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10060047 CITY OF CUPERTINO BUILDING PERMIT PERMIT NO' 10060047 CONTRACTOR �i�IED V IUILDING ADDRESS: 7542 LOCKFORD CT DATE ISSUED:06/09/2010 OWNER'S NAME: ISAAC&BETH BEREZOVSKY PHONE NO: JOB D ,SCRIPTION: RESIDENTIAL COMMERCIAL OWNER'S PHONE: 4082554353 LICENSED CONTRACTOR'S DECLARATION RE-I:OOF REMOVE COMP INSTALL OVER 1/2 PYLWOO Lic.# 50YR DARES License Class 3' SHINGLES ON FLAT ROOF CLASS Aa4 SQ 1 ' Date 2 Contractor the provisions of Chapter 9 I hereby affirm that I am licensed under (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 Valuation:$7000 Compensation,as provided for by Section 3700 of the Labor Code,for the Sq I t Floor Area: performance of the work for which this Peationissued. ance,as provided for by Occupancy Type: I have and will maintain Worker's Comp performance of the work for which this Apr Number:36226051.00 Section 3700 of the Labor Code,for the p permit is issued. ED APPLICANT CERTIFICATION IT EXPIRES IF WORK IS NOT START CE I certify that I haOR ve read this application and state that the above information a PERM II city and county ordinances and state laws relating VVITHIrj 180 DAYS OF PERMITAD INSPECTION. correct.I agree to comply with a ty to enter 180 DAYS FROM LA for inspection purposes. (We)agree to save to building construction,and hereby authorize representatives of this city upon the above mentioned property of Cupertino against liabilities,judgments, Date: indemnify and keep harmless the City p Issued by: costs,and expenses which may accrue against said City in consequence of the this permit. Additionally,the applicant understands and will comply granting of — th all non-point source r gulations per the Cupertino Municipal Code,Section RE--- 18. AI i roofs shall be inspected prior to any roofing material being installed.If a roof is 9 Date in stalled without first obtaining an inspecti ,I agree to remove all new materials for Signature inspection. j l Date: v 0 OWNER-BUILDER DECLARATION S gnature of Applicant: ALL ROOF COVERINGS TO BE CLASS I hereby a "A"OR BETTER ffirm that I am exempt from the Contractor's License Law for one of the following two reasons:or my employees y 1to ees with wages as their sole compensation, ,as owner of the property, d will do the work,and the structure is not intended or offered for sale(Sec-7044, HAZARDOUS MATERIALS DISCLOSURE Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to Code,Sections requirements under and 25534. I will have read the hazardous materials requirements under Chapter 6.95 o the California Health&Safety ter 9.12 and the construct the project(Sec.7044,Business&Professions Code). should I store or handle hazardous one of the following three maintain compliance with the Cupertino Municipal Code,Chap penalty of perjury Health&Safety Code,Section 25532(a) 1 hereby affirm under p ty P � y ui ment or devices which emit hazardous declarations: Management District I the Bay Area Air Quality air contaminants as defined by Chapter 9.12 and I have and will maintain a Certificate of Conserv of the the Worker's material. Additionally,should use egertino Municipal Code, will maintain compliance with the Cup Compensation,as provided for by Section 370025 3,and 25534. the Health&Safety Code,Sections25505, performance of the work for which this pe as rmit is as provided for by / Date: 1 have and will maintain Worker's Comp Owner or authorized agent: 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 shallCONSTRUCTION LENDING AGENCY not employ any person in any manner so as to become subject to the Workeexemption,I g for the erformance of Compensation laws of California. If,after making this certificate of exemption, ensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency p work's for which this permit is issued(Sec.3097,Civ C.) become subject to the Worker's Comp Lender's Name forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION Lender's Address trtify that I have read this application and state that the above information is .,rrect.I agree to comply with all city and county ordinances and state laws relatin€ purposes.(We)agree to save ARCHITECT'S DECLARATION to building construction,and hereby fao`thp rrectionrepresentatives of this city to enter upon the above mentioned property P plans shall be used as public records. Lindemnifyd keep harmless the City of Cupertino against liabilities,judgments,enses which may accrue againt said City in consequen cant understands and will comply ce of the Iunderstand my is permit.Additionally,the apppoint source regulations per the Cupertino Municipal Code,SectionLicensed ProfessionaDate REROOF TEAR-OFF POLICY COMMUNITY DEVELOPMENT DEPARTMENT- E UILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OF=ICIAL GUPERTINp 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 (408)777-3228• FAX(408)777-3333-buildingacupertino.org PROJECT ADDRESS (l �I f y AP J k U OWNER NAME ^ 2c r'` ``�y` PHONE f SS 113 S E-MAIL STREET ADDRESS H {'C U V 7� CITY, STATE,ZIP FAX c a CONTRACTOR NAME I( LICENSE NUMB$R�7 v - LICENSE TYPE BUS.LIC.