10050129 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20613 SCOFIELD DR CON TRACTOR:R E ROOFING& PERMIT NO: 10050129
CONiTRUCTION INC
DATE ISSUED:05/14/2010
'WNER'S NAME: ORLANDO LARSON
15231 CLYDELLE AVE
PHONE NO:(408)626-9320
uWNER'S PHONE: 4082580957
SAN JOSE,CA 95032
Li
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
ICENSED CONTRACTOR'S DECLARATION
- RE-ROOF REMOVE EXISTING I LAYER OF WOOD SHAKE
Licyrl s � Lic.# 2 INSTALL NEW 1/2" CDX,30# LIGHTWEIGHT TILE CLASS
Lontractor % Date A 1 I SQUARES
:�
I hereby a that I am-I tensed 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 Valuation:$13000
Sq.performance of the work for which this permit is issued. Ft Floor Area:
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 APP4 Number:35909007.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to entbr
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the Iss Lied by: Date:
grautin this Additionally,the applicant understands and will comply
ith all no t sourc gulattons{3 the Cupertino Municipal Code,Section
9.1&' % (�� '�I I w RE-ROOFS:
.- �_ Date
�"' ►at_ ei All roots shall be inspected prior to any roofing material being installed.If a roof is
installed 6v—G-01 rst 6btaVimi�g an inspgction,I agree to remove all new materials for
inspection. \ - I
a
❑ OWNER-BUILDER DECLARATION Date:
Sit,nhture of Ap I�
I hereby affirm that I am exempt from the Contractor's License Law for one of ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
the following two reasons:
1,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,
Business&Professions Code) HAZARDOUS MATERIALS DISCLOSURE
I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
C:ilifornia Health&Safety Code,Sections 25505,25533,and 25534. 1 will
I hereby affirm under penalty of perjury one of the following three in iintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: H:alth&Safety Code,Section 25532(a)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the w 171cm t nta na ompl definedlity Management District I
ce with-the Carper lea AirQu
pal Code,Chapter 9.12 and
t
performance of the work for which this permit is issued. tt a Health&Safes e,Secti 5,2 ,ltd 25534. / 1 I
- I-�h
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 Owner a(authoklzed a ent. - �� Date:
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 CONSTRUCTION LENDING AGENCY
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 Iork's for affirm
whit at there is is o s cnsruction(Sec.3091ng 7,Cagency for theperformance of
forthwith comply with such provisions or this permit shall be deemed revoked. I ender's Name
APPLICANT CERTIFICATION bender's Address
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
in the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION
-mnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting of this permif.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec: Twp: Rng: Sub: Blk: LDt :
APN . . . . . . . . : 359090)7. 00
DATE ISSUED. . . . . . . : 05/14/2010
RECEIPT #. . . . . . . . . : BS000010413
REFERENCE ID # . . . : 10050129
SITE ADDRESS . . . . . : 20613 3COFIELD DR
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER ORLANDO LARSON
ADDRESS 20613 S COFIELD
CITY/STATE/ZIP . . . : CUPERTNO CA, 95014-2945
RECEIVED FROM . . . . : R E ROOFING
CONTRACTOR PROCTOR, PAUL LIC # 20615
COMPANY R E ROOFING & CONSTRUCTION INC
ADDRESS 15230 CLYDELLE AVE
CITY/STATE/ZIP . . . : SAN JOSE, CA 95032
TELEPHONE (408) 6,!6-9320
FEE ID UNIT QUANTITY AMOUNT 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 19 . 00 247. 00 0 . 00 247 . 00 0 . 00
------ ---- ---------- ---------- ----------
TOTAL PERMIT 249.30 0 . 00 249 . 30 0. 00
METHOD OF PAYMENT AMOUNT F.EFERENCE NUMBER
----------------- --------------- --- -----------------
CHECK 249 .30 2250
---------------
TOTAL RECEIPT : 249.30
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 CUPERTINO
-[A- REROOF
CUPERTINO PERMIT APPLICATION
APN# Date:
Building Address: �—, 0� 3 U'a"I) �C
Owner's Name: CA j A_ rO U LAI� Su�,J Phone #:
HOA: Yes ❑ No If yes, provide letter from HOA q4- 29k-
1
Contractor: 4 Phone #:
Fax#:
Cupertino Business License #: � �� Contractor
License
cense #:
72- 7 -511
Type of Roof(;overing:
Existing: P roposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
X Wood Shakes ❑ Wood Shakes /� �}L V ) L
❑ Wood Shingles ❑ Wood Shingles ,
❑ Other(Specify) � r Other (Specify) t1 Ilrl Wo ��f 1 I L�
Number of existing coverings ( ❑ Provide I.C.C.E.S. Report#
�To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description: ),t OVA L I 1 �' L t< G'1F �1/ OV At� h1�f At,
Residential Commercial
Green Building: Please complete relevant portion of the Confirmed with-Planning Dept. if
Green Building Checklist & attach it to the applic=ation or if there are any restrictions: ❑
applicable, include in plan set & the sheet index.
