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10040082CITY OF CUPERTINO BUILDING PERMIT CONTRACTOR: ARMSTRONG PERMIT NO: 10040082 BUILDING ADDRF?S: 10930 MIRAMONTE RD INSTALLATION 4575 SAN PABLO AVE DATE ISSUED: 04/13/2010 0—NER'S NAME: AHMED HASAN PHONE NO: (510)777-1234 EMERYVILLE, CA 94608 t, , . ,JER'S PHONE: 4085170484 PLUMB LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT License Class C, 3 Li . # r S� /I MECH I- RESIDENTIAL r COMMERCIAL Contractor Date /.3 d JOB DESCRIPTION: RE -ROOF TEAR OFF WOOD SHINGLE ROOF &REPLACE I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions WITH CLASS A COMP SHINGLE NO NEW SHEATHING 30SQ 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 Valuation: $27000 Section 3700 of the Labor Code, for the performance of the work for which this Sq. Ft Floor Area: permit is issued. APPLICANT CERTIFICATION APN Number: 35601030.00 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 (We) agree to save EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. indemnify and keep harmless the City of Cupertino against liabilities, judgments, PERMIT WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs, and expenses which may accrue against said City in consequence of the understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. granting of this permit. A itionally, the applicant with all non -point sour gulations per the C ino Municipal Code, Section 9.18.1 j/ ' Issued by: Date: Si¢natur Date ❑ OWNER -BUILDER DECLARATION RE -ROOFS: material being installed. If a roof is I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing installed without first obtaining an inspection, I agree to remove all new materials for the following two reasons: I, as owner of the property, or my employees with wages as their sole compensation, inspection. will do the work, and the structure is not intended or offered for sale (Sec.7044, Signature of Applicant: Date: Business & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to Business & Professions Code). ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER construct the project (Sec.7044, 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 Codefor the Compensation, as provided for by Section 3700 of the Labor Co is issued. California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain Code, Chapter 9.12 and the Health & performance of the work for which this permit I have and will maintain Worker's Compensation Insurance, as provided for by compliance with the Cupertino Municipal Safety 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 by the Bay Area Air Quality Management District I will permit is issued. I certify that in the performance of the work for which this permit is issued, I shall contaminants as defined maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Code, Sections 25505, 25533, and 25534. not employ any person in any manner so as to become subject to the Worker's Health & Safety Compensation laws of California. If, after making this certificate of exemption, I Own or ►orize t: j become subject to the Worker's Compensation provisions of the Labor Code, I must Date: forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's for this is issued (Sec. 3097, Civ C.) certify 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 which permit Lender's Name ur, `he above mentioned property for inspection purposes. (We) agree to save ii ify and keep harmless the City of Cupertino against liabilities, judgments, Lender's Address cosLb, and expenses which may accrue against said City in consequence of the of this permit. Additionally, the applicant understands and will comply ARCHITECT'S DECLARATION granting with all non -point source re ations per the Cuperti Municipal Code, Section 9.18. Date j 1 I understand my plans shall be used as public records. Licensed Professional Signature �J 3 ITEMS OF 3 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 35601030.00 DATE ISSUED.......: 04/13/2010 RECEIPT #......... BS000010170 REFERENCE ID # 10040082 SITE ADDRESS 10930 MIRAMONTE RD SUBDIVISION ...... CITY CUPERTINO IMPACT AREA ...... OWNER AHMED HASAN ADDRESS 10930 MIRAMONTE RD CITY/STATE/ZIP CUPERTINO, CA 95014 