10020056 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7610 SQUIREWOOD WAY CONTRACTOR:ARMSTRONG PERMIT NO: 10020056
INSTALLATION
(""NER'S NAME: MCSHEFFREY RICHARD P AND ANNET 4575 SAN PABLO AVE DATE ISSUED:02/10/2010
G. NER'S PHONE: 4082559828 EMERYVILLE,CA 94608 PHONE NO:(510)777-1234
LICENSED CONTRACTOR'S DECLARATION
q Q) BUILDING PERMIT INFO: BLDG ELECT r PLUMB
License Class L 1Lic.# .1
MECH r RESIDENTIAL r- COMMERCIAL
Contractor Date z//0 016
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:RE-ROOF TEAR OFF BUILT UP FLAT ROOF&REPLACE
(commencing with Section 7000)of Division 3 of the Business&Professions WITH
Code and that my license is in full force and effect. CLASS B MIN SPF FOAM,600SQ FT CLASS A
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 Sq.Ft Floor Area: Valuation:$11000
permit is issued.
APPLICANT CERTIFICATION APN Number:36226033.00 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
upon the above mentioned property for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source re lations per the Cupertin Municipal Code,Section
9.18.
Sia"ature Date"/d Zcjd Issued by: Date:
❑ OWNER-BUILDER DECLARATION
RE-ROOFS:
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 material being installed.If a roof is
the following two reasons: installed without first obtaining an inspection,I agree to rem all new materials for
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,
Business&Professions Code) ii nature of Applicant: Date:
1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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 HAZARDOUS MATERIALS DISCLOSURE
Compensation,as prpvided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. 2alifornia Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by 'ompliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Section 3700 of the Labor Code,for the performance of the work for which this iafety Code,Section 25532(a)should I store or handle hazardous material.
additionally,should I use equipment or devices which emit hazardous air
permit is issued. ,ontaminants as defined b the Ba Area Air
y y Quality Management District I will
I certify that in the performance of the work for which this permit is issued,I shall naintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's 3ealth&Safety Code,Sections 2550 25533,and 25534.
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 owner or thorize age t•
forthwith comply with such provisions or this permit shall be deemed revoked. Date: /o
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is hereby affirm that there is a construction lending agency for the performance of work's
correct.I agree to comply with all city and county ordinances and state laws relating br which this permit is issued(Sec.3097,Civ C.)
to building construction,and hereby authorize representatives of this city to enter .ender's Name
ur 'he above mentioned property for inspection purposes.(We)agree to save
i ify and keep harmless the City of Cupertino against liabilities,judgments, j,ender's Address
co.u,and expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
with all non-point source re ulations per the Cuperti Municipal Code,Section
9.18. 1 understand my plans shall be used as public records.
Signature Date O licensed Professional
CITY OF CUPERTINO
3 ITEMS OF 6 PERMIT' RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: B1}=. Lot:
APN . . . . . . . . . 36226033 . 00
DATE ISSUED. . . . . . . : 02/10/2010
RECEIPT #. . . . . . . . . : BS000009728
REFERENCE ID # . . . : 10020056
SITE ADDRESS . . . . . : 76=.0 SQUIREWOOD WAY
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : MCSHEFFREY RICHARD P AND ANNET
ADDRESS . . . . . . . . . . : 76_.0 SQUIREWOOD WAY
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-5055
RECEIVED FROM . . . . : ARMSTRONG INSTALLAT
CONTRACTOR . . . . . . . : MI"CH FINE LIC # 22581
COMPANY . . . . . . . . . . : ARMSTRONG INSTALLATION
ADDRESS . . . . . . . . . . : 45"5 SAN PABLO AVE
CITY/STATE/ZIP . . . : EMERYVILLE, CA 94608
TELEPHONE . . . . . . . . : (5=.0) 777-1234
