10010061f
TIN O BUILDING PERMIT • 100 10061
_. CITY OF CUPER STERN ROOFING PERMIT NO.
CONTRACTOR: WE
BUILDING ADDRESS: 19240 STEVENS CREEK BLVD SERVICE DATE ISSUED: 01 /13/201
E
2594 OAKDALE AV
AMER TRADE PHONE NO: (415) 648 -6472
- `yER'S NAME: TOM HALL - SAN FRANCISCO, CA 94124
. PLUMB
()vvNER'S PHONE: 408$721765 ELECT
'S DECLARATION BUILDING PERMIT INFO: BLDG COMMERCIAL
13 LICENSED CONTRACTOR RESIDENTIAL
MECH
#
License Class Lic. ROOF RMV BLT UP RF & REPLC W/JM BLT UP RF
Date JOB DESCRIPTION: RE
Contractor provisions of Chapter 9 4GNR 4000
I hereby affirm that I am
licensed under the p professions CR CONSTS OF BASEHSEET, A 3- �F SAME MFR TOPGARD
(commencing d effect. LTR COVRGN W�A WHITE COAT
omm with Section 7000) of Divis n 3 of the Business
(c license is in full force
Code and that my two declarations:
I hereby reb affirm under penalty of perjury one of the following
maintain a certificate of consent to self-insure Code,, for the
I have and will Section 3700 of the Labor
Compensation, as provided for by
ermit is issued. rovided for by
performance of the work Wo which Compensation Insurance, as p Valuation: $29121
1 have and will maintain performance of the work for which this Sq. Ft Floor Area:
Section 3700 of the Labor Code, for the p occupancy Type:
permit is issued.
above information is APN Number: 37506006.01
APPLICANT aEnd statel that the that I have read this application
I cert ify 1 with all city and county ordinances and state laws relating
TARTER
correct. 1 agree to comply resentatives of this city FIRES IF WORK IS NOT S
agree to save IT EX
to building construction, and hereby for�nspection purposes. (We) g PERM
above mentioned Property Cupertino against liabilities, judgments,
OF PERMIT ISSUANCE OR
upon the of Cupe g WITHIN 180 DAYS
indemnify and keep harmless the City will comply
h may accrue against said City in conseganuance of the AST CALLED INSPECTIO
costs, and expenses whic y applicant understands 180 DAYS FROM L
gran ting of this permit. Additionally, the app ertino Municipal Code, Section
with all non -point source regulations per the Cup Date:
9.18. Issued by:
Date
Si .lture
—^ RE- ROOFS: installed. If a roof is
OWNER- BUILDER DECLARATION se Law for one of inspected prior to any roofing material being
hereby affirm that I am exempt from the Contractor's License
All roofs shall be inspe inn an inspection, I agree to remove all new materials for
I he y compensation, installed without first obtaining
the following two reasons: employees with wages as their sole comp inspection.
I, as owner of the property, or my Date:
d the structure is not intended or offered for sale (Sec.704 of Applicant:
will do the work, an Signature pp
Business & professions Code)
exclusively contracting with licensed contractors to OR BETTER
1, as owner of the property, ALL ROOF COVERINGS TO BE CLASS A
ct the project (Sec.7044, Business & Professions Code).
construct three
hereby affirm under penalty of perjury one of the following
I he y Worker's HAZARDOUS MATERIALS DISCLOSURE 6.95 of the
declarations:
l maintain a Certificate of Consent to self-insure ode, for the ment 25533, and 25534. I will maintain
will o read the hazardous materials requirements under Chapter
I have and w Section 3700 of the Lab I have Code, Sections
Compensation, as provided for by Chapter 9.12 and the Health
r which this permit is issued. California Health & Safety Cupertino Municipal Code,
performance of the work for on Insurance, as provided for by compliance with the Cup should I store or handle hazardous material.
P Compensation Safety Code, Section 25532(x)
I have and will maintain Worker's Comp rmance of the work for which this should I use equipment or devices which emit hzard District I will
Additionally, Area Air Quality Management
Section 3700 of the Labor Code, for the perform the Bay ter 9.12 and the
it is issued. which this permit is issued, I shall contaminants al►ance with the Cupertino Municipal Code, Chap
perm maintain comp
certify that in the performance of the work for w become subject to the Worker's Health & Safety Code, Sections 25505, 25533, and 2553 .
