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10030173 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10797 BROOKWELL DR CONTRACTOR:WILLIAMS ROOFING PERMIT NO: 10030173 OWNER'S NAME: INGRID JONES PO BOX 2532 DATE ISSUED:03/30/2010 VER'S PHONE: 4084313290 CUPERTINO,CA 95015 1 PHONE NO:(408)252-5120 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG I— ELECT r— PLUMB License Class � Lic.# t/ L MECH RESIDENTIAL COMMERCIAL `l/ Date 6 O (� Contractor JOB DESCRIPTION:RE-ROOF TEAR OFF SHAKE/INSTALL 7/16 OSB CLASS A I hereby affirm that I am licensed under the provisions of Chapter 9 INSTALL COMP SHINGLE 18SQ (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. Valuation:$5500 1 have and will maintain Worker's Compensation Insurance,as provided for by Sq,Ft Floor Area: Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:36921016.00 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 oe upertino Municipal Code,Section Date,0d;-/ 0 918 Issued by: Signature AES . Date RE-ROOFS: L, OWNER-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 aFer 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�'3r will do the work,and the structure is not intended or offered for sale(Sec.7044, Signature of Applicant: Business&Professions Code) I,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,Secti 25505,25533,and 25534. 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 Own Qtr a en : C) 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 hereby affirm that 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 upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address i• -nify and keep harmless the City of Cupertino against liabilities,judgments, 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 regulations per t e Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. 0 Licensed Professional Signature Dated / CITY OF CUPERTINO PERMIT RECEIPT OPERATOR: patg 3 ITEMS OF 4 COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 36921016 . 00 DATE ISSUED. . . . . . . : 03/30/2010 RECEIPT #. . . . . . . . . BS000010061 REFERENCE ID # 10030173 SITE ADDRESS 10797 BROOKWELL DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER INGRID JONES ADDRESS 10797 BROOKWELL DR CITY/STATE/ZIP CUPERTINO CA, CA 95014-4608 RECEIVED FROM W CONTRACTOR . . . . . . . ILLIAMS, THOMAS LIC # 6341 COMPANY . . . . . . . . . . : WILLIAMS ROOFING ADDRESS PO BOX 2532 CITY/STATE/ZIP CUPERTINO, CA 95015 TELEPHONE (408) 252-5120 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC --NEW-BAL- ---- ---------- ------------- ---------- ------ ---------- ---- 1BCBSC VALUATION 5, 500 .00 1. 00 0 .00 1 . 00 0 • 1BSEISMICR VALUATION 5, 500 .00 0 .60 0 . 00 0 . 60 0 . 00 1REROOFRES SQ FEET 18 . 00 234 . 00 0 . 00 234 . 00 ------ -- -- TOTAL PERMIT 235 .60 0 .00 235 .60 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: BS000010061 RECEIVED BY: PATRICIAG PAYOR: STEVE G WILLIAMS TODAY'S DATE: 03/30/10 REGISTER DATE: 03/30/10 TIME: 11: 27 4 1BCBSC 10030173 $1 . 00 1BSEISMICR 10030173 $ .60 10030173 $234 . 00 1REROOFRES BUSINESS LICENSE TAX RENW WMS ROOFING $114 . 00 ---------------- TOTAL DUE: $349 .60 CREDIT CARD: $349 .60 REF NUM: VISA TENDERED CHANGE $349.60 $ . 00 CITY OF i CITY OF CUPERTINO 1-7 10REROOF CUPERTINO PERMIT APPLICATION APN # Date: Building Address: ®7?7 Owner's Name: �, Phone #: l�p� - HOA: Yes ❑ No ( If yes, provide letter from HOA Contractor: Phone #: �-'Z o -- �Y'Z.-�(�Y� ��� ✓t� �� _� Fax#: —0 �Z Cupertino Business License #: Contractor License #: 7 3 Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles X 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# ❑ To be Removed ❑ Provide Mfgr. Installation Specs. Job Description: 0 61 05A clMs5 �i 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: , Ig 15;, `-1F4S0 O I Have Read, Understand an Will Comply with Cupertino's Tear-Off Policy: Signature Revised 02/05/09 CITY OF CITY OF CUPERTINO .12 REROOF CUPERTINO FEE SCHEDULE Number of Fee ID Fee Description Fee Permit Type Squares Group 1REROOFCOM Re-roof Commercial B 1COMMLROOF 1BCBSC Ca1'Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICO Seismic Commercial B 1REROOFRES 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 Community Development Department Building Division City of Cupertino 10300 Torre Avenue Telephone: (408)777-3228 7 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 insvection 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: ls� Job Site Address: Roofing Company Name: Applicant's Signature: _ b Date: 0.3 3,0 (/o Albert Salvador Building Official Revised 3/09/10 INPUT ResDurces Energy IAQ!Heatth, .Indoor Air rty and Qualmeshes 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 61AQ/Health pts y=yes 0 6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 0 7.Seal all Exposed Particleboard or MDF 4 IAQ/Health pts y=yes 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 0 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 Content Carpet with Low VOCs 4 Resource pts y=yes 0 1 1 ! Total Points Available: 146L 1301 57 Total Points Project Received: —01 0 0 G:data/progs/greenbuildingguidelines/remodelers/greenpointsfina1212.Mprotected.xls 1 ©3�3 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: f� 79f 7 � �� PERMIT# D-Ya/'7- OWNER'S NAME: L�Cr�7 -701-1-45'4 PHONE# GENERAL CONTRACTOR:(�Ji BUSINESS LICENSE# ADDRESS: 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 E OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. 1 am not using any subcontractors: Date Signature Please check applicable subcontractors and complete 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 P3 Owner/C ntractor Signature Date