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10050201 CITY OF CUPERTINO BUILDING PERMIT CONTRACTOR:BAY 101 ROOFING PERMIT NO: 10050201 BUILDING ADDRESS: 22210 QUINTERNO CT DATE ISSUED:05/27/2010 PO BO):925 OWNER'S NAME: SONJA M AND DAVID MARCUS TRUST C900PHONE NO:(408)957-0531 JER'S PHONE: 4082577627 ALVISO, A52 ❑ LICENSED CONTRACTOR'S DECLARATION BUILE ING PERMIT INFO: BLDG ELECT I— PLUMB License Class Lic.# 9 MECH f- RESIDENTIAL r COMMERCIAL Contractor n 'I �d �d�fi Date � L JOB DESCRIPTION: RE-ROOF TEAR OFF ASPHAL SHINGLES PUT ON 30LB I hereby affirm that I am licensed under the provisions of Chapter 9 FELT &30YR SHINGLES COLOR SHAKEWOOD CLASS A 23SQ (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 Valuation:$7000 Section 3700 of the Labor Code,for the performance of the work for which this rAPN Floor Area: permit is issued. APPLICANT CERTIFICATION lumber:35709068.00 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 upon the above mentioned property for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT IS OR costs,and expenses which may accrue agai said City in consequence of the granting of this permit. Additionally, he pl ant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point source r ion per e C pertino Municipal Code,Section 9.18. Issued b�� Date: Signature Date [� OWNER UILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All rc ofs shall be inspected prior to any roofing m1eeno re 1 og a all nlw mat If aealsof lfor the following two reasons: installed without first obtaining an insp g I,as owner of the property,or my employees with wages as their sole compensation, inspe tion. / will do the work,and the structure is not intended or offered for sale(Sec.7044, Signature of Applicant: Date: S` 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 HAZARDOUS MATERIALS DISCLOSURE declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's I have fo 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 1 store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Adc.itionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the C not employ any person in any manner so as to become subject to the Worker's He0th&Safe Code,Sections 25505,25533,and 25534. Compensation laws of California. If,after making this certificate of exemption,I On ner or aut} a nt: �^ /0 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. — L CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I h;reb 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 p to building construction,and hereby authorize representatives of this city to enter Le ider s Name upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address nnify 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.Additio lly,the app t understands and will comply with all non-point source on er t Cu ertmo Municipal Code,Section I understand my plans shall be used as public records. 9.18. . l - Signature Date S ?r& Licensed Professional CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lct: APN 35709068 .00 DATE ISSUED. . . . . . . : 05/27/2010 RECEIPT #. . . . . . . . . BS000010499 REFERENCE ID # 100502C1 SITE ADDRESS 22210 QUINTERNO CT SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER SONJA 11 AND DAVID MARCUS TRUST ADDRESS 22210 QUINTERNO CT CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-2749 RECEIVED FROM BAY 101 ROOFING INC CONTRACTOR JOSE R;\MIREZ LIC # 30420 COMPANY BAY 10L ROOFING ADDRESS PO BOX 925 CITY/STATE/ZIP . . . : ALVISO, CA 95002 TELEPHONE (408) a57-0531 FEE ID UNIT QUANTITY AMOU\TT 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 23 . 00 299 . 00 0 .00 ----299_00 ------0_00 ---------- ---------- TOTAL PERMIT 300 .70 0 . 00 300. 70 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- --------- CREDIT CARD 300 .70 VISA --------------- TOTAL RECEIPT 300 .70 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 CUPERTINO C REROOF CUPERTINO PERMIT APPLICATION APN# Date: `7 09 o (o � - Buildin Address: u � tl N �� X10 L Owner's Name:- C), (Ka-i L. 5 Phone #: HOA: Yes ❑ No [�If es, provide letter from HOA Contractor: Phone #: T 5- U 3 1 �1 /d FINS 7 �- Fax#: Cupertino Business License #: Contractor License #: Type of Roof(;overing: Existing: P roposed: ❑ 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 Mfg. Installation Specs. r Job Description: i /1jZ t f- /b P*l Z "r Residential Commercial Green Building: Please complete relevant portion Df the Con-firmed 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: Ooh I Have Read, Understand and Will Com 1 'th C ino's Tear-Off Policy: Signature Revised 02/05/09 CITY OF CITY OF CUPERTINO REROOF 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 Residenti it B 1SFDWLROOF 23 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES / Commission Fee / 1BSEISMICRE Seismic Residential B 1 1REROOFMRES Re-roof Multi-Family B 1MFDWLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMIICRE Seismic Residential B B 1BUSLIC Business License M.Indoor Air Quality and Finishes 1.Use Low/No-VOC Paint 1 IA01-iealth pts y=yes 0 2.Use Low VOC,Water-Based Wood Finishes 2 IAO'Health pts y=yes 0 3.Use LDw/No VOC Adhesives 3 IAL`Health pts y=yes 0 4.Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes D 5.Use Engineered Sheet Goods with no added Urea Formaldehyde 6IAQNsalth pts y=yes 0 6.Use Exterior Grade Plywood for Interior Uses 1 IAQ'Health pts y=yes 0 7.Seal all Exposed?arlolebcard x MDF 4IAC/Health pis Y= es D B.Use FSC Certified Materials for Interior Finish 4 Re:;oume pts y=yes 0 9.Use Finger-Jointed or Recycled-Content Trim 1 Re.;Duime pts y=yes 0 10.Install Whole House Vacuum System 3 IM/Health pts y=yes 0 1 1 D N.Flooring 1.Select FSC Certified Wood Flooring 8 Resource pts y=yes 0 2.Use f3OdJy,enewable Flooring 10laterials 4 Resource pts y=yes D 3.Use Recycled Content Ceramic Tiles 4 Resource pts yges D 4.Install Natural Linoleum in Place of Vinyl 5 IAQ'Health pts y=yes 0 5.Use Exposed Concrete as Finished Floor 4 Res)urce pts y=yes D 6.Install Recycled Content Carpet with Low VOCs 4 Res>urce pts y=yes 0 1 � 6 Total Points Available: 1 1401 130 57 Total Points Project Received: 0 0 0 G:datalprogslgreenbuildiigguideli modeleen ointsfina1212.Mproteoled.xls Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 CUPERTINO Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: U//v7� a PERMIT# f. 11-' -,;> V ---)- `:> k OWNER'S NAME: �//1 1Wf A4'f0S PHONE# . d 93- � D5 GENERAL CONTRACTOR: /Q r BUSINESS LICENSE# ADDRESS: CITY/ZIPCODE: f�L vlf T 0 *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSP TION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUB T C R HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: 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