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10050135 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 11140 SANTA TERESA DR CONTRACTOR:BAUTISTA BUILDERS PERMIT NO: 10050135 OWNER'S NAME: CONWAY JILL J TRUSTEE 1506 VI SELBY LN DATE ISSUED:05/17/2010 NER'S PHONE: 4082573377 REDWOOD CITY,CA 94061 PHONE NO:(650)465-4411 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG F ELECT PLUMB License Class 0-3c.Li # Cb 676-7 S MECH F RESIDENTIAL F_ COMMERCIAL� Contractor�>�1 l-,T4— 17L'(o(2_1-P5 Date �pt,,,190 I hereby affirm that I am licensed under the provisi ns of JOB DESCRIPTION:RE-ROOF TEAR OFF ONE LAYER SHAKE.APPLY OSB SHEATHING&CERTAINTEED CLASS A PRESIDENTIAL COMP (commencing with Section 7000)of Division 3 of the Business&Professions SHINC LE&NEW GUTTERS&DOWN SPOUTS 35SQ 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 Sq.Ft Floor Area: Valuation:$18808 permit is issued. APPLICANT CERTIFICATION APN Plumber:35617025.00 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 ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply 130 DAYS FROM LAST CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Issue I Date: /f � b, Signature ` '�a" Date '5 t 7It 6' ❑ OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All ro ifs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: install:d without first obtaining an inspection,I agree to remove all new materials for I,as owner of the property,or my employees with wages as their sole compensation, inspec tion. will do the work,and the structure is not intended or offered for sale(Sec.7044, Sign Business&Professions Code) a Date: ure of Applicant: '' 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 declarations: HAZARDOUS MATERIALS DISCLOSURE 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 I hav s read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Safer Code,Section 25532(a)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Addie ionally,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 main ain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534. Compensation laws of California. If,after making this certificate of exemption,I Ow �• o d gent: become subject to the Worker's Compensation provisions of the Labor Code,I must {�or auth27 forthwith comply with such provisions or this permit shall be deemed revoked. Date: l CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's correct.I agree to comply with all city and county ordinances and state laws relating for w rich this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save nify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. I und;rstand my plans shall be used as public records. Signature �� Date S 7 Licei sed Professional CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec : Twp: Rng: Sub: Blk: Lct : APN 35617025 . 00 DATE ISSUED. . . . . . . : 05/17/2010 RECEIPT # . . . . . . . . . BS000010422 REFERENCE ID # . . . : 10050135 SITE ADDRESS . . . . . : 11140 SANTA TERESA DR SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER CONWAY JILL J TRUSTEE ADDRESS 11140 SANTA TERESA DR CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4767 RECEIVED FROM . . . . : BAUTIS'IA BUILDERS CONTRACTOR . . . . . . . : MAURICIO BAUTISTA LIC # 31068 COMPANY BAUTISZA BUILDERS ADDRESS . . . . . . . . . . : 1506 W SELBY LN CITY/STATE/ZIP . . . : REDWOOD CITY, CA 94061 TELEPHONE . . . . . . . . : (650) 465-4411 FEE ID UNIT QUANTITY AMOUD'T PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ------ ---- ---------- ---------- ---------- 1BCBSC VALUATION 18, 808 . 00 1 . 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 18, 808 . 00 1 . 90 0 . 00 1 . 90 0. 00 1REROOFRES SQ FEET 37 . 00 4f1. 00 0 . 00 481 . 00 0. 00 ------ ---- ---------- ---------- ---------- TOTAL PERMIT 4f3 . 90 0 . 00 483 . 90 0 . 00 METHOD OF PAYMENT AMOUNT F_EFERENCE NUMBER ----------------- --------------- --- ----------------- CHECK 483 . 90 #275 --------------- TOTAL RECEIPT 483 . 90 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 12REROOF CUPERTINO PERMIT APPLICATION Date: .� APN# �� l �, 2- �" Building Address: Phone #: Owner's Name: �1.-c_- CC J HOA: Yes ❑ No If es, provide letter fl-om HOA Ami .�S' 7 -3 3 77 Contractor: Phone #(�V S1 y' -�'��l Fax# Contractor License #- 7� s�� Cupertino Business License #: I�G 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) r 399 Number of existing coverings 1 ❑ Provide I.C.C.E.S. Report# Csie ❑ To be Removed ❑ Provide Mfgr. Installation Specs. Job Description: -.