VALUATION 22, 000. 00 2 .20 0 . 00 2 .20 0. 00 1REROOFRES SQ FEET 39 . 00 507 . 00 0 .00 507 . 00 0 .00 ---------- ---------- ---------- ---------- TOTAL PERMIT 5:-0 .20 0. 00 510.20 0 .00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -- ------------------ CHECK 510 .20 #2558 --------------- TOTAL RECEIPT 510 .20 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- -------------------------- - 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 604 ROOF IN-PROGRESS 605 FINAL REROOF CITY OF CUPLRTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 7DA rE: REVIEWED BY: APN: BP#: "VALUATION: $22,000 PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof PRIMARY TOTAL APPLICATION OLREROOF USE: SFD or Duplex ROOF AREA: 3,900 S f TYPE: xw p: a 00 3U FEE ID 1REROOFFRE3 F-1 _ ,r NOTE: Thesefees are based on the preliminarp information availabl?and are only an estimate. Contact the De t or addn'1 info. FEE ITEMS (Fee Resolution 09-05I Fff ''1.09) FEE QTY/FEE MISC ITEMS Permit Fee: $507.00 F71 Work Without Permit? Q Yes 0 No $0.00 Strom Motion Fee: IBSEISMIgR $2.20 Select an Administrative Item Bld�_, Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $510.20 $0.00 TOTAL FEE $510.20 Revised: 7/27/2010 r _ CITY OF CITY OF CUPERTINO [isREROOF CUPERTINO PERMIT APPLICATION Date: :APN # _ Z 10 ilding Address: Owner's Name: ��-� ,���(— Phone #: No If es, provide letter from HOA ��� - 2� — 103 HOA: Yes ❑ N Contractor: Phone #:4K_ 62_� - 1►� ((^�^ C� � t i � • Fax#: Ltu �- 02- - I kt— Cupertino Business License #: Contractor License #: 7 21 a561� Type of Roof Covering: Existing: Pr oposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles f Asphalt Shingles 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 El Provide Mfgr. Installation Specs. Job Description:,JkMoV� ��(��' (� 2 1, �rVJ �� d� Residential - Commercial Green Building: Please complete relevant portion cif 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- Lk) 0 00 ave each,.-Unaers d a Comply with Cuportino's Tear-Off Policy: Signature y Revised 02/05/09 M.Indoor Air Quality and Finis-heS 1.Use Low/No-,!©C.Paint 1 IACMealth pts y--yes p 2.Use Low VOC,Water-Based Wood Finishes 2 IAC Health pts y=yes p 3.Use LowlNo VOC Adhesives 3 lAQ Health pts y=yes p 4.Use Salvaged Materials for Interior Finishes 3 Re:ource 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 p 7.Sed;3 E_4)asael d,or MW - - 4 IAQ'Health is = es p 8.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 D 10.Install Whole House Vacuum System 3 IAC/Health pts y=yes p N.Flooring 1 1 1 1.Select FSC Certified Wood Flooring 8 ResoJrce pts y=yes p 2.11se Rapid y#ianeurahfe Plooring Materials 4 Reso irce pts y=yes D 3.Use Recycled Content Ceramic Tiles 4 Reso irce pts y=yes D 4.Install Natural Linoleum in Place of Vinyl 5 IAW iealth pts y=yes p 5.Use Exposed Concrete as Finished Floor 4 Reso irce pts y=yes D 6.Install Recycled Content Carpet with Low VOCs 4 Reso rce pts y--yes p i Total Points Available: 140 1301 57 Total Points..Prti'ect eived: 01 01 0 2. 10 Mdata/progs/greenbuldingE jidelines/remodelerslgreenp6intsfinal21264protee4edxis REROOF TEAR-OFF POLICY COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL CUPERTINO 10300 TORRE AVENUE-CUPERTINO, CA 9:1014-3255 (408)777-3228-FAX(408)777-3333-buildirna(d)cupertino.org PROJECT ADDRESSAP/N�# OWNER NAME � A_, '_r �,`y PHO - /�I^0io E-MAIL STREET ADDRESS S(��l f��(3�M ( Y �(,i CITY, S TE,ZIo��LT)N.C� ` FAX NTR� O AME 'M/ / �� L,If�ENSE NUMBER 7�.�d L LIC NSE Y BUS.LIC# COMPANY NAME 1 V U N` E-MAIL,�i��`1 1 ^ , FAX / ,�G_ X26 �l b (J1) rL 4 E,0 �n IiIFIVIO STREET ADDRESS(G2 CITY,ST IP f (/� PHON ` J CA I UNDERSTAND AND AGREE TO THE FOLLOWING: I. The re-roof project shall comply with all applicable previsions 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 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 inspection 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 approximately 25% of the roofing material. 6. New roof coverings shall not be applied without first c btaining all inspections and written approvals from the building inspector. Any roofing which is apr lied without first obtaining an approved inspection will require the removal of all new material down to tl.e 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 itc!ms will be verified: a. Flat roofs shall have a minimum of 1/4"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-insf ection fee shall be paid before another inspection can be scheduled. By my signing below, I ach of the following is true: I am the property owner or authorized agent to act on the property owner's behalf. erstand a rhe to mp with the re-roof policy ate above. Signature of Applicant/Agent: y Date: 2 I J ReroofPolicy_201 0.doc revised 05/17/10