OPERATOR: patg COPY # : 1 RECEIVED FROM ARMSTRONG INSTAL LIC #T22581 CONTRACTOR ...... COMPANY ..........: ARMSTRONG INSTALLATION ADDRESS 4575 SAN PABLO AVE CITY/STATE/ZIP EMERYVILLE, CA 94608 TELEPHONE (510)777-1234 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT ---------- THIS REC- ------ --NEW BAL ----------------------- 1BCBSC VALUATION 1BSEISMICR VALUATION 1REROOFRES SQ FEET ---------- 27,000.00 27,000.00 30.00 ---------- 2.00 2.70 390.00 0.00 0.00 0.00 2.00 2.70 390.00 0.00 0.00 - -- 0_00 TOTAL PERMIT 394.70 0.00 394.70 0.00 METHOD OF PAYMENT ----------------- CHECK TOTAL RECEIPT : AMOUNT --------------- 394.70 --------------- 394.70 VOICE ID DESCRIPTION -------- ---------------------- 601 ROOF TEAR OFF 604 ROOF IN -PROGRESS REFERENCE NUMBER -------------------- #1638 VOICE ID DESCRIPTION -------- - -------------------------- 602 ROOF PLYWOOD NAIL 605 FINAL REROOF El APN # F, Building Address: CITY OF CUPERTINO REROOF PERMIT APPLICATION Date:U �3 If Owner's Name: HOA: Yes ❑ No If es�rov��videlttfrom HOA Contractor: n S Cupertino Business License #: Existing: ❑ Built -Up Roof irz.,. Asphalt Shingles ❑ Wood Shakes ❑ Wood Shingles ❑ Other (Specify) Number of existing coverings ❑ To be Removed Type of Roof Covering: Phone #: Li O y, 5,7, o qj Phone #: 51M,- 7 7Z',' z� Fax #:Z - Cont actor I,igense #: Proposed: ❑ Built -Up roof is Asphalt Shingles ❑ Wood Shakes ❑ Wood Shingles ❑ Other (Specify) Provide I.C.C.E.S. Report # / -15 ❑ Pvide Mfgr. Installation Specs. (ro,C Job Description: �',�� Commercial Lj Residential Confirmed with Planning Dept. if Green Building: Please complete relevant portion of the restrictions: Green Building Checklist & attach it to the application or if there are any applicable, include in plan set & the sheet index. Valuation: Z %� I Have Read, derstand and Wil mply with Cupertino's Tear -Off Policy: I Signature Revised 02/05/09 CUPERTINO Number of Fee ID Squares CITY OF CUPERTINO REROOF FEE SCHEDULE Fee Description EJRE:R00_F_C0M Re -roof Commercial 1BCBSC Cal Bldg Standards Commission Fee 1BSEISMICO Seismic Commercial 1REROOFRES Re -roof Residential 30 ' 1BCBSC Cal Bldg Standards Commission Fee f 1BSEISMICRE Seismic Residential Fee Permit Type Group B jrOMMLROOF B ALL PERMIT TYPES B B 1SFDWLROOF B ALL PERMIT TYPES B BTALL MFDWLROOF B PERMIT TYPES B L: 1REROOFMRES Re -roof Multi-Famil} 1BCBSC Cal Bldg Standards Commission Fee 1BSEISMICRE Seismic Residential 1BUSLIC Business License Fee Permit Type Group B jrOMMLROOF B ALL PERMIT TYPES B B 1SFDWLROOF B ALL PERMIT TYPES B BTALL MFDWLROOF B PERMIT TYPES B L: 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. n d the job is not ready, 7. NOTE: If you call for a plywood you will be charged a re -inspection fee of $126.00anThe re inspection fee must be paid before another ins ection can be scheduled. IMPORTANT: 1. Flat roofs must have a minimum of Y4 "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: /�►!c�`�G�SA�IT Job Site Address: Roofing Company Name: Applicant's Signature: Date: Albert Salvador Building Official Revised 3/09/10 1.Use Low/No-VOC Paint 1 IAQ/Health pts y=yes 2. Use Low VOC,Water-Based Wood Finishes 2 IAQIHealth pts y=yes 3. Use LowlNo VOC Adhesives 3 IAQMealth 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 is 6 IAQ/Healthy_y p es 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: a-1 411.13/6 140 130 57 01 01 0 G:data/progs/greenbuildmgguidelines/remodelerslgreenpointsfinal212.o4protected.xls Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 CUPERTINO CONTRACTOR/ SUBCONTRACTOR LIST c� PERMIT # � JOB ADDRESS: /D Q o t�wi6� � PHONE # OWNER'S NAME: A� w h� 1/ l u BUSINESS LICENSE # GENERAL CONTRACTOR: ✓tet Vf CITY/ZIPCODE: ,fie C ADDRESS: y�is .5 1, *Our municipal code requires all businesses working in the city to have a City of BE eSCHEDULEDhUNTIL THE NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL TR:;VE OBTAINED A CITY-' OF CUPERT GENERAL CONTRACTOR AND ALL S BC INO BUSINESS LICENSE. '7 1��G I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: NSE # V/ SUBCONTRACTOR 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 BUSINESS NAME Owner / Contractor Signature BUSINESS LICE 3 �U Date