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10020020 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 994 WESTLYNN WAY CONTRACTOR:TBD-TO BE PERMIT NO: 10020020 DETERMINED "WNER'S NAME: SWENSON OSWALD E AND AMY DATE ISSUED:02/02/2010 OWNER'S PHONE: 4083180240 PHONE NO: Q LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIAL License Class Lic.# �7RE-ROOF OF 21 SQUARES REMOVE OFF SHAKE ROOF REPLACEMENT WITH 40 YR ASPHALT SHINGLE 1/2 OSB Contractor04 Date 30# I hereby affirm that I am licensed under the provisions of Chapter 9 FELT CLASS A (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:$9200 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:35927010.00 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 relati ig 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 City in consequence of the —7 granting of this permit. Additionally,the applicant understands and will comply Issued by: i Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. / RE-ROOFS: signature i Date 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 2 Signature of Applicant: Date: G �� I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL OOF 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) 1,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,Sections 25505,25533 nd 25534. Section 3700 of the Labor Code,for the performance of the work for which this i Owner or authorized agent: 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 Compensation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I mi st 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 1 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 relati ig to building construction,and hereby authorize representatives of this city to enter -on the above mentioned property for inspection purposes.(We)agree to save :emnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION 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 source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date y�� CITY OF CUPERTINO 4 ITEMS OF 4 PERMI" RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: B1]c: Lot: APN 35327010. 00 DATE ISSUED. . . . . . . : 02 /02/2010 RECEIPT # . . . . . . . . . BS )00009672 REFERENCE ID # . . . : 10 )20020 SITE ADDRESS . . . . . : 991 WESTLYNN WAY SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER SWENSON OSWALD E AND AMY ADDRESS 993 WESTLYNN WAY CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM SILICON VALLEY HOME CONTRACTOR TBD - TO BE DETERMINED LIC # 00096 COMPANY TBD - TO BE DETERMINED ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : , TELEPHONE . . . . . . . . FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- -------- 1BCBSC VALUATION 9, 200 . 00 1. 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 9, 200 .00 1. 00 0 .00 1 . 00 0 . 00 1BUSLIC FLAT RATE 1. 00 114 . 00 0 . 00 114 . 00 0 . 00 1REROOFRES SQ FEET 21 .00 273 . 00 0 . 00 273 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 389. 00 0 .00 389 . 00 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 389. 00 1152 --------------- TOTAL RECEIPT 389. 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ------------------------ 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 604 ROOF IN-PROGRESS 605 FINAL REROOF 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 buildvlg inspector. A final inspection and approval shall be obtained from the b uilding 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 Ci-.y,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 na it inspection is required. 6. Any roofing which is applied withou-: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 1/ "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: ��lt Job Site Address: 2�2�� t ST/✓�h ��,� ' Roofing Company Name: ;2-,:z?c,, 11_,; /zle Y 1,41, Applicant's Signature: — Date: ?T2 /o Greg Casteel Building Official Revised 07/30/08 CITY OF CUPERTINO RF;ROOF CUPEi�TINO PERMIT APPLICATION 100 200 2-0 APN # Date: s q Building Address: _ Owner's Name: , G L Gil �� SU. Phone #: HOA: Yes ❑ No a If Yes, provide letter from HOA Contractor: Phone 7 Fax #: Cupertino Business License #: Contractor License #: Type of hoof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles jz Asphalt Shingles ia 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: �z �. 2 �t/ B ��<< r f�� ' r r .Nr% Y A: �,�� l �c Z GAS _ 17 Residential Commercial Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if Green Building Checklist & attach it to the a plication or if there are any restrictions: ❑ applicable, include in plan set & the sheet index. Valuation: �a I Have Read, Understand and Will Comply witt Cupertino's Tear-Off Policy: gnature Revised 02/05/09 CITY OF C"UPERTINO ✓ REROOF CITY Of CUPEkTINO FEE SCHEDULE Number of Fee ID Fee Description Fee Permit Type Squares Group 1 REROOFCOM Re-roof Commercial B 1COMMLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commissic n Fee 1BSEISMICO Seismic Cc,mmercial B 1RER00FRES Re-roof Residential B 1SFDWLROOF / 1 BCBSC Cal Bldg S':andards B ALL PERMIT TYPES Commission Fee 1 BSEISMICRE Seismic Residential B 1 REROOFMRES Re-roof Multi-Family B 1MFDWLROOF 1 BCBSC Cal Bldg Si andards B ALL PERMIT TYPES Commission Fee 1BSEISMICRE Seismic Residential B 1BUSLIC Business License B ,' M.Indoor Air Quality and Finishes 1.Use LowMo-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 LowNo 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 0 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 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 3 IAQ/Health pts y=yes 0 N.Flooring 1.Select FSC Certified Wood Flooring E Resource pts y=yes 0 2.Use Rapidly Renewable Flooring Materials Resource pts y=yes 0 3.Use Recycled Content Ceramic Tiles Resource pts y=yes 0 4.Install Natural Linoleum in Place of Vinyl i IAQ/Health pts y=yes 0 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 . 1 1 old Total Points 1 1401 1301 57 Total Points Project Received: 0 0 0 G:data/progs/gree ibuildingguidelines/remodelers/greenpointsfinal2.12.D4proteoted.xls RESIDENTIAL PROJECT COVER SHEET Assessor's Parcel Number: Name of owner. Project address. Contact person. F hone. 7 7 I ax. Net square footage of lot. Existing Proposed Square footage: First floor: Second floor: Garage: TOTAL: Are there at least two 10 foot by 20 foot clear spaces inside the garage? Y N Is privacy protection planting required for the project` Y N Build it Green Total Points On what floor(s) is work being done? Brief description of work. ' ;� y /� _,s� �^��/� %--y5 CG�(L!•`i' �i !� d'�y//v, c�Y i"'/G1, -� "h�/!_H. c%°�• i7PG_ �C'�� Code editions:2007 CBC (Y -N)2007 CFC ('t -N)2007 CMC (Y-N) 2007 CPC (Y -N)2007 NEC ('t -N) Effective l/1/08 Plan Review Process Work Book Page-8-Revised 8/05/08 Community Development 10300 Torre Avenue ,sbw� Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 XPEi�TINO Building Department JOB ADDRESS: PERMIT # OWNER'S NAME: PHONE # 07 o 1 GENERAL CONTRACTOR x oi, t211 FAX# i- I am not using any subcontractors: Si;nature Date 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 Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date