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10070140CITY OF CUPERTI VO BUILDING PERMIT BUILDING ADDRESS: 20111 JOHN DR CONTRACTOR: WESTERN ROOFING PERMIT NO: 10070140 SYSTEMS 'NER'S NAME: CARY CAMPBELL 1328 WHITE OAKS RD DATE ISSUED: 07/20/2010 OWNER'S PHONE: 4084465143 CAMPBELL, CA 95008 PHONE NO: (831)278-1837 Ld LICENSED CONTRACTOR'S DECLARATION F F f— BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class 3 Lic. # G 7 g 7 2 I— F r Contrac r Date? ZcJ / J MECH RESIDENTIAL COMMERCIAL I her y a ►rm th t I am livens der the provisions of Chapter 9 JOB DESCRIPTION: RE -ROOF TEAR OFF WOOD SHAKE, FILL SHEATING AS (commencing with Section 700 ivision 3 of the Business & Professions NEEDED, SYNTHETIC U, INSTALL METAL SHAKE PER [CC 5626 CLAASSSS A A 26SMENT6SQ 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 Sq: Ft Floor Area: Valuation: $16000 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I" v, APN Number: 36933036.00 Occupancy Type: 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 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. re Date—7— Zy / J Issued b Date: ❑ 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 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 stricture is not intended or offered for sale (Sec.7044, Business & Professions Code) Signature of Applic Date: I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). ALC ROOF COVERINGS T BE ASS "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 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 Code, I mustcaner o utho ' agent: Date: — �✓ �c/ forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I hereb affirm tha 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 Q ermit is issued (Sec. 3097, Civ C.) to building construction, and hereby authorize representatives of this city to enter Lender's Name the above mentioned property for inspection purposes. (We) agree to save .nnify and keep harmless the City of Cupertino against liabilities, judgments, Lender's Address costs, 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 2 ITEMS OF 4 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk.: Lot: APN ........: 36S33036.00 DATE ISSUED.......: 07/20/2010 RECEIPT #......... BS(,00010912 REFERENCE ID # ...: 10(70140 SITE ADDRESS .....: 20_.11 JOHN DR SUBDIVISION ...... CITY CUPERTINO IMPACT AREA ...... OWNER CARY CAMPBELL ADDRESS 20:.11 JOHN DR CITY/STATE/ZIP ...: CUPERTINO, CA 95014 OPERATOR: patg COPY # : 1 RECEIVED FROM MICHAEL D LUNNEBORG CONTRACTOR MICHAEL LUNNEBORG LIC # 25896 COMPANY ..........: WESTERN ROOFING SYSTEMS ADDRESS 13:28 WHITE OAKS RD CITY/STATE/ZIP ...: CAMPBELL, CA 95008 TELEPHONE (831)278-1837 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT ---------- THIS REC ---------- NEW BAL --- ----------------------- 1BCBSC VALUATION ---------- 16,000.00 ---------- 1.00 0.00 1.00 0.00 1REROOFRES SQ FEET 26.00 338.00 0.00 338.00 ---------- 0.00 ---------- TOTAL PERMIT ---------- 339.00 ---------- 0.00 339.00 0.00 METHOD OF PAYMENT ----------------- CREDIT CARD TOTAL RECEIPT AMOUNT --------------- 756.00 --------------- 756.00 VOICE ID DESCRIPTION -------- ---------------------------- 601 ROOF TEAR OFF REFERENCE NUMBER -------------------- VISA VOICE ID DESCRIPTION -------- ---------------------------- 602 ROOF PLYWOOD NAIL 604 ROOF IN -PROGRESS 605 FINAL REROOF CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION lalADDRESS: FEE DATE: MISC ITEMS REVIEWED BY: APN: BP#: -VALUATION: 1$16,000 PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re -roof PRIMARY USE: SFD or Duplex TOTAL ROOF AREA: 2,600 S f APPLICATION TYPE: 1 R3SFDADD/REM xW as cc 3U ]VnTF- Thoco fops aro hosed on the preliminary information available and are only an estimate. Contact the Dept for addn'1 info. FEE ITEMS (Fee Resohrtion 09-051 F/1' %;'1i09) FEE QTY/FEE MISC ITEMS Permit Fee: $338.00 Work Without Permit? Q Yes No $0.00 Strom Motion Fee: 1BSE CR $1.60 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $340.60 $0.00 TOTAL FEE: $340.60 Revised: 6/30/2010 CITY OF CITY OF CUPERTINO REROOF c u P N o PERMIT APPLICATION i o� 7 u I q J APN #L-� 5� 0 � � Date: Building Address: Z& I I Owner's Name:Ai Phone #: AOA: Yes ❑ No [�If yes, provide letter from HOA Contractor:40�� 7 S s ,� f Phone Fax #: 33 Cupertino Business License #: Contractor License #: Type of Roof Covering: Existing: Proposed: ❑ Built -Up Roof ❑ Built -Up roof ❑ Asphalt Shingles ❑ Asphalt Shingles Shakes ❑ Wood Shakes roWood Wood Shingles ❑ Wood Shingles ❑ Other (Specify) Other (Specify) -e7l— Number of existing coverings ❑ Provide I.C.C.E.S. Report # �G z ❑ To be Removed ❑ Provide Mfgr. Installation Specs. Job Description: / 71ft sit'A41_: ar NP&We. C � s>.v 7Y4 �✓� � � li �h�� , �<< r� z � L Lis .