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10060174CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10744 BROOKWELL DR OWNER'S NAME: CATHERINE JOHNSON NER'S PHONE: 4082552963 l} ) LICENSEED CONTRACTOR'S DECLARATION License Class C -? ) Lic. # (yt Y3 _1 Contractor c 04� y "} ) Date L — Z g — Z -a ' o 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. Signature Date C7 2 Q _Z0 L-1 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 stricture 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 constrict the project (Sec.7044, Business & Professions Code). 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 revoked. 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 mnify and keep harmless the City of Cupertino against liabilities, judgments, , 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 Date CONTRACTOR: CUPERTINO ROOF, INC PERMIT NO: 10060174 1052 KELLY DR DATE ISSUED: 06/28/2010 SAN JOSE, CA 95129 PHONE NO: (408)973-9427 BUILDING PERMIT INFO: BLDG ELECT r— PLUMB MECH r— RESIDENTIAL r COMMERCIAL I— JOIN DESCRIPTION: RER-ROOF TEAR OFF SHAKES & INSTALL 7/16 OSB. INS1 ALL FELT 50YR SHINGLES CLASS A 26SQ Sq. Ft Floor Area: Valuation: $12800 API\ Number: 36921039.00 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Date: RE -ROOFS: All n )ofs shall be inspected prior to any roofing material being installed. If a roof is insta led without first obtaining an inspection, I agree to remove all new materials for inspection. Sign, iture of Applicant ``-- Z-- Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I ham a read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safe, y Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will mair tain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. r— Ow}ieior uthoriz agent: �,-� Z� Date CONSTRUCTION LENDING AGENCY I her,;by affirm that there is a construction lending agency for the performance of work's for w hich this permit is issued (Sec. 3097, Civ C.) Len( er's Name Lent er's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CITY OF CUPERTINO 2 ITEMS OF 2 PERMIT R];CEIPT OPERATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: Blk: ].jot: APN ........: 36921039.00 DATE ISSUED.......: 06/28,2010 RECEIPT #.........: BSO00010721 REFERENCE ID # ...: 10060/74 SITE ADDRESS .....: 10744 BROOKWELL DR SUBDIVISION ...... CITY .............. CUPERTINO IMPACT AREA ...... OWNER ............: CATHE]2INE JOHNSON ADDRESS ..........: 10744 BROOKWELL DR CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-4609 RECEIVED FROM ....: DAVE :SMITH PRE CONTRACTOR .......: DAVE ;SMITH LIC # 25701 COMPANY ..........: CUPERTINO ROOF, INC ADDRESS ..........: 1052 :CELLY DR CITY/STATE/ZIP ...: SAN JOSE, CA 95129 TELEPHONE ........: (408))73-9427 FEE ID UNIT QUANTITY AMOiJNT PD -TO -DT THIS REC NEW BAL ----------------------- 1BCBSC VALUATION -------------------- 12,800.00 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 --------------- 339.00 --------------- 339.00 VOICE ID DESCRIPTION -------- ---------------------------- 601 ROOF TEAR OFF REFERENCE NUMBER -------------------- Mil VOICE ID DESCRIPTION -------- ---------------------------- 602 ROOF PLYWOOD NAIL 604 ROOF IN -PROGRESS 605 FINAL REROOF CITY OF CITY OF Cv PERTINO REROOF CUPERTINO PERMIT APPLICATION [ (DV-,, k1 7 q APN # � � c) � Date: � _ � � �. 2 Building Address: , Owner's Name: C 614� ,.4,. w�.