FEE ID UNIT QUANTITY ]MOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- -- -------- ---------- ---------- ----------
1BCBSC VALUATION 11, 000 . 00 1. 00 0 . 00 1 . 00 0 . 00
1BSEISMICR VALUATION 11, 000 . 00 1 . 10 0 . 00 1 .10 0 . 00
1REROOFRES SQ FEET 6 . 00 78 . 00 0 .00 78 . 00 0. 00
-- -------- ---------- ---------- ----------
TOTAL PERMIT 80 . 10 0 . 00 80 . 10 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
REROOF
CUPEkTINO PERMIT APPLICATION
APN # .�3 � � � L �� Date: _
4-
Building Address: / 1
Owner's Name: AAAe4t Phone #:
HOA: Yes ❑ No If esrovide ester from HOA
Contractor: Phone #: ,z3y
rm. -/r Fax #: f/o- SSSS/�rL
Cupertino Bu iness License #: Contractor License #:
2ys1,9/
Type of FCoof Covering:
Existing: Proposed:
X Built-Up Roof A Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other (Specify) 4t Other (Specify) A�w
Number of existing coverings -' Provide I.C.C.E.S. Report# a�3�
To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description: /-,°✓cauj/ ��-� v�4� ��a /'�0U k d
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:
zwo
I Have Read, U Verstand and Will C ply with Cupertino's Tear-Off Policy:
Signature
Revised 02/05/09
CITY OF CUPERTINO
RERDOF
CUPERTINO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1REROOFCOM Re-roof Commercial B 1COMMLROOF
IBCBSC Ca1'Bldg St,�dards B ALL PERMIT TYPES
Commission Fee
1BSEISMICO Seismic Commercial B
LP 1REROOFRES Re-roof Residential B 1SFDWLR00F
IBCBSC Cal Bldg St,-.ndards B ALL PERMIT TYPES
Commission Fee
IBSEISMICRE Seismic Residential B
1RER00FMRES Re-roof Multi-Family B 1MFDWLR00F
IBCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
IBSEISMICRE Seismic Residential B
IBUSLIC 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 IBC 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 C:ty,the following steps are
required:
1) Pre-inspection and/or tear off approval.
2) In-progress inspection approval.
3) Final inspection approval.
a) Spark arrester installation.
5. If plywood is installed,a plywood nz it inspection is required.
6. Any roofing which is applied withot#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$176.18. The re-inspection fee must
be paid before another inspection can be scheduled.
IMPORTANT:
1. Flat roofs must have a minimum of I/i "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: �InHL° �C � G✓�L/� 1Z°
Job Site Address: G b dG d14
l ,
Roofing Company Name: S7{` ; S 1/ to>)'
Applicant's Signature: ^��i Date: L/1oIU��
Greg Casteel
Building Official
Revised 07/30/08
Indoor Air Quality and Finishes
1.Use towINo-VOC Pain 1 IAQ/Health pts y=yes 0
2.Use Low VOC,Water-Based Wood Finishes ?IAQ/Health pts y=yes. 0
3.Use Low/No VOC Adhesives 3 IAQ/Health pts y=yes D
4.Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes 0
5.Use Engineered Sheet Goods with no added Urea
Formaldehyde 31AQ/Health pts y=yes 0
0
6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes
7.Seal all EVosed P.arfdaboard or MDF 4 IAQ/Health pts y=yes 0
8.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 31AQ/Health pts y=yes 0
. mkm 1 1
N.Flooring
1.Select FSC Certified Wood Flooring E Resource pts y=yes 0
2.Use Rapidly Renewable Flooring Materials 2 Resource pts y=yes 0
3.Use Recycled Content Ceramic Tiles z Resource pts y=yes 0
4.Install Natural Linoleum in Place of Vinyl i IAQ/Health pts y=yes D
5.Use Exposed Concrete as Finished Floor Resource pts y=yes 0
6.Install Recycled Content Carpet with Low VOCs Resource pts y=yes 0
Total Points Available: 1 1401 130[----5-71
Total Points Project Received:1 1 01 01 0
G:data/progs/gree ibuildingguidalines/remodelers/greenpointsfinal2.12.D4protected.xis
Community Development
10300 Torre Avenue
' Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
v V I Ek'NO
Building Department
JOB ADDRESS: PERMIT #
,16/a s u, ,r cAboj V�
OWNER'S NAME: PHONE # 7 77 is 3 y
GENERAL CONTRACTOR: / # /,97L
I am not using any subcontractors: I L
Si,nature Date
Please check applicable subcontractors and corn-Aete the following information:
21 SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
Glass/ Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
A0 Ile-,j
Owner/Contractor Signature Date