10040003 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 6595 CLIFFORD DR CONTRACTOR:THD AT-HOME SERVICES, FPERMIT NO: 10040003
INC.
NER'S NAME: FRANCIS RICHARD N AND JANE D 2690 CUMBERLAND PKWY ST
300 ISSUED:04/01/2010
OWNER'S PHONE: 4082574809ATLANTA,GA 30339-3913 NO:(510)731-1004
Pq LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class G 3 5 13 Lie.# 93 60 2-
MECH r RESIDENTIAL COMMERCIAL
Contractor
a
t
JOB DESCRIPTION:REROOF WITH I LAYER TEAR OFF.NO RESHEET,25SQ
I hereby aff me
visions of Chapter 9 CLASS A TIMBERLINE 30 HIGH DEFINITION
(commenci it0)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,Ft Floor Area: Valuation:$9787
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. APN Number:36926006.00 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 180 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 Issued by`_—"ji1� Date:
9.18.
iture Date /
RE-ROOFS:
❑ NER BUILDER DECLARATION
All roofs 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 installed 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, Date:
will do the work,and the structure is not intended or offered for sale(Sec.7044, Signature of Applicant:
Business&Professions Code)
1,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 have 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&
Safety Code,Section 25532(a)should I store or handle hazardous material.
I have and will maintain Worker's Compensation Insurance,as provided for by 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 Health&Safety Code,Sections 25505,25533,and 25534.
not employ any person in any manner so as to become subject to the Worker's c� l
Compensation laws of California. If,after making this certificate of exemption,I ?affirm
ed agent: Date: I / 1 /G
become subject to the Worker's Compensation provisions of the Labor Code,I must
forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION 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 Lender's Name
to building construction,and hereby authorize representatives of this city to enter
the above mentioned property for inspection purposes.(We)agree to save Lender's Address
mify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regu ations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records.
9.18.
'//0
Licensed Professional
Signature Date
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN 36926006 . 00
DATE ISSUED. . . . . . . : 04/01/2010
RECEIPT # . . . . . . . . . BS000010076
REFERENCE ID # . . . : 10040003
SITE ADDRESS . . . . . : 6595 CLIFFORD DR
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER FRANCIS RICHARD N AND JANE D
ADDRESS 6595 CLIFFORD DR
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4555
RECEIVED FROM . . . . : JEFF RAINEY
CONTRACTOR FRANCES BLAKE LIC # 29818
COMPANY THD AT-HOME SERVICES, INC.
ADDRESS 2690 CUMBERLAND PKWY STE 300
CITY/STATE/ZIP . . . : ATLANTA, GA 30339-3913
TELEPHONE (510) 731-1004
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- -------------
---------- ---------- ------
1BCBSC VALUATION 9, 787 .00 1. 00 0 . 00 1 . 00 0 . 00
1BSEISMICR VALUATION 9, 787 . 00 1. 00 0 . 00 1 . 00 0. 00
1REROOFRES SQ FEET 25 . 00 325 . 00 0 . 00 325 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 327 . 00 0 . 00 327 . 00 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- -------------
CREDIT CARD 327 . 00 VISA
---------------
TOTAL RECEIPT 327. 00
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
REROOF
CUPERTINO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1REROOFCOM Re-roof Commercial B 1COMMLROOF
IBCBSC Cal'Bldg Standards B ALL PERMIT TYPES
Commission Fee
1BSEISMIC0 Seismic Commercial B
r� 1REROOFRES Re-roof Residential B 1SFDWLROOF
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
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
Fax: (408)777-3333
Building Department
Subject: Re-roofing policy for the City of Cupertino
1. Prior to permit issuance,you must agree to comply with 2007 CBC Standards
and manufacturers specification's on re-roofing. All roofs are Class"A" per Cupertino
municipal code 16.04.080.
ed without
2. New roof coverings shall not be applifirst obtaining all inspection
and written approval from the building inspector. A final inspection and
approval shall be obtained from the building inspector when the re-roofing
is completed.
3. All roofs shall be inspected prior to any roofing installation.
4. To receive a final sign off from the City,
he following steps are required:
in
Pre- spection and/or tear off approval.
a) AT TEAR OFF PULL OUT ALL ROOF FASTENERS.
2) In-progress inspection approval.
3) Final inspection approval.
a) Spark arrester installation.
5. If plywood is installed,a plywood nail inspection is required.
6. Any roofing which is applied without first obtaining an inspection,
will require the removal of all new material down to the sheathing,
so a proper City inspection can be performed.
7, NOTE: If you call for a plywood nail inspection and the job is not ready,
you will be charged a re-inspection fee of$126.00. The re-inspection fee must
be aid before another
inspection can be scheduled.
IMPORTANT:
1. Flat roofs must have a minimum of 1/4" per foot slope and demonstrate
that there is no ponding.
be on the job site at the time on inspection.
2. An I.C.B.O. report is required to
I understand and will comply with the above stated policy on re-roofing.
Homeowner's Name:
Job Site Address:
Roofing Company Name:
Applicants Signature:
te: f U
Albert Salvador
Building Official
Revised 3/09/10
.Indoor Air Quality and tnishes
1.Use Low/No-VOC Paint 1 IAQ/Health pts y=yes 0
2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes 0
3.Use Low/No VOC Adhesives 3 IAQ/Health pts y=yes 0
4.Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes 0
5.Use Engineered Sheet Goods with no added Urea
Formaldehyde 61AOJHealth pts y=yes
0
0
6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes
4 IAQ/Health pts y=yes
7.Seal all Exposed Particleboard or MDF 0
S.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes 0
9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y=yes 0
10.Install Whole House Vacuum System 3 IAQ/Health pts y=yes LO 1 0
1 1 1
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 0
3.Use Recycled Content Ceramic Tiles 4 Resource pts y--yes 0
4.Install Natural Linoleum in Place of Vinyl 5 IAQ/Health pts y=yes 0
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 1
Total Points Available: 401-1301 57
Total Points Project Received: 0 0 0
G:data/progs/greenbuildingguidelines/remodelers/greenpointY2.04protectedxls
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
Fax: 408-777-3333
CUPERTINO
CONTRACTOR / SUBCONTRACTOR`LIST
iZ, PERMIT
JOB ADDRESS: 6 `� G� PHONE#
OWNER'S NAME: Dt GK F`Z.4 �► S
GENERAL CONTRACTOR: '70� ��J+ter � CITY/ZIPCODE LICENSEBUSINESS 9� 5 7 2
ADDRESS: 'Z S(o r �� "j'�'��'
n the city to have a City of Cupertino business license.
*Our municipal code requires all businesses working i
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S)
HAVE OBTAINED AHC TY OF CUPERT[NO
UNTIL THE
GENERAL CONTRACTOR AND ALL SU CONTRACTOR
BUSINESS LICENSE. V/ I 10
I am not using any subcontractors: ature Date
Please check applicable subcontra ors and omplete 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
Date
0 er/Contractor Signature