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10060095 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7525 BOLLINGER RD CONTRACTOR:CUPERTINO ROOF,INC PERMIT NO: 10060095 OWNER'S NAME: FAN CHAN 10 i2 KELLY DR DATE ISSUED:06/16/2010 WNER'S PHONE: 4087681023 SP N JOSE,CA 95129 PHONE NO:(408)973-9427 LICENSED CONTRACTOR'S DECLARATION JCB DESCRIPTION: RESIDENTIAL 11 COMMERCIALE] License Class - 3 1 Lie.# S (9 S9 RE-ROOF TEAR OFF WOOD SHAKE,OSB INSTALL FELT Contractor -�- R/' +1 Q 7?,4.C-Pr\ Date 6 4(YR COMP CLASS A 25 SQUARES 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. Sq.Ft Floor Area: Valuation:$9500 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 APN Number:35923030.00 Occupancy Type: permit is issued. -P ) APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION. 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 Is:ued by: Date: with all on-po source regulations per the Cupertino Municipal Code,Section _ 9.18. y �I�tO RE-ROOFS: Signature Date —/G ' Al roofs shall be inspected prior to any roofing material being installed.If a roof is installed without first obtaining an inspection,I agree to remove all new materials for ins pection. �I OWNER-BUILDER DECLARATION �0 1 Sil;nature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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 HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I will I hereby affirm under penalty of perjury one of the following three m:intain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's in.terial. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. wi I maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by thi•Health&Safety Coder tions 25505,25533,and 25534. Section 3700 of the Labor Code,for theerformance of the work for which this --. _ p Owner or authorized agent: Date: 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 CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I must I h;reby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. we rk's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 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 '-mnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION s,and expenses which may accrue against said City in consequence of the I u iderstand my plans shall be used as public records. g.anting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 CU PERTI NO Fax: 408-777-3333 CONTRACTOR/ SUB('ONTRACTOR LIST JOB ADDRESS: S Z PERMIT# 006 OWNER'S NAME: PHONE# GENERAL CONTRACTOR: v Qe '-} > cc BUSINESS LICENSE# ADDRESS: CITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. 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. I am not using any subcontractors: Signat.ire Date Please check applicable subcontractors and complete the following information: V 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 4c� V X Septic Tank Sheet Metal Sheet Rock Tile I Owner/Contractor Signature Date REROOF TEAR-OFF POLICY COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDINc3 OFFICIAL CUPERTINO 10300 TORRE AVENUE •CUPERTINO, CA 55014-3255 (408)777-3228- FAX(408)777-3333-buildirg(Mcugertino.org PROJECT ADDRESS , Y APN# 2 C) 0 ' OWNER NAME �\ C 1 Y ) PHONE I ,^ E-MAIL J STREET ADDRESS ' \ ry CITY, STATE,ZII FAX 1 V z �11 =t-� �S�t CONTRACTOR NAME r l .No J�C LICENSE NUMBER1 p� LICEP` �TYPE BUS.LIC.# COMPANY NAME E-MAIL (G FAX Sf" . STREET ADDRESS f 1 ' CITY, E,ZIP \�--G PH 2_ q ( q 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 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% :)f 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 tie 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 it 1-ms will be verified: a. Flat roofs shall have a minimum of'/4"per foot oslope and must demonstrate there is no ponding. b. Listings from approved testing agencies for all pr,--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 i:ispection and the work is not complete, you will be charged a re-inspection fee of$126.00. The re-inspection fee shall be paid before another inspection can be scheduledcan be scheduled. By my signing below, I,certi- each of the following is true: I am the property