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09100194 (2) CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 992 SEPTEMBER DR CONTRACTOR:BECKS ROOFING PERMIT NO:09100194 OWNER'S NAME: TONG DANIEL AND MAYLIAN H 6191 OCHO RIOS DR DATE ISSUED: 10/28/2009 l ?R'S PHONE: 4086919978 SAN JOSE,CA 95123 PHONE NO:(408)365-8979 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG f- ELECT f- PLUMB License Class — Lia# t -Z- f- r r� MECH RESIDENTIAL COMMERCIAL Contractor Q� Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:RE-ROOF TEAR OFF,OSB#301,13 50 YR ELK (commencing with Section 7000)of Division 3 of the Business&Professions CLASS A 26SQ Code and that my license is in full force and effect. 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:$10500 1 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 APN Number:36215025.00 Occupancy Type: permit is issued. 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 PERMIT 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, 180 DAYS FROM LAST CALLED INSPECTION. costs,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 he Cupertino Municipal Code,Section Issued by- _ Date:(c.�� 9.18. Signature Date/Q � RE-ROOFS: LJ OWNER-BUILDER DECLARATION All roofs shall be inspected prior to any roofing material being installed.If a roof is installed without first obtaining an inspection,1 agree to remove all new materials for 1 hereby affirm that I am exempt from the Contractor's License Law for one of inspection. the following two reasons: 1,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date: will do the work,and the stricture 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 ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). 1 hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& 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 maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the permit is issued. Health&Safety Code,Sections 25505,25533,and 25534. 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 Owner o tl ed agee%� Compensation laws of California. If,after making this certificate of exemption,I 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 I hereby affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.) I certify that I have read this application and state that the above information is Lender's Name 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 Lender's Address upon the above mentioned property for inspection purposes.(We)agree to save inify 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 I understand my plans shall be used as public records. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Licensed Professional Signature Date CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36215025 .00 DATE ISSUED. . . . . . . : 10/28/2009 RECEIPT #. . . . . . . . . BS000009059 REFERENCE ID # . . . 09100194 SITE ADDRESS . . . . . : 992 SEPTEMBER DR SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER TONG DANIEL AND MAYLIAN H ADDRESS 992 SEPTEMBER DR CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4141 RECEIVED FROM . . . . : CARL A BECKS CONTRACTOR . . . . . . . : BECKS, CARL LIC # 21908 COMPANY BECKS ROOFING ADDRESS . . . . . . . . . . : 6191 OCHO RIOS DR CITY/STATE/ZIP . . . : SAN JOSE, CA 95123 TELEPHONE (408) 365-8979 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 10, 500. 00 1 .00 0 .00 1 . 00 0 . 00 1BSEISMICR VALUATION 10, 500 . 00 1 .10 0. 00 1 .10 0 . 00 1REROOFRES SQ FEET 26 . 00 338 .00 0. 00 338 . 00 0 .00 ---------- ---------- ---------- ---------- TOTAL PERMIT 340 .10 0. 00 340 .10 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 340 .10 VISA --------------- TOTAL RECEIPT 340 .10 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 604 ROOF IN-PROGRESS 605 FINAL REROOF CITY OF CUPERTINO REROOF CUPEkTiNO PERMIT APPLICATION APN # ��_, t �b �� Date: Building Address: Owner's Name: Phone #: D eq n o'v9 c� c� HOA: Yes E] No �If es provide letter from HOA ! G Contractor: Phone #: 5�4e C AYZ-L 5 otSf//V Fax #: Cupertino Business License #: Contractor License #: Z� Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles ,& Asphalt Shingles 14 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. 'T-ca.�t, d -F 0 - o l b - — l� Job Description f _ 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: bb I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy: G Signature Revised 02/05/09 CITY OF CUPERTINO a REROOF COF CUPERTINO 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 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 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 1/4 "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: TJ h Roofing Company Name: l Applicant's Signature: Date: ''2g`" Greg Casteel Building Official Revised 07/30/08 . ndoor rr ua rty an rros es 1•Use LOWINo-VOC Paint 1 IAQ/Health pts y=yes 0 2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes. 0 3.Use Low/No VOC Adhesives 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 ed.P'�ar =W or MDF 4 IAQ/Health. pts y=yes 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 0 10.Install Whole House Vacuum System 3 IAQ/Health pts y=yes 0 1 1 1 N.Flooring 1.Select FSC Certified Wood Flooring 8 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/Healthpts 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 i 1 Total Points Available: 1 1401 130 57 Total Points Project Received:1 1 01 01 0 c G:data/progs/greenbuildingguidelines/remodelers/greenpointsfinal2.12.o4protected.xis Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 ,;UPEkTINO Building Department JOB ADDRESS: PERMIT # �. -V q OWNER'S NAME: PHONE # '3 `j �l GENERAL CONTRACTOR: _ FAX# I am not using any subcontractors: !d �� 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