�- � G' Residential - Commercial Green Building: Please complete relevant porton of the Cor£rmed AthTIanning 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: QcJJ___ I Have Read, Understand and Will Comply with Cupertino's Tear -Off Policy: Si tore Revised 02/05/09 CUPERTINO REROOF TEAR -OFF POLICY COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE • CUPERTINO, -A 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • b jilding(aDcupertino.org PROJECT ADDRESS �J 1 l ` J()k1,J �> G APN# OWNER NAME CP Cp � PH41 ��& -�`I`r3 E-MAIL STREET ADDRESS Zo/ / Ji• ,a b � CITY, STA FE, ZIP 6L t\ FAX CONTRACTOR NAME h ,' J4L ' ��tJ /^ 4gh LICENSE NUMBEP (f 2-, - LICENSE TYPE 3 4 BUS. LIC. # COMPANY NAME E-MAIL FAX . / -,L -5 3 STREET ADDRESS /.?Z4- Gv� � r �-c CITY, STA" �, ZIP _ k Soy PHONE 3 s 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 minirlum of one day before the requested inspection date. Please schedule inspections online or call (408)717-3228 between 7:30-3:30 (Mon -Fri). 3. Tear -off roof inspection is required. Please cal 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 fclr 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 dowr 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 followi ng items 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 x.11 pre -manufactured products used shall be available on-site to review at the time of the inspectiot- 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 rc-inspection fee shall be paid before another insaection 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 beal£ I underst nd and agree to comply with the re -roof policy stated above. Signature of Applicant/Agent: Date: 7-7v'I0 ReroofPo(icy_2010.doc revised 05/17/10 1. Use LoWND-VOC PWM 1 IAQ/Health pts y --yes 2. Use Low VOC, Water -Based Wood Finishes 2 IAQ/Health pts y=yes' 3. Use Lowlilo VOC Adhesives 3 IAQ/Health pts Y --yes; 4. Use Salvaged Materials for Interior Finishes 3 Resource pts y --yes; 5. Use Engineered Sheet Goods with no added Urea 5 IAQ/Health pts y=yes Formaldehyde 61AQMealth pts y --yes S. Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 7.$9W all Exposed Particleboard or MDF 4 IAQMealth pts y=yes 8. Use FSC Certified Materials for Interior Finish 4 Resource pts y --yes 9. Use Finger -Jointed or Recycled -Content Trim 1 Resource pts y --yes 10. Install Whole House Vacuum System 3 IAQMealth pts y --yes N. Flooring 1. Select FSC Certified Wood Flooring 8 Resource pts y --yes 2. Use Rapidly Renewable Flooring Materials 4 Resource pts y --yes 3. Use Recycled Content Ceramic Tiles 4 Resource pts y --yes 4. Install Natural Linoleum in Place of Vinyl 5 IAQ/Health pts y=yes 5. Use Exposed Concrete as Finished Floor 4 Resource pts yeses 6. Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes Total Points Available: Total Points Project Received: G:datalprogslgr, 140 130 57 01 01 0 eeted.xls CUPERTINO CONTRACTOR / SL BCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: Z (91 t k PERMIT # 4120-70 -0 OWNER'S NAME: C- C.b PHONE # 1+4' S/"3 GENERAL CONTRACTOR: BUSINESS LICENSE # ADDRESS: 04S R- CITY/ZIPCODE: C l.. l q��v *Our municipal code requires all businesses working in the city to have a city of uupertmo uusiness ncense. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. -7_ I am not using any subcontractors: / Zvi Si€;natur Date Please check applicable subcontractors and complete t all ng information: ner ontractor Signature Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile ner ontractor Signature Date