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09090186 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10659 S BLANEY AVE #CONTRAICUTOR.TBD-TO BE DETERMINED PERMIT NO:09090186 DATE ISSUED:09/25/2009 OWNER'S NAME: CHAWATHE ARVIND K AND ANITAPHONE NO: iER'S PHONE: 4089962346 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB Ltd' License Class Lic.# z � MECH RESIDENTIAL COMMERCIAL Contractor(1-17ccttN ;1 ' ��Dy�te `� 7 JOB DESCRIPTION:REMOVE EXISTING SHAKE AND INSTALL I hereby affirm that 1 am licensed under the provisions o Chapter 9 ASPHALT SINGLE (commencing with Section 7000)of Division 3 of the Business&Professions CLASS A,7/16'OSB PLYWOOD,30 LB FELT 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:$7000 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:36933009.00 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 PENT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter 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 re lations er the Cupertino Municipal Code,Section --- Date: 9.18. _ .._._- Issued `�~ Signature -/ `Date RE-ROOFS: LIOWNER-BUILDERDECLARATION All roofs shall be inspected prior to any roofing material being installed.If a roof is Contractor's License Law for one of installed without first o 1 hereby affirm that 1 am exeminspection. btainin an inspecti n,I agree to remove all new materials for pt from theonra the following two reasons: 1,as owner of the property,or my employees with wages as their sole compensation, Date: -21-el will do the work,and the structure is not intended or offered for sale(Sec.7044, Signature of Applicant: Business&Professions Code) 1,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: to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 o the I have and will maintain a Certificate of Consent Compensation,as provided for by Section 3700 of the Labor Code,for the complianCaliforniace Health Code, with the Cupertino Cod05Chapt r 9.12 h 2 and the Health&fain l performance of the work for which this permit is issued. 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 1 certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534. not employ any person in any manner so as to become subject to the Worker's r_Y� Compensation laws of California. If,after making this certificate of exemption,I Dater V become subject to the Worker's Compensation provisions of the Labor Code,I must*4t:� 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 mify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18• Licensed Professional Signature Date__ aM CITY OF CUPERTINO 11 REROOF 6q0 goes CUPEkTINO PERMIT APPLICATION APN # Date: �6R 33 . 00 Building Address: Owner's Name: Phone #: HOA: Yes ❑ No [] If yes, provide letter from HOA (41OV- ✓ 4' 2 Contractor: Phone #: CTT CST-R�! i 1 Lai 1 f�i G. Fax #: Cupertino Business License #: Contractor License #: E9? Z Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles VAsphalt 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: F;0 LF5r> Residential Commercial Lj 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: I Have Read, Und s#and a d Will Comply with Cupertino's Tear-Off Policy: Si ature Revised 02/05/09 CITY OF CUPERTINO REROOF CUPEkT]NO FEE SCHEDULE Number of Fee ID Fee Description Fee Permit Type Squares Group 1REROOFCOM Re-roof Commercial B 1COMMLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICO Seismic Commercial B S 1REROOFRES Re-roof Residential B 1SFDWLROOF 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 CITY OF CUPERTINO PERMIT RECEIPT OPERATOR: patg 4 ITEMS OF 4 COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 36933009 . 00 DATE ISSUED. . . . . . . : 09/25/2009 RECEIPT #. . . . . . . . . BS000008764 REFERENCE ID # 09090186 SITE ADDRESS . . . . . : 10659 S BLANEY AVE SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER CHAWATHE ARVIND K AND ANITA ADDRESS CITY/STATE/ZIP CUPERTINO CA, 95014-4542 RECEIVED FROM TBD -MTOVBEUSTAMANT DETERMINED LIC # 00096 CONTRACTOR . . . . . . . COMPANY TBD - TO BE DETERMINED ADDRESS . . . . . . . . . . CITY/STATE/ZIP TELEPHONE . . . . . . . . FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC- __NEW-BAL- ---------- ------------- ---------- ---------- ---------- ----- 1BCBSC VALUATION 7, 000 . 00 1 . 00 0 .00 1. 00 0 .0 1BSEISMICR VALUATION 7, 000 . 00 0 .70 0 . 00 0 .70 0 .00 1BUSLIC FLAT RATE 1. 00 114 . 00 0 . 00 114 . 00 0 . 00 1REROOFRES SQ FEET 25. 00 325 .00 0 .00 325 . 00 ------ -- ------------ ---------- --------- TOTAL PERMIT : 440 .70 0 .00 440.70 0 .00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- -- CHECK 440 .70 #151 ------ -------- TOTAL RECEIPT 440 .70 D I VOICE ID DESCRIPTIONVOICE ___________________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 Tone 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 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 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: ITA- job Site Address: �'�' V3 Roofing Company Name: Applicant's Signature: ' T- Date: 51— Greg Greg Casteel Building Official Revised 07/30/08 INPUT ResDurns Energy 1ADHeatth M.Indoor it Qua ity and intshes 1.Use Low/No-VOC Paint 1 IAQ/Health pts y=yes 0 2.Use Low VOID,Water-Based Wood Finishes 2 IAQ/Health pts y=yes. 0 3.Use Low/No VOIDAdhesives 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 Exposad Partideboard 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 1 i 1 N.Flooring 1.Select FSC Certified Wood Flooring B 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 1 1 1 Total Points Available: 1 1401 130 57 Total Points Project Received: 0 0 0 � - J� G:7datal4oenb2.04protected.Asuildingguidelines/remodelers/greenpointsfinal2.1 Community Development 10300 Torre Avenue Cupertino CA 95014 xTelephone(408)777-3228 CITY OF Fax(408)777-3333 „UPEkTINO Buildin De artment JOB ADDRESS: � PERMIT # � �Q (,S- � OWNER'S NAME: _A4Q PHONE #11 ��c- V GENERAL CONTRACTOR: tJC . FAX # I am not using any subcontractors: 61 Signature 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 Vbwner/ Signature Date