09100156 (2) CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10560 CARVER DR CONTRACTOR:PERRY FARNUM PERMIT NO:09100156
OWNER'S NAME: PERRY FARNUM 10560 CARVER DR DATE ISSUED: 10/22/2009
WNER'S PHONE: 4085052868 CUPERTINO,CA 95014 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION -
BUILDING PERMIT INFO: BLDG I ELECT� PLUMB!
License Class Lic.# f— F--
MECH RESIDENTIAL COMMERCIAL
Contractor Date
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: RE-ROOF OSB 30 FELT CLASS A-14
(commencing with Section 7000)of Division 3 of the Business&Professions SQUARES. REMOVE AND
Code and that my license is in full force and effect. REROOF UPSTAIRS BEDROOM&LIVING ROOM.
1 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:$5000
1 have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the perfonnance of the work for which this APN Number:37533040.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
1 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 relating 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
Issued
by
granting of this permit. Additionally,the applicant understands and will comply ,. � Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature 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
Signature of Applicant: Date:
hereby affirm that 1 am exempt from the Contractor's License Law for one of — —the following two reasons: ALL ROOF 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. 1 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 1 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
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,Se ions 5505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this iJ
Owner or authorized agent: 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,1 CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must 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 _
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
-non 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
.osts,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 so ce regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date (02'2
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: suew
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 37533040 . 00
DATE ISSUED. . . . . . . : 10/22/2009
RECEIPT #. . . . . . . . . : BS000009013
REFERENCE ID # . . . : 09100156
SITE ADDRESS . . . . . : 10560 CARVER DR
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . . :
OWNER . . . . . . . . . . . . : PERRY FARNUM
ADDRESS . . . . . . . . . . : 10560 CARVER DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : PERRY FARNUM
CONTRACTOR . . . . . . . : LIC # *OWNER*
COMPANY . . . . . . . . . . : PERRY FARNUM
ADDRESS . . . . . . . . . . : 10560 CARVER DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
TELEPHONE . . . . . . . .
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 5, 000. 00 1 . 00 0 . 00 1 . 00 0 . 00
1BSEISMICR VALUATION 5, 000. 00 0 .50 0 . 00 0 . 50 0 . 00
1REROOFRES SQ FEET 14 . 00 182 . 00 0 . 00 182 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 183 . 50 0 . 00 183 . 50 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 183 .50 VISA
---------------
TOTAL RECEIPT 183 . 50
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
al,a
CITY OF CUPERTINO
REROOF
CUPEkT1NO PERMIT APPLICATION
APN # Date:
,3 7 3-3 0�16
Building Address:
X1.2
Owner's Name: '? ,L'in Phone #:
HOA: Yes ❑ No B If yes, provide letter from HOA 9(, 'C'�
Contractor: Phone #:
Fax #:
Cupertino Business License #: Contractor License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
gr"'Asphalt Shingles V Asphalt 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: _ :FEL—C` _ �- t_ r� � I - `t
d c Via' v�, �- �,, t til
Residential 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:
i� � .
I ve Frtd, Understand and Will Comply with Cupertino's Tear-Off Policy:
Signature
Revised 02/05/09
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 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 comwith the above stated policy on re-roofing.
VC,
Homeowner's Name: �,� �, �V W
Job Site Address:
Roofing Company Name-
Applicant's Signature: "A Date:
Greg Casteel
Building Official
Revised 07/30/08
M.indoor Air Quality and Finishes
1.Use LowNo-OC Paint 1 IAOJHealth pts y=yes 0
2.Use Low VOC,Water-Based Wood Finishes 2 IAOJHealth pts y=yes 0
3.Use LDw/No VOC Adhesives 3 IAD/Health pts y=yes 0
4.Use Salvaged Materials for Interior Finishes 3 Resource pts y--yes D
5.Use Engineered Sheet Goods wish no added Urea
Formaldehyde 61AQ/Health pts y=yes 0
6.Use Exterior Grade PlytNood for Interior Uses 1 IAQ/Health pts y=yes0
7.Seal all i&olebawdor MDF 4 IAQ/Health ats y= es ___ ___ 0
B.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 D
10.Install Whole House Vacuum System 3 IAQ&iealth pts y--yes 0
1 1 D
N.Fiooring
1.Select FSC Certified Wood Flooring B Resource pts y=yes 0
2.Use Sapidly Ranewable Flooring Materials 4 Resource pts y=yes D
3.Use Recycled Content Ceramic Tiles 4 Resource pts y=yes 0
4.Install Natural Linoleum in Place of Vinyl 5 IAD/Health pts y=yes 0
5.Use Exposed Concrete as Finished Poor 4 Resource pts y=yes 0
6,Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes 0
No 1 1 NIMBI
Total Points Availab e: 1 1401 130 57
Total Points Project Received:j 01 01 0
G:datalprogslgreenbuildingguidelines/remodelerstgreanpointsfina1212D4pdaDied.xls
OWNER-BUILDER VERIFICATION
1. (Check one) I or my immediate family (parent,spouse or child) will perform:
A. —./ All the work authorized by this permit
B. _ A portion of the work
C. None of the work
If B or C is checked,complete 2 or 3 below.
2. A state licensed contractor will be hired to do:
A. _ All of the work
B. _ A portion of the work (complete section below)
Contractor Address/City Phone # State License # Type of work to
be performed
3. _ I will utilize unlicensed person(s) other than my immediate family to perform all or
portions of the authorized work. I understand that I may be an employer (see reverse side). A
Certificate of Insurance covering workers' compensation must be on file at the City of
Cupertino Building Department office.
Person/Firm Address/City Phone Number Type of work to be
performed
.................................................................................................................................................................
I declare under penalty of perjury that the above is true and correct. I have read and understand the
Owner-Builder Information (re)rse 'de).
Cp
Property Owner's Signature: wLti` Date:
Job Address: C-�\2 uj�Y� t1 Permit#
Any changes to the information provided on this form shall be submitted to the City of Cupertino Build
Department.
Community Development
10300 Torre Avenue
a Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
XPEkTINO
Building Department
JOB ADDRESS: PERMIT #
O R'S NAME: iZv, �-- C,- L,1 61 PHONE # qQ0 6-a 86 8-
GENERAL CONTRACTOR: FAX # LIOO - M -
I am not using any subcontractors: �--- I
Z Q,a
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
Owner/Contractor Signature Date