Valuation:
I Have erstand and Will Comply with Cupertino's Tear-Off Policy:
Signature
Revised 02/05/09
CITY OF
CITY OF CUPERTINO
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 1SFDWLROOF
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
1BSEISMICRE Seismic Resident:al B
1REROOFMRES Re-roof Multi-Family B 1MFDWLROOF
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
1BSEISMICRE Seismic Resident:.al B
1BUSLIC Business License B
i
101211111100015=M e 'Alip
M.Indoor Air Quality and Finishes
1.Use Low/No-VOC Paint 1 IAC/Health pts y=yes D
2.Use Low VOC,Water-Based Wood Finishes 2 IAC/Health pts y=yes 0
3,Use Low/No VOC Adhesives 3 IACIHealth pts y=yes D
4.Use Salvaged Miiaterials for Interior Finishes 3 Re,;ource pts y=yes D
5.Use Engineered Sheet Goods with no added Urea
Formaldehyde 6IACIHealth pts y=yes D
6.Use Exterior Grade Plywood for Interior Uses 1 IACJHealth pts y=yes D
_ 7.Seal all Exposed Partiobbcard 3r MDF 41ACYHealft pts Y= es
B.Use FSC Certified Materials for Interior Finish 4 Re source pts y=yes D
9.Use Finger-Jointed or Recycled-Content Trim 1 Re3(Durce pts y=yes D
10.Install\Whole House Vacuum System 3 IA,)/Health pts y=yes D
1 i D
W.Flooring
1.Select FSC Certified Wood Flooring 8 Resource pts y=yes 0
2.Use f3apidly.Renewable Flooring Materials 4 Resource pts y=yes D
3.Use Recycled Content Ceramic Tiles 4 Resource pts y=yes D
4.Install Natural Linoleum in Place of Vinyl 5 IAC/Health pts y=yes D
5.Use Exposed Concrete as Finished Floor 4 ResDuroe pts y=yes D
6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes 0
M .
B 1 1
Total Points Available: 1 1401 130 57
Total Points Project Received: 0 51 0
G:datalprogslgreanbuild noouidelinpSlramodelarslgreanpointsfinaIZ 12.D4protested.xls
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDIN3 OFFICIAL
10300 TORRE AVENUE • CUPERTINO, CA 45014-3255
CUPERTINO
(408)777-3228- FAX(408)777-3333• buildi ig(&cupertino.org
-[ 77
PROJECT ADDRESS 2 �r ( $ r(l ' _b APN# CX_
OWNER NAMEOklktiN Lf Su- I PHONE • _ )3 ()Ott. E-MAIL
STREET ADDRESS ^ U(_ I `I/ l I l ' CITY, STATE,ZIPf(�� ( ' FAX
CONTRACTOR NAME (! _KU� 11,4 l/j LICENSE NUMBER'7 1 �� -1 LI N P BUS.LIG#
COMPANY NAME �i E-MAIL J FAX
STREET ADDRESS CITY,STATE,ZPHON /f _ 62G2-3O _1L- AS oot924
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 day before 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
F been replaced, you must call for a roof inspection. A building 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 appli& without first obtaining an approved inspection will
require the removal of all new material down to the ,heathing 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 followin€ item will be verified:
a. Flat roofs shall have a minimum of/" per foot of slope and demonstrate there is no ponding.
b. A listing from an approved testing agency shall be a,7ailable 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 cert y to each-o e follo I am the property owner or authorized agent to act on
ie property owner's behalf. I nder and e col�th e-roof policy stated ab ve.
Signature of Applicant/Agent: Date:
ReroofPolicy_1010.doe revised 04/14/10