09080383 (2) CITY OF NO BUILDING PERMIT
BUILDING ADDRESS: 11586 FALLCREEK SPR T � CONTRACTOR:R A CONSTRUCTION PERMIT NO:09080383
3151 R.CHARTER PARK DR DATE ISSUED:08/26/2009
OWNER'S NAME: BO LI
,EWS PHONE: 4083935289
SAN JOSE,CA 95136 PHONE NO:(408)559-1877
❑ LICENSED CONTRACTOR'S DECLARATION LUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class_4�3_7_ Lic.# 6-3-N-3 MECH F RESIDENTIAL f— COMMERCIAL r
Contrac or_T /`/' l - Date "
OB DESCRIPTION:RE-ROOF REMOVE WOOD SHAKE,INSTALL A
1 hereby affirm that I am licensed under the provisions of Chapter 9 t'OMP SHINGLE
(commencing with Section 7000)of Division 3 of the Business&Professions ROOF OVER EXISTING PLYWOOD CLS A 16SQ
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. Valuation:$8500
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:36651020.00 Occupancy Type:
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
correct.l 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 thc 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 LZ �
with all non-point source regulations per the Cupertino Municipal Code,Section �— Date:O
9.18. Issued bF
Signature__ Date
RE-ROOFS:
❑ OWNER-BUILDER DECLARATION All roofs shall be inspected prior to any roofing material being installed.If a roof is
1 hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for
the following two reasons: inspection. /tp
1,as owner of the property,or my employees with wages as their sole compensation, Date: �--Z6 v/
will do the work,and the structure is not intended or offered for sale(Sec.7044, Signature of Applicant::O; �
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:
ent 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 Cons
Compensation,as provided for by Section 3700 of the Labor Code,for the compancliforniae wl
with Cupertino&Safety MunicipalCode,Chapter 9.12 h maintain2 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
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 ��i
Compensation laws of California. If,after making this certificate of exemption,I Owner or z agent: Date: (9
become subject to the Worker's Compensation provisions of the Labor Code,I muss
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 Lender's Nawhich e permit is issued(Sec.3097,Civ C.)
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
ur -,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,
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 C.UPERTINO
REROOF
CUPEkT1NO PERMIT APPLICATION
APN # -" / f J v. (� Date:
Building Address:�8
Owner's Name: fSd Phone#: 3
HOA: Yes ❑ No ❑ If yes, provide letter from HOA Z� l ZO
Contractor: (2v✓V5 /Dp'(/ Phone #:
Fax #:
r Cupertino Business License #: Contractor License #:
213�r2- (33y3�
Type of hoof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles >' 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.
+ CY10
Job Description: y ()L)V, W00o r KE c IW s r� - f
,51A,v V Gr, tzoor- vu 6��Is/J A rL W®Q0 /6 [7
Residential , Commercial ❑
Green Building: Please complete relevant pc rtion 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: T ��5_0
()
I Have Read, Understand and Will Comply wi':h Cupertino's Tear-Off Policy:
Signatur
Revised 02/05/09
.. CITY OF CUPERTINO
REROOF
CM OF FEE SCHEDULE
CUPS T1NO
Number of Fee ID Fee Descrifition Fee Permit Type
Squares Group
1REROOFCOM Re-roof Corrmercial B 1COMMLROOF
1BCBSC Cal Bldg Stz.ndards B ALL PERMIT TYPES
Commission.Fee
1BSEISMICO Seismic Commercial B
IREROOFR SS Re-roof Residential B 1SFDWLROOF
l �
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
1 Commission Fee
1BSEISMICRE Seismic Re;;idential B
1 REROOFMRES Re-roof Multi-Family B 1MFDWLROOF
1BCBSC Cal Bldg S-:andards B ALL PERMIT TYPES
Commissicn 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 ag.-ee 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 b uilding 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 Ci-y,the following steps are
required:
1) Pre-inspection and/or tear off apr roval.
2) In-progress inspection approval.
3) Final inspection approval.
a) Spark arrester installation.
5. If plywood is installed,a plywood nz it inspection is required.
6. Any roofing which is applied withot t first obtaining an inspection,
will require the removal of all new material down to the sheathing,
so a proper City inspection can be PE rformed.
7. NOTE: If you call for a plywood nail inspection and the job is not ready,
you will be charged a re-inspection fie 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'44" 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:
__B_0�__
Job Site Address:
!l X86 /u s r
Roofing Company Name:
Applicant's Signature: Date:
Greg Casteel
Building Official
Revised 07/30/08
INPUT ReSDurces Energy 1ACIHeatth
M.Indoor Air Quality and Finishes
1.Use Low/No-VOC Paint IAQ/Health pts y=yes 0
2,Use Low VOC,Water-Based Wood Finishes 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 D
5.Use Engineered Sheet Goods with no added Urea
Formaldehyde 31AQ/Health pts y=yes 0
6.Use Exterior Grade Plywood for Interior Uses I IAQ/Health pts y=yes 0
7.Sea]all Exposed Particleboard 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 D
10.Install Whole House Vacuum System 3 IAQ/Health pts y=yes 0
. 1 1 1
N.Flooring
1.Select FSC Certified Wood Flooring E.Resource pts y=yes D
2.Use Rapidly Renewable Flooring Materials Resource pts y=yes 0
3.Use Recycled Content Ceramic Tiles Resource pts y=yes 0
4.Install Natural Linoleum in Place of Vinyl 3 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 f Resource pts y=yes10 0
. 1 i MIEW
Total Points Available: 140Y 130 57
Total Points Project Received: 0 0 0
�7 2 --d 2'
&data/progs/grl uildngguidelines/remodelers/greenpointsfinal212.Wrotected.xls
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
.,UPEkTINO
Buildini De artment
JOB ADORES PERMIT # Q
OWNER'S NAME: d L PHONE
GENERAL CONTRACTOR cr►S;= FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSIrTESS 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