# COMPANY NAME 1 I /` E-MAIL L^l l ' r4 lj" FAX STREET ADDRESS � /1 CITY,STATE,ZIP` r1v PHONE L!ly q0 G I UNDERSTAND AND AGREE T D THE FOLLOWING: 1. The re-roof project shall comply with all applicable provi3ions of the 2007 California Building Code. 2. You must schedule all needed inspections a minimum of ane 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 tea--off inspection after the roof is torn off and all the nails/fasteners have been removed. Any and all dr)-rotted wood shall be replaced prior to this inspection. A building inspector will be available within Dne hour. There are special hours for this service: 7:30 — 10:30ani and 1:00—3:30pm (Mon—Thurs); 7:30 — 10:30ani 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-;)rogress 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 obtz ining 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 from tho building inspector when the re-roofing is complete. To receive a final sign-off, the following itemE will be verified: a. Flat roofs shall have a minimum of I/4" per foot of slc pe 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 inspi;ction 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 below, I certify each of the following is true: I am the property owner or authorized agent to act on the property owner's behalf. I un rstaand agree to comp y with the re-roof policy stated a�byove. Signature of Applicant/Agent: Date: ReroofPolicy_2010.doc revised 05/17/10 IA.Indoor Air Quality and Finishes 0 1 IAO Nealth pts )v=yes 1.Use LowfNo-VOC Pafnt D 2.Use Low VOC,Water-Based Wood Finishes 2 IA 'Health pts MasD 3.Use Low/No VOC Adhesives 3 lAQ'Health pts y=yes 3 Re:ource pts Mas D 4.Use Salvaged Materials for Interior Finishes 5.Use Engineered Sheat Goods with no added Urea p Formaldehyde fi IAC/Health pts y= }es D 1 IACMealth pts ME's6.Use Exterior Grade Plywood for Interior Uses 41AC JHealth is += es D - 7.Seal all Expn�d Par ialebcard or MDF + 0 B.Use FSC Certified Materials for Interior Finish 4 Re3Dume pts y=)es 0 9.Use Finger-Jointed or Recyclad-Content Trim 1 Resource pts y=yeS D iD.Install Whole House Vacuum System 3 IADIHealth pts y=yes N.Flooring p B Re source pts )v=yes 1.Select FSC Certified Wood Flooring D 2.Use gapidly BenewabJe Flooring Materials 4 Re,ource pts MaS 0 3.Use Recycled Content Ceramic 4 Resource pts y=ye5 Tiles _ � alth pts y=yes D 4.Install Natural Linoleum in Place of Vinyl 5 IA JHe 4 Re source pts y=yeS 0 5.Use Exposed Concrete as Finished Floor 0 6.Install Recycled Content Carpet with Low VOCs 4 RE source pts y=yes Total Points Available: 1�0 130 57 Total Points Project Received: 0 0 0 G:datalprogslgreanb iildingguidellne enpointsfina12.12.04pmlar ed.xls CITY OF CITY OF CUPERTINO REROOF CUPERTINO PERMIT APPLICATION MDOju APN# d 5 l Date: 6 Building Address: �+�- LOC K It � 1A ro c: Owner's Name: f S A A C ��U k Phone #: Wo� HOA: Yes ❑ No Ef If Yes, provide letter from HOA Contractor: Q Phone #: t-�O,y S,761 56'9__-S — ('�}pvte – Fax#: ,� f 1 Cupertino Business License #: Contractor License #: ?�` Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof F-1 ilt-Up roof ar"Asphalt Shingles ur Asphalt Shingles ❑ Wood Shakes El Wood Shakes ❑ Wood Shingles F- Wood Shingles ❑ Other(Specify) El Other (Specify) Number of existing coverings ci Provide I.C.C.E.S. Report # ❑ To be Removed L Provide Mfgr. Installation Specs. Job Description: iN51--tL ova ^v t, AAu.1� 30 �cLp ,�,� �,c,,�•-� ��,,f�� Residential 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: I Have Read, Unde stand and Will Comply with Cupertino's Tear-Off Policy: Signa re Revised 02/05/09 CITY of CITY OF CUPERTINO REROCIF FEE SCHE3ULE CUPErHO Fee Permit Type Number of Fee ID Fee Description Group Squares OM Re-roof Comm(,rcial B 1COMMLR00F 1REROOFC Cal Bldg Standards B ALL PERMIT TYPES 1BCBSC Commission Foe 1BSEISIVIICO Seismic Coma-ercial B 1RER00FRES Re-roof Residential B 1SFDWLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee I 1BSEISNIICRE Seismic Residential B I 1REROOFMRES Re-roof Multi-Family B 1MFDWI,R00F 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 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: Lot : APN 36226053 . 00 DATE ISSUED. . . . . . . : 06/09/2( 10 RECEIPT # . . . . . . . . . BS00001( 590 REFERENCE ID # 1006004" SITE ADDRESS 7542 LOCKFORD CT SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER ISAAC & BETH BEREZOVSKY ADDRESS . . . . . . . . . . : 7542 LOCKFORD CT CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-5047 RECEIVED FROM GABRIEL SILVA CONTRACTOR TBD - TO BE DETERMINED LIC # 00096 COMPANY TBD - TO BE DETERMINED ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : TELEPHONE . . . . . . . . : FEE ID UNIT QUANTITY AMOUNT' PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ------ 1BCBSC VALUATION 7, 000 . 00 1 . 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 7, 000 . 00 0 . 70 0 . 00 0 . 70 0 . 00 1REROOFRES SQ FEET 24 .00 312 . 00 0 . 00 -- -312_00 -- - -0_00 -- -------- ---------- TOTAL PERMIT 313 . 70 0 . 00 313 . 70 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- ------------ CREDIT CARD 313 . 70 VISA --------------- TOTAL RECEIPT 313 . 70 VOICE ID DESCRIPTION VOICE ID DESCRIPTION - -------- ---------------------------- ------- ---------------------------- 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 604 ROOF IN-PROGRESS 605 FINAL REROOF