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10040042CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 10200 JOHNSON AVE I CONTRACTOR: DADDARIO ROOFING I PERMIT NO: 10040042 I OWNER'S NAME: MATTHEW THOMAS 1ER'S PHONE: 4082618820 ❑ LICENSED CONTRACTOR'S DECLARATION License Class Lic. # Contractor Date Ci -i _c) 7 Zd r O I hereby affirm that I a� licensed 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 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 permit is issued. 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 upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. 1734 WILLA WAY SANTA CRUZ, CA 95062 DATE ISSUED: 04/07/2010 PHONE NO: (831)476-9109 BUILDING PERMIT INFO: BLDG f— ELECT f— PLUMB r MECH I— RESIDENTIAL i— COMMERCIAL r— JOB DESCRIPTION: RE -ROOF T/O COMP INSTALL CLASS A 19SQ NEW 30 YEAR COMPOSITION Sq. Ft Floor Area: I Valuation: $7705 APN Number: 37525066.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by Dater'^/-- Signature s Date p C7^ �'ci�� U OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: I, 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) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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 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 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 forthwith comply with such provisions or this permit shall be deemed revoked. 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 upon the above mentioned property for inspection purposes. (We) agree to save unify and keep harmless the City of Cupertino against liabilities, judgments, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Date 0!,J--r_)7--2e16 RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Appl Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Owner or authorized agent: Date: 4 ,=Y — 7— -Z 0 (L `f CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional 3 ITEMS OF 3 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 37525066.00 DATE ISSUED.......: 04/07/2010 RECEIPT #.........: BS000010117 REFERENCE ID # ...: 10040042 SITE ADDRESS 10200 JOHNSON AVE SUBDIVISION ....... CITY CUPERTINO IMPACT AREA ...... OWNER MATTHEW THOMAS ADDRESS 10200 JOHNSON AVE CITY/STATE/ZIP ...: CUPERTINO, CA 95014 OPERATOR: patg COPY # : 1 RECEIVED FROM ....: EDGAR MONTOYA CONTRACTOR EDGAR MONTOYA LIC # 26245 COMPANY ..........: DADDARIO ROOFING ADDRESS 1734 WILLA WAY CITY/STATE/ZIP ...: SANTA CRUZ, CA 95062 TELEPHONE (831)476-9109 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC ---------- NEW BAL ---------- ----------------------- 1BCBSC VALUATION ---------- 7,705.00 ---------- 1.00 ---------- 0.00 1.00 0.00 1BSEISMICR VALUATION 7,705.00 0.80 0.00 0.80 0.00 1REROOFRES SQ FEET 19.00 247.00 0.00 247.00 ---------- 0.00 ---------- TOTAL PERMIT ---------- 248.80 ---------- 0.00 248.80 0.00 METHOD OF PAYMENT ----------------- CREDIT CARD TOTAL RECEIPT : AMOUNT --------------- 248.80 --------------- 248.80 VOICE ID DESCRIPTION -------- ---------------------------- 601 ROOF TEAR OFF REFERENCE NUMBER -------------------- VISA VOICE ID DESCRIPTION -------- ---------------------------- 602 ROOF PLYWOOD NAIL 604 ROOF IN -PROGRESS 605 FINAL REROOF CITY OF CITY OF CUPERTINO 01 REROOF CUPERTINO PERMIT APPLICATION APN # 7 _ Date: Building Address: V1 0,-,, Lc` Owner's Name: Nva 4-41 e -L) Phone #: ej HOA: Yes ❑ No If Yes, provide letter from HOA Contractor: a &, -i C, F Phone #: ?s :� r ly ? .-- q t c c( Fax #: 3 G - `t� 9 3 C« c `. v Cuperiino Business License #: Contractor License #: 3v 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 1 ❑ Provide I.C.C.E.S. Report # ❑ To be Removed ❑ Provide Mfgr. Installation Specs. Job Description: C o- _S Residential Commercial ❑ 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 plan set & the sheet index. Valuation: -7o • .--- I Have Read, Understand and Will Comply with Cupertino's Tear -Off Policy: Revised 02/05/09 CITY OF CUPERTINO Lai REROOF CUPERTINO FEE SCHEDULE Number of Squares Fee ID Fee Description Fee Group Permit Type 1REROOFCOM Re -roof Commercial B 1COMMLROOF 1BCBSC Ca1'Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICO Seismic Commercial B 1REROOFRES Re -roof Residential B 1SFDWLR00F -� 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICRE Seismic Residential B 1REROOFMRES Re -roof Multi -Family B 1MFDWLROOF 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 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 specifications on re -roofing. All roofs are Class "A" per Cupertino municipal code 16.04.080. 2. New roof coverings shall not be applied without first 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, the following steps are required: Pre -inspection 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 paid 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. 2. An I.C.B.O. report is required to be on the job site at the time on inspection. I understand and will comply with the above stated policy on re -roofing. Homeowner's Name: -M!A. 4= LVAo t j 1-1 p wn a Job Site Address:J rjc c, h v► 5 e N a ✓-t- r Roofing Company Name:L ct �.0 v / <?'ts Applicant's Signature: Date: 0q— Albert Salvador Building Official Revised 3/09/10 1. Use LowND-VOC Paint 1 IAQ/Health pts y=yes 2. Use Low VOC, Water -Based Wood Finishes 2 IAQ/Health pts y=yes 3. Use LowMo VOC Adhesives 3 IAQ/Health pts y=yes 4. Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes 5. Use Engineered Sheet Goods with no added Urea 4 Resource pts y=yes Formaldehyde 61AQ/Health pts y=yes 6. Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 7. Seal all Exposed Particleboard or MDF 4 IAQ/Health. pts y=yes 8. Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes 9. Use Finger -Jointed or Recycled -Content Trim 1 Resource pts y=yes 10. Install Whole House Vacuum System 3 IAQ/Health pts y --yes N. Flooring 1. Select FSC Certified Wood Flooring 8 Resource pts y=yes 2. Use Rapidly Renewable Flooring Materials 4 Resource pts y=yes 3. Use Recycled Content Ceramic Tiles 4 Resource pts y=yes 4. Install Natural Linoleum in Place of Vinyl 5 IAQ/Health pts y=yes 5. Use Exposed Concrete as Finished Floor 4 Resource pts y=yes 6. Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes Total Points Available: Total Points Project Received: 140 1301 57 01 0 0 G:data/progs/greenbuildinoguidelines/remodelers/green fina1212.04prev ea .x CUPERTINO CnNTR ACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: IC -2,-C, 19 ✓r �c6/- ` PERMIT # U � �Z— OWNER'S NAME: f C wia y PHONE # IF L <i - 25 f r c % GENERAL CONTRACTOR: BUSINESS LICENSE # ADDRESS: I w CITY/ZIPCODE: *Our municipal code requires all businesses working in the city to uavr it v -«y �, ..N�■ ■•� �u==•� 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:. Date Signature Plnaco ehipek annlirahle subcontractors and complete the following information: �L Owner / Contractor Signature Date 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 400fing Septic Tank Sheet Metal Sheet Rock Tile Owner / Contractor Signature Date