� Se --j Phone #: HOA: Yes ❑ Nom[] If yes, pMvide letter from HOA Contractor: � v � � 1 � ` i Phone #: `J Fax #: Cupertino Business License #: Contractor License #: Type of Roof Covering: Existing: Proposed: ❑ Built -Up Roof y� ❑ Built -Up roof ❑ Asphalt Shingles `-a 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 ❑ Provide Mfgr. Installation Specs. Job Description: --� Q ,_ p..Q� ��1--•�1�� 3 vl S j'�� �1 6 D S' rj Feld- rNS+C0 Reside 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: 1 Z) z o o Iav ad, Understand and Will Comply with Cup -Irtino's Tear -Off Policy: 7 Signt ture Revised 02/05/09 CITY or CITY OF CU PERTINO REROOF cUPER INO FEE SCHEDULE Number of Squares Fee ID Fee Description Fee Group Permit Type 1REROOFCOM Re -roof Commercial B 1COMMLROOF 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICO Seismic Commercial B 1REROOFRES Re -roof Residential B 1SFDWLROOF 1BCBSC Cal Bldg Standards Commission I'ee B ALL PERMIT TYPES 1BSEISMICRE Seismic Residential B 1RER00FMRES Re -roof Multi -Family B 1MFDWLROOF 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICRE Seismic Residential B 1BUSLIC Business License B REROOF TEAR -OFF POLICY COMMUNITY DEVELOPMENT DEPARTME� T • BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL CUPERTINO 10300 TORRE AVENUE • CUPERTINO, CA f 5014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(kupertino.org PROJECT ADDRESS 1 N'1 APN,#/^ OWNER NAME. \ I � 1/r0 , T© `l �. 1 PHONE •� r/�-2G1 1'J E-MAIL STREET ADDRESS ' -) !,y Q I / L` CITY, STATE, ZIP L' � //. �, tF) ^ u FAX CONTRACTOR NAM 1 J \/ _ _. LICENSE Nli� LICENSy Tl BUS. LIC'_ # COMPANY NAME*�J^. E-MAIL FAX STREET ADDRESS,. O CITY, STATE, ZIP .'+ T' 0) � j -LPHON 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 minimurr of one day before the requested inspection date. Please schedule inspections online or call (408)777-3 228 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 al dry -rotted wood shall be replaced prior to this inspection. A building inspector tvill be available within one hour. There are special hours for this service: 7:30 — 10:-,Oam and 1:00 — 3:30pm (Mon — Thurs); 7:30 — 10:_�'Oam 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 ar 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 down to the sheathing so a proper inspection can be performed. 7. A final inspection and approval shall be obtained frori the building inspector when the re -roofing is complete. To receive a final sign -off, the following ii ems will be verified: a. Flat roofs shall have a minimum of '/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 nspection 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 scheduled. By my signing be ow, I certify eac of the following is true: I am the property owner or authorized agent to act on the property owner's behalf. I u rstand d agree to comply with the re -roof policy stated above. Signature of Applicant/Agent: Date: Ln — ^�� A —�_20 1 0 —'" ReroofPolicy_2010.doc revised 05/17/10 M. Indoor Air Quality and Finishes 1. Use Low/No-VOC Paint 1 IAO/Health pts y=yes 2. Use Low VOC, Water -Based Wood Finishes 2 IA(VHealth pts y=yes 3. Use Low/No VOC Adhesives 3 IAO/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 Formaldehyde 61A(VHealth pts y=yes 6. Use Exterior Grade Plywood for Interior Uses 1 IA(d/Health pts y=yes 7. Seal all Exposed Particleboard or MDF 4 IA(VHealth. pts y=yes B. Use FSC Certified Materials for Interior Finish 4 Re3ource pts y=yes 9. Use Finger -Jointed or Recycled -Content Trim 1 Re3ource pts y=yes 1 D. Install Whole House Vacuum System 3 lA XHealth pts y=yes - N. Flooring 1. Select FSC Certified Wood Flooring 8 Reswrce pts y=yes 2. Use Rapidly Renewable Flooring Materials 4 Res)urce pts y=yes 3. Use Recycled Content Ceramic Tiles 4 Res )urce 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 Res )urce pts y=yes 6. Install Recycled Content Carpet with Low VOCs 4 Res wrce pts y=yes Total Points Available: Total Points Project Received: 1401 130 57 01 01 0 G:data/progs/greenbuildn 39uidelines/remodelers/greenpointsfinal2.12.04protected.xis