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10050001 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10863 WILKINSON AVE CONTRACTOR:CALIFORNIA ROOFING PERMIT NO: 10050001 INC "NER'S NAME: VANDERWYK FRANCISCA J 1595 5 10TH ST DATE ISSUED:05/03/2010 OWNER'S PHONE: 4082520391 SAN JOSE,CA 95112 PHONE NO:(408)293-7977 A LICENSED CONTRACTOR'S DECLARATION BUI.DING PERMIT INFO: BLDG r- ELECT PLUMB License Class ( — C� Lic.# ( ���U'J MECH RESIDENTIAL COMMERCIAL Contractor - Date `'� 2 h� h t -a� nse tide he ovisions of Chapter 9 JOB DESCRIPTION:RE-ROOF REMOVE EXISTING METAL ROOFING&INSTAL 1/2"CDX PLYWOOD SHEETING INSTALL CERTAINTEED (commencing with Section 7000) i on 3 of the Business&Professions PREc IDENTIAL COMP CLASS A 26SQ FIRE RATED**SEE Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: �S �� t rt 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.1't Floor Area: Valuation:$12000 permit is issued. APPLICANT CERTIFICATION API\Number:35613023.00 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 I:'ERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. —� Dater �d -- Issued Date S;t t7 OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All i oofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: instilled without first obtaining an inspection,I agree to remove all new materials for 1,as owner of the property,or my employees with wages as their sole compensation, insp sction. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Sigr ature of A�plieant Date: i j /to as owner of the property,am exclusively contracting with licensed contractors to — e_ ' construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER Z 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 ha ve 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. 1 will maintain I have and will maintain Worker's Compensation Insurance,as provided for by con pliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Saf-ty 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 Additionally,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 not employ any person in any manner so as to become subject to the Worker's He:lth&Safety Code,Sections 25505,25533,and 25534. 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 ` r ithori t: _ --� Date: forthwith comply with such provisions or this permit shall be deemed revoked. — y_ CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION 1 certify that I have read this application and state that the above information is I ht reby 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 which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name the above mentioned property for inspection purposes.(We)agree to save mify and keep harmless the City of Cupertino against liabilities,judgments, Leiider's Address costs,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 re ulations per the Cupertino Municipal Code,Section 9.18. 1 understand my plans shall be used as public records. ----ac Sign—a uuiate ' �J Licensed Professional CITY OF CUP]?,RTINO 3 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 35613023 . 00 DATE ISSUED. . . . . . . : 05/03/ 2010 RECEIPT #. . . . . . . . . : BS0000L0299 REFERENCE ID # . . . : 100500 )1 SITE ADDRESS . . . . . : 10863 4ILKINSON AVE SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER VANDER4YK FRANCISCA J ADDRESS 10863 4ILKINSON AVE CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4733 RECEIVED FROM . . . . : CALIFORNIA ROOFING CONTRACTOR HAPPER P CAMPBELL LIC # 28096 COMPANY CALIFORNIA ROOFING INC ADDRESS 1595 S 10TH ST CITY/STATE/ZIP . . . : SAN JOSE, CA 95112 TELEPHONE (408) 293-7977 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 12, 000 . 00 1. 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 12, 000 . 00 1.20 0 . 00 1 .20 0 . 00 1REROOFRES SQ FEET 26 . 00 338 . 00 0 . 00 338 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 340 .20 0 .00 340 .20 0. 