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10040178 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 858 LILY AVE CONTRACTOR:TNT ROOFING CO PERMIT NO: 10040178 `)WNER'S NAME: MARY JANE OLMSTEAD 1610 BLOSSOM HILL RD STE 6C DATE ISSUED:04/30/2010 OWNER'S PHONE: 4089963465 SAN JOSE,CA 95124 PHONE NO:(408)277-0800 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL Z RE-ROOF REMOVE SHAKE INSTALL OSB PLYWOOD License Class C Lic.# 0�� 30ILB Contractor / 0Date FELT LIFETIME COMP 23 SQUARES I hereby affirm that I am 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. Sq.Ft Floor Area: Valuation:$11200 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 APN Number:35903038.00 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 enter 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 Ci tyin consequence of the %:�� �---7Date:. granting of this permit. Additionally,the applicant understands and will comply Issued ry: -3 with all non-po ource regulations per the Cupertino Municipal Code,Section 9.18. �, RE-ROOFS: '-igna re ��`� Date < ' V 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. ❑ OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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 HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&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 air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sec 'ons �255 d 25534. / Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent �eI�i 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 I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender'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 ,on the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION lemnify 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 permit.Additionally,the applicant understands and will comply with all non-point,sodrce regulations r Cupertino Municipal Code,Section Licensed Professional 9.18. c Signature Date M.Indoor Air Quality and Finishes 1.Use Low/No-V©C Paint 1 IADJHealth pts y=yesD 2.Use Low VOC,Water-Based Wood Finishes 2 IAD/Health pts y=yes 7 0 3.Use Low/No VOC Adhesives 3 IAQ/Health pts y=yes D 4.Use Salvaged Materials for Interior Finishes 3 ReSDUM3 pts y=yes 0 5.Use Engineered Sheat Goods with no added Urea Formaldehyde 6IAQ/Health pts y--yes 0 6.Use Exterior Grade PlytaIood for Interior Uses 1 IAQ/Haalth pts y=yes D 7.Seal ai-Expmeel Parbof ib d or MDF _ 4 IAQ/Health pts y=yes _ D B.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 1D 10.Install Whole House Vacuum System 3 IAQ/Health pts y=yes 0 1 1 1 N.Flooring 1.Select FSC Certified Wood Flooring 8 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 Gontent Carpet with Low VOCs 4 Resource pts y=yes 0 1 1 1 Total Points Available.1 1401 130 57 Total Points Project Received: 01 0 0 G:daWprogslgreenbuildngguidelirnslramodelerslgreenpointsfinaIL 12.Mprotected.rjs CITY OF CITY OF CUPERTINO REROOF CUPERTINO PERMIT APPLICATION APN# Date: Building Address: cv L / A Owner's Name: � �- ©t µ is h-04) Phone #: � ^ HOA: Yes ❑ No If es, provide letter from HOA Contractor: 01-kFax #: Z,7 - o Fax#: Z� � 2"�_ Cupertino Business License #: Contractor License #: p Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles 't Asphalt Shingles r�\ Wood Shakes ❑ Wood Shakes l❑ Wood Shingles ❑ Wood Shingles ❑ Other(Specify) ❑ Other (Specify) Number of existing coverings ❑ Provide I.C.C.E.S. Report# ❑ To be Removed ❑ Provide Mfgr. Installation Specs. Job Description: �2 S� n-0 Sly 0(.I (&o')1)) OS 6 j'7 tl IQ 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: 0U I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy: �ignatu Revised 02/05/09 CITY OF CITY OF CUPERTINO lisREROOF 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 2� 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee ` 1BSEISMICRE Seismic Residential B 1REROOFMRES Re-roof Multi-Family B 1MFDWLR00F 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 -building(j@cupertino.org PROJECT ADDRESS (j Z-4 APN# OWNER NAME V PHONE ? y E-MAIL „j f STREET ADDRESS C Ci � CITY, STATE,ZIP �!` FAX CONTRACTOR NAME e LICENSE NUMBER LICENSEf3 BUS.LIC.# COMPANY NAME E-MAIL (�� FAX STREET ADDRESS ( iI I Jt{,/` (y(k 0 J/ ' CITY,STATE,ZIP PHONE 7 Pry 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 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 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 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 comply with the re-roof policy stated abo e``. Signature of Applicant/Agent: ' Date: f� ReroojPolicy_2010.doc revised 04/14//0