&:�A d� j c` _K N-ori C-- C'c TA�'`'a � s A,%5 � rr s �j �d� 7`'ff o4 ' t -- t , Residential - Commercial Green Building: Please complete relevant portion of the Conf rmed with Planning Dept. if Green Building Checklist & attach it to the application or if there are any restrictions: applicable, include in lan set & the sheet index. Valuation: I Have Read, Understand and Will Comply with Ci.pertino's Tear-Off Policy: Signature Revised 02/05/09 CITY OF CITY OF CUPI:RTINO REROO:F 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 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee / 1BSEISMICRE Seismic Residential B 1RER00FMRES Re-roof Multi-Family B 1MFDWLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICRE Seismic Residential B 1BUSLIC Business License B' REROOF TEAR-OFF POLICY COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDIN<; OFFICIAL 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228 FAX(408)777-3333•buildirg(a)cupertino.orq PROJECT ADDRESS 7APN 4C� �°��;� _(eA / \ CVO PHONE _ •Z E-MAIL � OWNER NAME �p Wry 7T n STREET ADDRESS TY, STATE,Zl'� � u �- 0 f-Y FAX TRACTOR Nnne❑ Y-_ r LICENSE UMBER 0sral BUS.LIC.# (tel o u( <5 ! �— 76 7 `.> a b �J C PANYNAME , 3 EMAI��`1 cry, h.,Isrfw Ct'�� FAX37U /G�C7C� CI STATE,ZI t ON C 4(e ) STREET ADDRESS rJL( 0 a q.5Q0 (�iJb } _ 1 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. An inspection request shall be scheduled the d_aybefore the inspection date. Please call (408)777- 3228 between 7:30 - 3:30pm (Mon-Fri) to schedule the next day inspection. 3. After the roof is torn off and the nails/fasteners have been removed and all the dry-rotted wood has been replaced, you must call for a roof inspection Vbuilding inspector will be available with one hour. There are special hours for the 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. New roof coverings shall not be applied without first obtaining all inspection and written approvals from the building inspector. Any roofing which is applie I 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. 6. A final inspection and approval shall be obtained from the building inspector when the re-roofing is completed. To receive a final sign-off, the following item will be verified: a. Flat roofs shall have a minimum of 1/" per foot of s lope and demonstrate there is no ponding. b. A listing from an approved testing agency shall be available on-site to review at the time of the inspection. c. Proper spark arrestor installation. 7. NOTE: . If you call for a plywood nailing inspection and the job is not ready, you will be charged to a re- inspection fee of$126.00. The re-inspection fee shall be paid before another inspection can be scheduled. ,y my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I understand and agree to cc mply with the re-roof policy stated above. — 16 Signature of Applicant/Agent: � Date: ReroofPolicy_1010.doe revised 04/14//0 M.MOD Air Quality and Finishes 1.Use LowND-VOC Paint 1 IACJHealth pts y=yes p 2.Use Low VOC,Water-Based Wood Finishes 2 IACJHsalth pts y=yes 0 3.Use Low/iso VOC Adhesives 3 IACIHealth pts y=yes p 4.Use Salvaged Materials for Interior Finishes 3 Re source pts y=yes D 5.Use Engineered Sheet Goods with no added Urea Formaldehyde 6IACJHealth pts y=yes 0 6.Use Exterior Grade Plywood for Interior Uses 1 IACJHealth pts y=yes p 7.Seal all xDosad Pari olabcard 3r MDF _ 4 IACJHeaith pts y=yas __ p B.Use FSC Certified Materials for Interior Finish 4 Re source pts y=yes D 9.Use Finger-Jointed or Recycled-Content Trim 1 Ra,ource pts y-yes D 1 D.Install Whole House Vacuum System 3 IAOJHealth pts y=yes p 1 1 D N.Flooring 1.Select FSC Certified Wood Flooring B Resource pts y=yes 0 2.Use Rapidly Renewable Flooring Materials 4 Resource pts y=yes D 3.Use Recycled Content Ceramic Tiles 4 Resource pts y=yes 0 4.Install Natural Linoleum in Place of Vinyl 5 IAD-'Health pts y=yes p 5.Use Exposed Concrete as Finished Floor 4 Resource pts y=yes 0 6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes 0 1 1 � Total Points Available: 401 1301 57 Total Points Project Received: 01 01 0 G:data/progslgreenbuildinr,guidalines/ramodeler/greanpointsfinal21 ZD4proteaiad.xls Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 C U P E RT I N O Telephone: 408-777-3228 Fax: 408-777-3333 CONTRACTOR/ SUBC1ONTRACTOR LIST JOB ADDRESS: ( r !.E PERMIT# Q j OWNER'S NAME: PHONE# GENERAL CONTRACTOR: ?L1C -- BUSINESS LICENSE# /C> ADDRESS: 136-5 -J-(-A,- j7I,g..- l�-,y4• CITY/ZIPCODE: CAvt i�%L Soa *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. � 1 ._ I am not using any subcontractors: �!� c5 (7 Signat ire 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