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 604 ROOF IN-PROGRESS 605 FINAL REROOF CITY OF CUPERTINO RECEIPT NUMBER: BS000010299 RECEIVED BY: PATRICIAG PAYOR: CALIFORNIA ROOFING TODAY' S DATE: 05/03/10 RECrISTER DATE: 05/03/10 TIME: 09 : 37 4 10050001 $1 .00 1BCBSC $1 .20 1BSEISMICR 10050001 $338 .00 1REROOFRES 10050001 $114 . 00 BUSINESS LICENSE TAX RNEW =CALIFORNIA ROOFING ---------------- TOTAL DUE: $454 .20 CHECK $454 .20 R3F NUM: #9105 TENDERED CHANGE $454 .20 $ . 00 CITY OF �� "' 7 C,� CITY OF CUPERTINO 12REROOF CUPERTINO PERMIT APPLICATION Date: C,,:: Building Address: Owner's Name: c < ,�„ V v�i-� �i 't! Phone #: LA OX- ?S7 HOA: Yes ❑ No [] If es, provide letter from HOA Phone #: q o V 3 ---7L;-/7 Contractor: C E; l r—,,t 1 -�': = Fax#: ��-'i� _-`�L4 - l(21 t Contractor License #: Cupertino Business License #: 1 -1" ; 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# ig- To be Removed ❑ Provide Mfg. Installation Specs. Job Description: vA -' LEA Residential Commercial El 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 lan set & the sheet index. Valuation: I Have Read, Understand and Will Comply with Cu;)ertino's Tear-Off Policy: Signature Revised 02/05/09 CITY OF CITY OF CUPERTINO .0 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 1BSEISNIIC0 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., BUILDING OFFICIAL 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228 • FAX(408)777-3333- buildirg4cupertino.mg PROJECT ADDRESS �APN# -7 OWNER NAME" PHONE E-MAIL k—r_ Zai-—Cj 5 C, 1 STREET ADDRESS CITY, STATE,ZIF FAX V" CA r ; CONTRACTORppwI.AMME LICENSE NUMBER LICENSE PE BUS.LIC.# g c-O G— COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP (� PHONE 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 bef)re 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. 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 .s 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 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. 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/" per foot of slope 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 End 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. - 'ly my signature below, I certify to each of the following: : am the property owner or authorized agent to act on .le property owner's behalf. I understand an agree to comply with the re-roof policy stated above. Signature of Applicant/Agent: Date: ReroofPolicy_2010.doc revised 04114110 lip M.Indoor Air Quality and Finishes 1.Use Low/ND-VOC Paint 1 IACJHealth pts y=yes D 2.Use Low VOC,Water-Based Wood Finishes 2 IACJHealth pts y=yes D 3.Use Low/No VOC Adhesives 31ACJHealth pts y=yes D 4.Use Salvaged lflateriais for Interior Finishes 3 Re3Durce pts y=yes D 5.Use Engineered Sheet Goods with no added Urea Formaldehyde 61ACJHealth pts y=yes 0 6.Use Exterior Grade Plywood for Interior Uses 1 IAC /Health pts y=yes D 7.Seal al Evosad ftp leboard or MDF — 4 IACJHealth pts r=yes D B.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes D 9.Use Finger-Jointed or Recycled-Content Trim 1 R=source pts y=yes D 10.Install Whole House Vacuum System 3 lAQ/Health pts y=yes D 1 1 1 N.Flooring 1.Select FSC Certified UJood Flooring 8 RBEDurCe pts y--yes D 2.Use Rao ly BenewaWe Flooring Materials 4 Re.-ource pts y=yes D 3.Use Recycled Content Ceramic Tiles 4 ReS ource pts y=yes 0 4.Install Natural Linoleum in Place of Vinyl 5 IACJHealth pts y=yes D 5.Use Exposed Concrete as Finished Floor 4 Re-ource pts y=yes D 6.Install Recycled Content Carpet with Low VOCs 4 Re'Duma pts y=yes 0 1 1 1 Total Points Available: I 140 1301 57 Total Points Project Received: 01 01 Q 22c� G:datalprogslgreenbuDd ngguidelines/ramodelers/greenpointsfinalL I2.D4protecied.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: 1 05�/o-� VUl EM-�>©V PERMIT# OWNER'S NAME: PHONE# lU�'2Ci 3--7ci—? GENERAL CONTRACTOR: BUSINESS LICENSE# ADDRESS: l S,� , CITY/ZIPCODE: *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. I am not using any subcontractor"-- "n Date Please check applicable subcontractors and complete the following information: V 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