09090217CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10810 WILLOWBROOK WAY
CONTRACTOR: CUPERTINO ROOF, INC
PERMIT NO: 09090217
OWNER'S NAME: NAKAGAWA TAD
1052 KELLY DR
DATE ISSUED: 09/30/2009
ER'S PHONE: 4082524539
SAN JOSE, CA 95129
PHONE NO: (408)973-9427
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO: BLDG [_ ELECT f— PLUMB
License Class L Lic. #
COMMERCIAL
MECH RESIDENTIAL
Q q
Contractor ' '�� ► Date
I hereby affirm that I am licensed and he provisions of Chapter 9
JOB DESCRIPTION: RE -ROOF TEAR OFF SHAKES INSTALL 7/160SB
(commencing with Section 7000) of Division 3 of the Business & Professions
INSTALL
30# FELT INSTALL 50 YEAR SHINGLES CLASS A 22 SQ
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: $11000
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
permit is issued.
APN Number: 36922046.00
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
to building construction, and hereby authorize representatives of this city to enter
PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes. (We) agree to save
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
180 DAYS FROM LAST CALLED INSPECTION.
granting of this permit. Additionally, the applicant understands and will comply
with all nn- oint source regulations per the Cupertino Municipal Code, Section
�P'
9.18.
Issued' Date
Date 9 .3 `` o�
Signature
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
CJ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
installed withou t obtaining an inspection, I agree to remove all new materials for
the following two reasons:
inspection.
1, as owner of the property, or my employees with wages as their sole compensation,
_ -di
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
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
construct the project (Sec.7044, Business & Professions Code).
HAZARDOUS MATERIALS DISCLOSURE
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
I have read the hazardous materials requirements under Chapter 6.95 of the
Compensation, as provided for by Section 3700 of the Labor Code, for the
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 &
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
I 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
Compensation laws of California. If, after making this certificate of exemption, IO
ne r authorized agent:
Date:
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION
I hereby affirm that there is a constriction 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
nify and keep harmless the City of Cupertino against liabilities, judgments,
C , and expenses which may accrue against said City in consequence of the
ARCHITECT'S DECLARATION
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
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 36922046.00
DATE ISSUED.......: 09/30/2009
RECEIPT #.........: BS000008798
REFERENCE ID # ...: 09090217
SITE ADDRESS .....: 10810 WILLOWBROOK WAY
SUBDIVISION ......:
CITY CUPERTINO
IMPACT AREA ......:
OWNER NAKAGAWA TAD
ADDRESS 10810 WILLOWBROOK WAY
CITY/STATE/ZIP ...: CUPERTINO, CA 95014
RECEIVED FROM ....: DAVE SMITH
CONTRACTOR DAVE SMITH LIC # 25701
COMPANY CUPERTINO ROOF, INC
ADDRESS 1052 KELLY DR
CITY/STATE/ZIP ...: SAN JOSE, CA 95129
TELEPHONE (408)973-9427
OPERATOR: patg
COPY # : 1
FEE ID UNIT
-----------------------
QUANTITY
----------
AMOUNT
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
22.00
286.00
0.00
286.00
0.00
TOTAL PERMIT
----------
288.10
----------
0.00
----------
288.10
----------
0.00
METHOD OF PAYMENT
-----------------
CREDIT CARD
TOTAL RECEIPT
AMOUNT
---------------
288.10
---------------
288.10
VOICE ID DESCRIPTION
-------- ----------------------------
601 ROOF TEAR OFF
REFERENCE NUMBER
--------------------
MC
VOICE ID DESCRIPTION
-------- ----------------------------
602 ROOF PLYWOOD NAIL
604 ROOF IN -PROGRESS 605 FINAL REROOF
CITY OF
CUPEkT1NO
CITY OF CUPERTINO
REROOF
PERMIT APPLICATION
APN #
Date:
r -
Building Address:
Owner's Name:
Phone #:
HOA: Yes ❑ ~ No'-fEl If yes, provide letter from HOA
Contractor: .
1
C �-' C� -� �• �, C
Phone #:
913 - g `l z
-i
Fax
Cupertino Business License #:
Contractor License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built -Up Roof ❑ Built -Up roof
❑ Asphalt Shingles Asphalt Shingles
Wood Shakes ❑ Wood Shakes
C3 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:
4t ss
Residue--❑ 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: ) j C7 cVJ
p I -Hayti. Read, Understand and Will Comply with Cupertino's Tear -Off Policy:
Revised 02/05/09
i
CM OF
CUPEkT1NO
CITY OF CUPERTINO
REROOF
FEE SCHEDULE
Number of
Squares
Fee ID
Fee Description
Fee
Group
Permit Type
1 REROOFCOM
Re -roof Commercial
B
1COMMLROOF
1BCBSC
Cal Bldg Standards
Commission Fee
B
ALL PERMIT TYPES
1BSEISMICO
Seismic Commercial
B
2
1RER00FRES
Re -roof Residential
B
1SFDWLR00F
f
1BCBSC
Cal Bldg Standards
Commission Fee
B
ALL PERMIT TYPES
1BSEISMICRE
Seismic Residential
B
1 REROOFMRES
Re -roof Multi -Family
B
1MFDWLROOF
1BCBSC
Cal Bldg Standards
Commission Fee
B
ALL PERMIT TYPES
1BSEISMICRE
Seismic Residential --B
1 BUSLIC
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 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 Raid before another infection 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:
Job Site Address:
Roofing Company N
10 � I c I.,-, I � l 6
Applicant's Signature:
Greg Casteel
Building Official
Revised 07/30/08
Date:
1. Use L4Dw Jo-VOC Paint
1 IAQ/Health pts
y=yes
2. Use Low VOC, Water -Based Wood Finishes
2 IAQ/Health pts
y=yes'
3. Use LowIND VOC Adhesives
3 IAQ/Health pts
y=yes
4. Use Salvaged Materials for Interior Finishes
3 Resource pts
y=yes
5. Use Engineered Sheet Goods with no added Urea
4 Resource pts
y=yes
Formaldehyde
61AQ/Health pts
y=yes
6. Use Exterior Grade Plywood for Interior Uses
1 IAQ/Health pts
y=yes
7. Sea] at] E)rposed Particleboard or MDF
4 IAQ/Health pts
y=yes
8. Use FSC Certified Materials for Interior Finish
4 Resource pts
y=yes
9. Use Finger -Jointed or Recycled -Content Trim
1 Resource pts
y=yes
10. Install Whole House Vacuum System
3 IAQ/Health pts
y=yes
N. Flooring
1. Select FSC Certified Wood Flooring
8 Resource pts
y=yes
2. Use Rapidly Renewable Flooring Materials
4 Resource pts
y=yes
3. Use Recycled Content Ceramic Tiles
4 Resource pis
y=yes
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
6. Install Recycled Content Carpet with Low VOCs
4 Resource pts
y=yes
Total Points Available:
Total Points Project Received:
C
140 130 57
01 0 0
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CITY OF
',UPEkTINO
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Building Department
JOB ADDRES
PERMIT #
OWNER'S NAME:
PHONE # "_ 2 -
GENERAL CONTRACTOR: C',i 12
FAX #
Mi
I am not using any subcontractors:
Signature Date
Please check applicable 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