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10010174 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10463 HENEY CREEK PL CONTRACTOR:QUALITY FIRST HOME PERMIT NO: 10010174 BU IMPROVEMENTS 1ER'S NAME: GRANT DAVID 6545 SUNRISE BLVD STE 202 DATE ISSUED:01/29/2010 CITRUS HEIGHTS,CA 95610 OWNER'S PHONE: 4088329887 PHONE NO:(916)788-2921 CONTRACTOR'S DECLARATION IT INFO: BLDG ELECT PLUMB ❑ LICENSED m� BUILDING PERM �7�Lic.# y RESIDENTIAL COMMERCIAL License Class MECH Contractor Date JOB DESCRIPTION:RE-ROOF TEAR-OFF EXISTING WOOD SHINGLES. I hereby affirm that I am licensed under the provisions of Chapter 9 INSTALLING NEW 9/16 OSB&ASPHAT SHINGLES CLASS A (commencing with Section 7000)of Division 3 of the Business&Professions 47SQ 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:$24000 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:34248015.00 Occupancy Type: 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 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, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Issued b- Date:/, C. ature Date ❑ OWNER-BUILDER DECLARATION RE-ROOFS: All roofs shall be inspected prior to an roofing material being installed.If a roof is I hereby affirm that I am exempt from the Contractor's License Law for one of p p Y g the following two reasons: installed without first obtai 'ng an inspection,I agree to remove 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, Signature of Applicant: Date: Business&Professions Code) I,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 HAZARDOUS MATERIALS DISCLOSURE declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the Compensation as p 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& I have and will maintain Worker's Compensation Insurance,as provided for by 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 permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the come subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534. not employ any person in any manner so as to be Compensation laws of California. If,after making this certificate of exemption,I Own r authorize en 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 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 Y correct.I agree to comply with all city and county ordinances and state laws relating forhick Name this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Len der'sthe above mentioned property for inspection purposes.(We)agree to save Lender's Address unify and keep harmless the City of Cupertino against liabilities,judgments, costs,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 regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. Signature Date Licensed Professional __�a CITY OF CUPERTINO PERMIT RECEIPT OPERATOR: patg 3 ITEMS OF 3 COPY # = 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 34248015 . 00 DATE ISSUED. . . . . . . : 01/29/2010 RECEIPT #. . . . . . . . . : BS000009648 REFERENCE ID # . . . : 10010174 SITE ADDRESS 10463 HENEY CREEK PL SUBDIVISION . . . . : . . CUPERTINO CITY IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : GRANT DAVID ADDRESS . . . . . . . . . . : 10463 HENEY CREEK PL CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-0828 RECEIVED FROM . . . . : QUALITY FORST LICE# 30398 CONTRACTOR GC ANDERS COMPANY . . . . . . . . . . : QUALITY FIRST HOME IMPROVEMENT ADDRESS . . . . . . . . . . : 6545 SUNRISE BLVD STE 202 CITY/STATE/ZIP . . . : CITRUS HEIGHTS, CA 95610 TELEPHONE . . . . . . . . : (916) 788-292 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT- -THIS-REC- --NEW-BAL- ---------- ---------- ---------- ----- 1. 00 0 .00 1 . 00 0 . 0 1BCBSC VALUATION 24, 000 . 00 .40 0 .00 2 .40 0 . 00 1BSEISMICR VALUATION 24, 000 . 00 611 . 00 0 . 00 611 . 00 0 . 00 1REROOFRES SQ FEET 47 • TOTAL PERMIT 614 .40 0 . 00 614 .40 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCENUMBER - -- CHECK 614 .40 #1528 TOTAL RECEIPT 614 .40 DESCRIPTION VOICE ID DESCRIPTION VOICEID ---------------______ -------- ---------------------------- 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 604 ROOF IN-PROGRESS 605 FINAL REROOF CITY OF CUPERTINO REROOF CUPEI�TINO PERMIT APPLICATION APN # Date: LA ?b 0 0 Building Address: Ow er's NameO�� }�' Phone#: HOA: Yes ❑ No If yes, provide letter from HOA D� Contractor: Phone#: � Fax #: Cupertino Busine License Contractor License #: 0 Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles � Asphalt Shingles )<,Wood Shakes o 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:��,y_ o� ��f S�r� (,r/UGI) s /t5 � New )45;j7h4/� 5h ` n� /�S Residential Commercial El 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: El applicable, include in plan set & the sheet index. Valuation: I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy: Signa e Revised 02/05/09 CITY OF CUPERTINO REROOF ciTv of CUPEI�TINO FEE SCHEDULE Number of Fee ID Fee Description Fee Permit Type Squares I I Group 1REROOFCOM Re-roof Commercial B 1COMMLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICO Seismic Commercial B (( 1REROOFRES Re-roof Residential B 1SFDWLR00F I 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee / 1BSEISMICRE Seismic Residential B 1 REROOFMRES 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 Fax: (408)777-3333 BuildingDepartment 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 City, 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 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$176.18. The re-inspection fee must be paid before another inspection can be scheduled. IMPORTANT: 1. Flat roofs must have a minuinum 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: � 1 job Site Address: 9 Roofing Company Name: Date: Applicants Signature: Greg Casteel Building Official Revised 07/30/08 s Ira M.Indoor Air Quality and Finishes 0 1 IAQ/Health pts y=yes 1.Use LAMO-VOC P&t 0 2.Use Low VOC,Water-Based Wood Finishes 2 IAQIHealth pts y=yes. 3.Use Lowly VOC AdhaWm 3 IAQIHealth pts y=yes is Yes D 4.Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes 0 5.Use Engineered Sheet Goods with no added Urea 0 Formaldehyde 61AQ/Health pts y=yes Y D 6.Use Exterior Grade Plywood for Interior Uses 1 IAQIHealth P -- 0 7. pA*jdnard,w NIDF 41AQIHealth. pts y=yes 8.Use FSC Certified Materials for Interior Finish 4 Resource pts y=ye5 0 9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y=yeS 0 10.Install Whole House Vacuum System 3 IAQIHealth pts y=yes 0 1 0 N.Flooring 1.Select FSC Certified Wood Flooring 8 Resource pts y=yeS 0 2.Use Rapkfy Renewable Flooring Materials 4 Resource pts y=yeS 0 3.Use Recycled Content Ceramic Tiles 4 Resource pts y=yes D D 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 0 6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yesl 0 Total Points Available: 1401 1301 57 Total Points Project Received: 0 0 0 G:dat4rgreenbuiidingguidelines/remocireenpointsfinal2.12.04protected.xis Community Development 10300 Torre Avenue Cupertino CA 95014 a Telephone(408)777-3228 Fax(408)777-3333 CITU OF %UPE TINO Bul*ld* D e artment OB A KESS: PERMIT # J �'� R'S N PHONE # O - GENERAL CONTRA OR: FAX# I am not using any subcontractors: Signature Date subcontractors and com lete the f oRowin information: Please check applicable NESS LICENSE # SUBCONTRACTOR BUSINESS NAME BUSINESS 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