owner or authorized agent to act ,in the property owner's' behalf. understand and agree to ccmply with the re-roof policy stated above. Signature of Applicant/Agent: Date: ReroofPolicy_2010.doc revised 05/17/10 M.Indoor Air Oualfty an Finishes 1.Use LowMaVOC Paint 1 IAC/Health pts Ayes7� 0 2.Use Low VOC,Water-Based Wood Finishes 2 IAC/Health pts y=yes 0 3.Use Low/No VOC Adhesives 3 IAC/Health pts y=yes 0 4.Use Salvaged Materials for Interior Finishes 3 Re:ource pts y=yes 0 5.Use Engineered Sheet Goods with no added Urea Formaldehyde 61AC/Health pts y=yes 0 0 6.Use Exterior Grade Plywood for Interior Uses 1 IAC/Health pts y=yes 7.Seal all Exposed Particleboard or MDF 4 IAC/Health. pts y=yes 0 8.Use FSC Certified Materials for Interior Finish 4 Re:ource pts y=yes 0 9.Use Finger-Jointed or Recycled-Content Trim 1 Re:ource pts y=yes 0 10.Install Whole House Vacuum System 3 IA(WHealth pts y=yes 0 1 1 1 N.Flooring 1.Select FSC Certified Wood Flooring 8 Resc urce pts y=yes 0 2.Use Rapidly Renewable Flooring Materials 4 Resc urce pts y=yes 0 3.Use Recycled Content Ceramic Tiles 4 Resc urce pts y=yes 0 4.Install Natural Linoleum in Place of Vinyl 5 IAaHealth pts y=yes 0 5.Use Exposed Concrete as Finished Floor 4 Resc urce pts y=yes 0 6.Install Recycled Content Carpet with Low VOCs 4 Resc urce pts y=yes 0 ME1 011 1 Total Points Available: 1401 1301 57 Total Points Project Received: 01 0 0 G:data/progs/greenbuildini guidelines/remodelers/gree1npointsfinal2.12.04protected.xls CITY OF CITY OF Ct-PERTINO REROOF CUPERTINO PERMIT APPLICATION APN# 2f 2 3 �� ' Date: Building Address: -- Z- Owner's Name: Pr-, C. L,<:z <J Phone #: HOA: Yes ❑ No If Yes, provide letter from HOA Contractor: Phone #: (. U 6 C_+ ).%I V c p1 Fax#: Cupertino Business License #: Contractor License #: 1!5 b �_ Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles "-o Asphalt Shingles 1�s Wood Shakes o Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other (Specify) ❑ Other (Specify) Number of existing coverings 2 ' o Provide I.C.C.E.S. Report# To be Removed ❑ Provide Mfgr. Installation Specs. Job Description: �- o , W Gos 1 6i <:�_c�SS Residentia 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: SD ve Read, Understand and Will Comply with Cupertino's Tear-Off Policy: Sign re Revised 02/05/09 CITY OF CITY OF CUPERTINO RERDOF 41 1 CUPERTINO FEE SCHEDULE Number of Fee ID Fee Description Fee Permit Type Squares Group 1REROOFCOM Re-roof Commercial B 1COMMLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICO Seismic Commercial B 1RER00FRES Re-roof Residential B 1SFDWLR00F f 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICRE Seismic Residential B 1REROOFMRES Re-roof Multi-Family B 1MFDWLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission _yee 1BSEISMICRE Seismic Residential B 1BUSLIC Business License B CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec : Twp: Rng: Sub: Blk: I,ot : APN . . . . . . . . : 35923030 . 00 DATE ISSUED. . . . . . . : 06/16/2010 RECEIPT #. . . . . . . . . : BS000010641 REFERENCE ID # . . . : 10060095 SITE ADDRESS . . . . . : 7525 BOLLINGER RD SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPER"INO IMPACT AREA . . . . . . OWNER FAN CHAN ADDRESS : 7525 BOLLINGER RD CITY/STATE/ZIP . . . : CUPER"INO, CA 95014-4332 RECEIVED FROM . . . . : CUPER"INO ROOFING CONTRACTOR . . . . . . . : DAVE :>MITH LIC # 25701 COMPANY . . . . . . . . . . : CUPER"INO ROOF, INC ADDRESS . . . . . . . . . . : 1052 KELLY DR CITY/STATE/ZIP . . . : SAN JOSE, CA 95129 TELEPHONE . . . . . . . . : (408) 1+73-9427 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ----- ----- ---------- ---------- ---------- 1BCBSC VALUATION 9, 500 . 00 1 . 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 9, 500 . 00 1 . 00 0 . 00 1 . 00 0 . 00 1REROOFRES SQ FEET 25 . 00 _,25 . 00 0 . 00 325 . 00 0 . 00 ----- ----- ---------- ---------- ---------- TOTAL PERMIT :,27 . 00 0 . 00 327 . 00 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -- ------------------ CREDIT CARD 327 . 00 mc: --------------- TOTAL RECEIPT 327 . 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 604 ROOF IN-PROGRESS 605 FINAL REROOF