I ce fy manner so as to bec
not employ any person in any this certificate of exemption, I
I must owner or authorized agent:
Compensation laws of California. If, after making Date:
the Worker's Compensation provisions of the Labor Code,
become subject to provisions or this permit shall be deemed revoked.
forthwith comply With such p
CONSTRUCTION LENDING AGENC performance of work's
APPLICANT CERTIFICATION I hereby
affirm that there is a construction lending agency for the p
ad this application and state that the ces ands ate laws relating which this permit is issued (Sec. 3097, Civ C.)
I certify that I have re and county ordinance to enter for
correct. I agree to comply with all city representatives of this city Lender's Name
and hereby authorize rep We a agree to save
to building construction, for ins ection purposes. ( ) g
ur ',e above mentioned the City of Cupertino against liabilities, judgments,
Lender's Address
ii :ify and keep in consequence of the
accrue against said City
cons, and expenses which may 11 the applicant understands and will comply ARCHITECT'S DECLARATION
granting of this permit. Additionally, per the Cupertino Municipal Code, Section public records.
with all non -point source regulations p I understand my plans shall be used as p
9.18.
Date Licensed Professional
Signature
3 ITEMS OF 3
CITY OF CUPERTINO
RECEIPT OPERATOR: patg
PERMIT COPY # : 1
Sec: Twp: Rng: Sub: Blk: Lot:
37506006.01
APN
DATE ISSUED 01/13/2010
RECEIPT # : ;: ; ; ; ;; BS000009555
REFERENCE ID # ••• 10010061
SITE ADDRESS 19240 STEVENS CREEK BLVD
SUBDIVISION
•::::;:; CUPERTINO
CITY .••
IMPACT AREA
TOM HALL - AMER TRADE
OWNER ••••• ...... 19240 STEVENS CREEK BLVD
ADDRESS .••••..... CUPERTINO,
CA 95014
CITY /STATE /ZIP
OSCAR TORRES LIC # 29322
RECEIVED FROM MARK BLEDSOE
CONTRACTOR;: WESTERN ROOFING SERVICE
COMPANY • 2594 OAKDALE AVE
ADDRESS .••ZIP•:: SAN FRANCISCO, CA 94124
CITY/STATE/ZIP (415) 648, -6472
TELEPHONE .•.•.•.
THIS REC NEW BAL
QUANTITY AMOUNT - - PD_TO_DT_ _--- - - - - -- ---- - - - - --
FEE ID UNIT Q____ - - - -- --- - - - - -- 0.00
0.00 2.00
__________ - - - - - -- - -- -- 29121.00 2.00 3.00 0.00
C VALUATION 00 3.00 0.00 0.00
1BCBS 29,121. 0.00 221.00
1BSEISMICR VALUATION 17,00 221.00 - -_ -- - - - - --
1REROOFRES SQ FEET ______ - - -- - -- 226.00 0.00
226.00 0.00
TOTAL PERMIT
AMOUNT REFERENCE NUMBER _ -
METHOD OF PAYMENT ----- ___ -_- --- - --
-
----------------- -- 226.00 VISA
CREDIT CARD ____ ____ _ ______
226.00
TOTAL RECEIPT : VOICE ID DESCRIPTION
-_-- -_ -_-
VOICE ID DESCRIPTION_ - - -_- -- - - - - --
___ - - - -- 602 ROOF PLYWOOD NAIL
601 ROOF TEAR OFF 605 FINAL REROOF
604 ROOF IN- PROGRESS
� CITY OF C1 ERTINO P
REROOF
PERMIT APPLICATION
CUPERTINO
XPN #
Building Addr ss :
C c de S ("Wet V Q �
l o;2q
Owner's Name: •""T0 v%,v �k o_Lk-
HOA Yes E] N
No If es rovide letter from HO
Contractor: We �.,
CA
Cupertino Business License #: a93 -7-Z
Existing:
` C Built -Up Roof
❑ Asphalt Shingles
❑ Wood Shakes
❑ Wood Shingles
❑ Other (Specify)
Number of existing coverings
❑ To be Removed
Type of Roof Covering:
Date:
wm�
Phone #: (qW g � " I ltl�_
C, 6 40% ) Tg+ 3
Phone #: (--4- 1 ) "% - � 2
Fax #•
Contractor License #:
Proposed:
Built -Up roof
❑ Asphalt Shingles
❑ Wood Shakes
❑ Wood Shingles 6A .fo,
)gr Other (Specify) ��`'� eon
Report #
❑ Provide I.C.C.E.S. p
❑ Provide Mfgr. Installation Specs.
