10050207 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 1518 PRIMROSE WAY CON]RACTOR:AMC CONSTRUCTION PERMIT NO: 10050207
OWNER'S NAME: PAOLINI JAMES R AND NORMA J 15320 ELVINA AVE DATE ISSUED:05/27/2010
'NER'S PHONE: 4089263830 SAN LEANDRO,CA 94579 1 PHONE NO:(510)357-8451
LICENSED CONTRACTOR'S DECLARATION BUIL DING PERMIT INFO: BLDG r— ELECT r— PLUMB
License C1ass1cQY1 �.�Lic.#� MECH r RESIDENTIAL r COMMERCIAL r
Contractor MCA I.- ` 1( ate
I hereby affirm that I am licensed and the provisions of Chapter 9 JOB DESCRIPTION:RE-ROOF T/O SHAKE,OSB ROOF DECK,PRESIDENTIAL
COMI CLASS A 27SQ
(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 Sq.F Floor Area: Valuation:$13000
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
APN(Number:36615017.00 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 PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the 1.80 DAYS FROM LAST CALLED INSPECTION.
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. Issued by:_ i� Date:
Signature Date 7— /z
RE-ROOFS:
OWNER-BUILDER DECLARATION
All n Hofs 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 insta led 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, Sign,uture of Applicant: Date:
Business&Professions Code) —
I,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's I ha ie read the hazardous materials requirements under Chapter 6.95 of the
Compensation,as provided for by Section 3700 of the Labor Code,for the Cali:ornia Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
performance of the work for which this permit is issued. com Aiance 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.
Additionally,should I use equipment or devices which emit hazardous air
Section 3700 of the Labor Code,for the performance of the work for which this 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 Hea'.th&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 Qwner o uthorizedr
become subject to the Worker's Compensation provisions of the Labor Code,I must V __Date: ! (1
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION I he eby 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,vhich 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
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
s,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION
.sting 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.
`� Lic:nsed Professional
Signature V`v Dat ��
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
C U P E RT I N O Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: y%% 1r0S a y PERMIT
OWNER'S NAME: PHONE# IO-5 S 'Ddb
GENERAL CONTRACTOR: C BUSINESS LICENSE# q S`
ADDRESS: CITY/ZIPCODE: v� �Gt qS�
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSFECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE. re
I am not using any subcontractors: Signatu Date
Please check applicable subcontractors and complete thinformation:
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
Owner/Contractor Signature Date
CITY OF CUPE RTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN 3661507.7 . 00
DATE ISSUED. . . . . . . : 05/27/:010
RECEIPT #. . . . . . . . . BS0000:.0505
REFERENCE ID # . . . : 10050207
SITE ADDRESS 1518 PI:IMROSE WAY
SUBDIVISION . . . . . .
CITY CUPERT::NO
IMPACT AREA . . . . . .
OWNER PAOLIN:: JAMES R AND NORMA J
ADDRESS 1518 PRIMROSE WY
CITY/STATE/ZIP . . . : CUPERT::NO, CA 95014
RECEIVED FROM . . . . : AMC CONSTRUCTION
CONTRACTOR . . . . . . . : MARIO 14ARROQUIN LIC # 31047
COMPANY . . . . . . . . . . : AMC C014STRUCTION
ADDRESS 15320 :�',LVINA AVE
CITY/STATE/ZIP . . . : SAN LEANDRO, CA 94579
TELEPHONE (510) 357-8451
FEE ID UNIT QUANTITY AMOUIT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ----- ----- ---------- ---------- ----------
1BCBSC VALUATION 13, 000 . 00 1 .00 0 .00 1. 00 0 .00
1BSEISMICR VALUATION 13, 000 . 00 1.30 0. 00 1.30 0 .00
1REROOFRES SQ FEET 27. 00 351 . 00 0 .00 351. 00 0 .00
---------- ---------- ---------- ----------
TOTAL PERMIT 333 .30 0 .00 353 .30 0 .00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 353 .30 #1004
---------------
TOTAL RECEIPT 353 .30
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 CUP.ERTINO
12REROCIF
CUPERTINO PERMIT APPL[CATION
Date:
Building Address: ,. c CL_(
-- Phone
Owner's Name: � ..� � ✓�'l Off#
0
IPaoZ �'V1 1 `
HOA: Yes ❑ NoIf es, rovide letter from HOA
Contractor: __ Phone #: f�/o
Fax#: 51o_ �,5 -
Cupertino Business License #: Contractor License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ; 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: nn
Ff.e.S1.'b(2 .,\ A 1nA &W\ �S 1 �'0 0 �S
Residential Commercial
Green Building: Please complete relevant portion (if the Confirmed with-Planning Dept. if
Green Building Checklist & attach it to the applic�.tion or if there are any restrictions:
applicable, include in plan set & the sheet index.
Valuation
I Have Read, Understand and Will Comply with Cupi;rtino's Tear-Off Policy:
31Cf
Signature
Revised 02/05/09
CITY OF
CITY OF CUPERTINO
REROOF
CUPERTINO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Group
Squares
1REROOFCOM Re-roof Commercial B 1COMIVILROOF
1BCBSC Cal Bldg Standard3 B ALL PERMIT TYPES
Commission Fee
1BSEISMICO Seismic Commercial B
1REROOFRES Re-roof Residenti i1 B 1SFDWLR00F
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
1BSEISMICRE Seismic Residential B
1RER00FMRES Re-roof Multi-Family B 1MFDWLR00F
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
1BSEISMICRE Seismic Residential B
1BUSLIC Business License B
!.lndOOr Air Quality and Finishes
1.Use LowfNo-VOC Paint 1 IAO health pts y=yes 0
2.Use Low VOC,Water-Based Wood Finishes 2 IAD/`Iealth pts y=yes 0
3.Use Lflw/No VOC Adhesives 3 IAO/-lealth pts y=yes 0
4,Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes 0
5.Use Engineered Sheat Goods with no added Urea 0
Formaldehyde fi IAC�Health pts y=yes
S.Use Exterior Grade Plywood for Interior Uses 1 IACLHealth pts y=yes 0
7.Seal all DcDas d Pariiolabcard or MDF_ 4 IAQ,Health is r= as —— --- 0
B.Use FSC Certified Materials for Interior Finish 4 Resume pts y=yes 0
9.Use Finger-Jointed or Recycled-Contant Trim 1 Resource pts y=yes 0
10.Install Whole House Vacuum System 3 IACJHealth pts y=yes 0
6 1 D
N.Flooring
1.Selact FSC Certified Wood Flooring B 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
7
4.Install Natural Linoleum in Place of Vinyl 5 IAO Health pts y=yes 0
5.Use Exposed Concrete as Finished Floor 4 Resi>ume pts y=yes 0
6.Install Recycled Content Carpet with Low VOCs 4 Resourca pts y=yes 0
Total Points Available: 140 1301 57
Total Points Project Received: 0 01 0
)0
G:datalprogs/greanbuild igguidelines/ramodelers/greenp6intsfinal2.12.04proteoted.xis