10070013 CITY OF CUPERTI140 BUILDING PERMIT
BUILDING ADDRESS: 11106 PALOS VERDES DR CONTRACTOR:CASTILLO'S ROOFING PERMIT NO: 10070013
OWNER'S NAME: HSIN-PING LEE 1703 CATHAY DR DATE ISSUED:07/01/2010
PER'S PHONE: 4088579857 SAN JOSE,CA 95122 PHONE NO:(408)251-3565
❑ LICENSED CONTRACTOR'S DECLARATION
� � BUILDING PERMIT INFO: BLDG r- ELECTF PLUMB�
License Class Lic.#
I '1 MECH r RESIDENTIAL F COMMERCIAL I—
Cori d
Date
I hereby affirm th I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:RMV WOOD SHAKE,INSTALL 7/16"OSB INSTALL 30LB
(commencing with Section 7000)of Division 3 of the Business&Professions FELT&NEW 40 COMP SHINGLES,CLASS A 24SQ
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:$10000
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION APN Number:35620044.00 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 relating
to building construction,and hereby authorize representatives of this city to enter PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes. (We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION.
granting of this permit. Additionally,the applicant understands and will comply
with all non-point sou a regulations per the Cupertino Municipal Code,Section
9.18. Issued by: Date:
Signature Date �V
Li OWNER-BUILDER DECLARATION RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed.If a roof is
I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for
the following two reasons:
inspection.
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, Signature of Applic - Date:
Business&Professions Code)
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 I have read the hazardous materials requirements under Chapter 6.95 of the
Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material.
Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534.
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 Ow er r auth ized agent: /o
become subject to the Worker's Compensation provisions of the Labor Code,I must Date:
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's
I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.)
correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address
unify and keep harmless the City of Cupertino against liabilities,judgments,
and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records.
9.18.
SigDate / /b Licensed Professional
nature
CITY OF CUPERTINO
FEE ESTIMATOR-- BUILDING DIVISION
ADDRESS: DATE: REVIEWED BY:
APN: BP#: 100700'3 *VALUATION: j$10,000
xPERMIT TYPE: Minor Building Permit PL�,N CHECK TYPE: Re-roof
PRIMARY TOTAL APPLICATION 2,400
USE: SFD or Duplex ROOF AFEA: S.f. TYPE:
xW
as
3 �
FEE ID
1 RERC OFFRES
NOTE. Thesefees are based on the preliminary information<<vailable and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 29-051 ?'I,.09) FEE QTY/FEE MISC ITEMS
J
Man
Permit Fee: $312.00
I��'tt)li �l�ci?'I,Ic'C' C1rtr't I'G'C'.
Work Without Permit? Q Yes No $(1.00
Strong Motion Fee: IBSEISMICR $1.00 Select an Administrative Item
Bider Stds Commission Fee: 1BCBSC $1 .00
SUBTOTALS: $314.00 $0.00 TOTAL FEE: $314.00
Revised: 5/27/2010
CITY OF CUPERTINO
2 ITEMS OF 2 PERMI'P RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Bl -,: Lot:
APN . . . . . . . . : 35520044 . 00
DATE ISSUED. . . . . . . : 07/01/2010
RECEIPT #. . . . . . . . . : BS)00010755
REFERENCE ID # . . . : 10)70013
SITE ADDRESS . . . . . : 11L06 PALOS VERDES DR
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : HSLN-PING LEE
ADDRESS . . . . . . . . . . : 11106 PALOS VERDES DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : CA3TILLO'S ROOFING
CONTRACTOR . . . . . . . : JO3E CASTILLO LIC # 25850
COMPANY . . . . . . . . . . : CA3TILLO'S ROOFING
ADDRESS . . . . . . . . . . : 1733 CATHAY DR
CITY/STATE/ZIP . . . : SAV 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
1REROOFRES SQ FEET 24 . 00 312 .00 0 .00 312 . 00 0 . 00
- --------- ---------- ---------- ----------
TOTAL PERMIT 313 . 00 0 . 00 313 . 00 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 313 . 00 #16460
---------------
TOTAL RECEIPT 313 . 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
CITY OF
CITY OF C.UPERTINO
[a REROOF
CUPERTINO PERMIT APPLICATION
APN# ` Date:
� '
q I
Building Address:
OCo Pal 0 S V6
Owner's Name: 1" r S . (,ems Phone #:
' � � 0UAL
HOA: Yes ElNo 2--l"'If yes, provide letler frHOA
Contractor: Phone #: 251-�,S (P5
0,Pro S Roo-�7, Fax#:
Cupertino Business License #: Contractor License #:
Lf D S(o
Type of R sof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ uilt-Up roof
❑ Asphalt ShinglesAsphalt Shingles
o, Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other (Specify)
Naber of existing coverings ❑ Provide I.C.C.E.S. Report#
ra' To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description: '�emp V e. W Oo d S F; 71-n 5'h-yrt 1 1 J t(o" OS S -To Sf lit
b. F 1�-, Al-� 0 Ho C6) s _ c2,�/ Sn,
Residential Commercial
Green Building: Please complete relevant portion of the Confirmed with-Planning Dept. if
Green Building Checklist & attach it to the ap ilication or if there are any restrictions: ❑
applicable, include in plan set & the sheet index.
Valuation:
I Have ead, Understand and Will Comply with Cupertino's Tear-Off Policy:
Sign re
Revised 02/05/09
M.Indoor Air Quality and Finishes
1.Use Low/No-VOC Paint 1 IAQ/Health pts y--yes D
2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes D
3.Use Low/No VOC 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 6IAQ/Health pts y=yes 0
6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 0
7.Seal all Exposed Particleboard or MDF 4 IAQ/Health. pts y=yes 0
8.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
N.Flooring
1.Select FSC Certified Wood Flooring 8 Resource pts y--yes 0
2.Use Rapidly Renewable Flooring Materials 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
Total Points Available: 140 1301 57
Total Points Project Received:1 01 01 0
'
-711 6
G:datalprogs/gref nbuildingguidelines/remodeleralgreenpointsfinal212.04protected.xis