Job Description: W a
c�
r_imc e e-
� La.���.. o �` sue.
a7 stne e- F k 1t nYra 1� I a ba Co
�.� Commercial
Residential ❑�"
Confirmed with Planning Dept•
t restrictions: if
here are any ❑
• Please complete re
Green Building. levant portion of the
n Building Checklist & attach it to the application or if
Gree
le include in plan set & the sheet index.
a "cab ,
Valuation: Zvi
1
I Have Read, Understand and Will Comply y with Cupertino's Tear -Off Policy:
Signature
Revised 02/05/09
CITY OF CUpERTINO
R E_ ROOF
CITY OF FEE SCHEDULE
CUPEkTINO
Fee Description Fee Permit Type
Number of Fee ID Group
Squares
1REROOFCOM Re -roof Commercial
B 1COMMLROOF
1BCBSC
Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee B
1BSEISMICO Seismic Commercial
1REROOFRES
Re -roof Residential B 1SFDWLROOF
� 1BCBSC
Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee B
1BSEISMICRE Seismic Residential
B 1MFDWLROOF
1
REROOFMRES Re -roof Multi-Family
BSC Cal Bldg Standards
B ALL PERMIT 'TYPES
IBC
Commission Fee
1BSEISMICRE
Seismic Residential B
B
1BUSLIC Business License
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
you must 1. Prior to permit issuance, y agree to comply with 2007 IBC Standards
and manufacturers specifications on re- roofing. All roofs are Class "All per Cupertino
municipal code 16.04.080. all inspection ection
coverings shall not be
and writte n approval applied without first obtaining d
2. New g
roval from the building inspector. A final inspection an
tained from the building inspector when the re-roofing
approval shall be ob
is completed.
s shall be inspected prior to any roofing installation.
3. All roofs
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. ins ection is required.
5. If plywood is installed, a plywood nail p
which is applied without first obtaining an inspection,
6, Any roofing .
well require the removal of all new material down to the sheathing,
so a p P ro er City inspection can be performed. 'ob is not ready,
you will be charged a re p
E• If ou call for a plywood nail inspection and they
7' NOT Y re-inspection fee of $176.18. The re- inspection fee must
hg
_paid before another ins ection can be scheduled.
IMPORTANT:
1,
t have a minimum of 1Flat roofs mus
/4 " per foot slope and demonstrate
that there is no ponding.
' aired to be on the job site at the time on inspection.
2. An I.C.B.O. report is r e q
understand and well comply 1 with the above stated policy on re- roofing.
I
Homeowner's Name:
Job Site Address:
Q ZZ4 0
Roofing Company Name:
Applicant's Signature: _Lv�_
Greg Casteel
Building Official
Ks
S �Q .
Revised 07/30/08
Date: f / 41 Ze 10
y
M. Indoor Aar uuaillp a ►�� �,..,...__
1 IA0/Health pts yJYes
0
1. Use Low/No -VbC Paint
2 IAWealth pts y =yes
p
2. Use LOw 110C, Neater -Based Wood Finishes
3 IAD]Health Pts Y--Yes
0
3. Use Lvvu VOC Adhesives
3 Resource pts Y--Yes
4. Use Salvaged Materials for Interior Finishes
p
5. Use Engineered Sheet Goods With no added Urea
6 IAQ/Health pts y -ye5
0
Formaldehyde
6. Use Exterior Grade Plywood for Interior Uses
11WHealth pts Mes
41AOlHealth. pts = es
0
7..Ssal1 «cP
4 Resource pts y =yes
S. Use FSC Certified Materals IN interior Finish
I Resource pts Y =Yes
0
9. Use Finger- Jolinted or Recyc r led- Content
3 IAQ/Health pts y =yes
Install Whole House Vacuum System
1 Md
N. Flooring
6 Resource pts ) ,= es
0
0
1. Select FSC Certified 1Nood Flooring
Floonng Matwi als
4 Resource pts y -yes
0
2. Use BaO ' anev�ahle
4 Resource pts y =yes
p
3. Use Recycled Content Ceramic Tiles
- 5 IAQIHealth Pts MeS
0
4. Install Natural Linoleum in Place of V!ny I
4 Resource pts y =yes
0
5. Use Exposed Concrete as Finished Low VOCs
4 Resource pts y =yes
1
6. Install Recycled Content Carpet with
1
140 130 57
Total Points Available:
4 ul
' Received:
Total Points Pro ect
--
'
/0
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CITY OF
:UPE TINO
I am not using any subcontractors:
Buildin
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777 -3228
Fax (408) 777 -3333
artment
Signature ` Date
Please check a licable subcontractors and complete the following information:
Owner/ Contractor Signature
Date
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