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09080394 (2) CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 11081 SANTA TERESA DR CONTRACTOR:JNSJ ROOFING INC PERMIT NO:09080394 OWNER'S NAME: THEISNER WILLIAM G AND DOROTHY 691 W SAN CARLOS ST DATE ISSUED:08/28/2009 ?ER'S PHONE: 4082538106 SAN JOSE,CA 95126 PHONE NO:4082796171 ❑ LICENSED CONTRACTOR'S DECLAR/A�TIION BUILDING PERMIT INFO: BLDG� ELECT f— PLUMB� License Class C. 3 Lic.# _�f�V Za �--� MECH RESIDENTIAL COMMERCIAL Contractor Date �'/7b-<n,�'— I hereby affir at I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:RE-ROOF,T/O WOOD SHAKE,INSTALL OSB (commencin ith Section 7000)of Division 3 of the Business&Professions ROOF DECK OVER EXISTING,INSTALL NEW 30#FELT UNDERLAYMENT, Code and that my license is in full force and effect. INSTALL 40YR LANDMARK CLASS A T/O WOOD SHAKE 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. 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 Sq.Ft Floor Area: Valuation:$10500 permit is issued. APPLICANT CERTIFICATION APN Number:35616004.00 Occupancy Type: 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 upon the above mentioned property for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. , /�1 [a' Date / �O�y Issued by: _ Date:� 2-'s Signature /// _ L OWNER-BUILDER DECLARATION RE-ROOFS: 1 hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for 1,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, f Business&Professions Code) Signature of Applicant: ' Date: 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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 HAZARDOUS MATERIALS DISCLOSURE Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534. Compensation laws of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must I Owner or autho ' ed a nt: forthwith comply with such provisions or this permit shall be deemed revoked. Date: 9 APPLICANT CERTIFICATION F7 CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save it' unify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. I understand my plans shall be used as public records. Signature Date Licensed Professional CITY O% Dc1 Una l 7__; CITY OF CUPERTINO REROOF C u P i_RT i N o PERMIT APPLICATION APN# Date: n� Building Addre 11061 - �:Sa Z _ Owner's Namet5(: - ,.t 4 C, -Ri l�li t5k Phone #: 4&6) HOA Yes No If es, provide letter from HOA C a�J 0 Contractor: Phone #: 0V,'- 9-(0 f T I O-N�s_ ` 10 Fax#: )da CC -057 Cupertino Business License #: Contractor License #: 7 YO Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles d,'*AXsphalt Shingles w" Vood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other(Specify) ❑ Other (Specify) Number of existing coverings f _ ❑ Provide I.C.C.E.S. Report # ❑ To be Removed ' ❑ Provide Mfgr. Installation Specs. Description: 6 UL Ditf Job -e!X r�� ✓ l�Sdac l j�a i 1�s�t K j v►S+u 11 cS.� (cx-- GU 1 v SIr1G �1i1 1 ��r �rL � /ia iN �d� Ise. � r ,A Residential Commercial Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if Green Building Checklist & attach it to the Eipplicati or if there are any restrictions: ❑ applicable, include in plan set & the sheet index. Valuation: r� '_...IDD I Have Read, Undersand and Wi11 Comply with Cupertino's Tear-Off Policy: Signature Revised 02/05/09 CITY r CITY OF CUPERTINO RFROOF `A1 FEE SCHEDULE c� r�0 F;rI Number of Fee ID Fee Description Fee Permit Type Squares Group 1REROOFCOM Re-roof Commercial B 1COMMLROOF 1BCBSC Cal Bld€; Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICO Seismic Commercial B (P 1REROOFRES Re-roof Residential B 1SFDWLR00F a, / 1BCBSC Cal Bldl; Standards B ALL PERMIT TYPES Commission Fee / 1BSEISMICRE Seismic Residential B 1REROOFMRES Re-roof Multi-Family B 1MFDWLROOF 1BCBSC Cal Bldg; Standards B ALL PERMIT TYPES Commi:sion Fee 1BSEISMICRE Seismic Residential B 1 BUSLIC Busines> 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 le-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 buildvlg 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 fe,� of$176.18. The re-inspection fee must be paid before another inspection cal 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 or the job site at the time on inspection. I understand and will comply with the above stated policy on re-roofing. Homeowner's Name: k2 !Z LI JI `�' ( `Y � f / Job Site Address: 54 AJ I I.2 4&lecStq D Roofing Company Name: ��S ,� �'c�O�//✓C2 Applicant's SignatWe-, Date: r 2d D ll' Greg Casteel Building Official Revised 07/30/08 Green Building Plan Check Index of Green Building Points/Categories A. Category Example of an Index or Table of Green Plan Sheet or Page Points Building Points Categories that must be shown and referenced on the Project Plans See below B. Site 9. Install H.E. Irrigation, (details/spac)" L-1 2 points 11. Permeable Paving, Note L-1 2 points C. Foundation 1. Use 15 % Flyash Concrete, (note) S-1 5 points D. Structural 3. Uses Wood I-Joist, (See Spec.) S-2 2 points 5. Use Truss with heels, (detail) S-2 2 points 6. B. OSB Sheathing, detail S-2 2 points E. Ext. Finish 1. Composite Decking, (Note/Spec..) A-3 2 points 4. B. Fiber Cement Siding, (Note/Spec. A-4 2 points F. Plumbing 1. Insulate all H.W. pipes, (Note/Spec.) P-1 2 points 5. Tankless W.H., (Note/Spec.) A-2 2 points 11. A 2500 Gal. Tank, (Note/Spec L-1 10 oints G. Electrical 4. E. Ceiling Fans, (Note/Spec.) A-3 4 points H. Appliances 1. Energy Star Dishwasher, (Note/Spec.) A-3 1 point 3. Energy Star Refrigerator, NoteiS ec. A-3 1 point P. Other 1. List Green Features on Plans A•1 1 point TOTAL POINTS1 40 points Plan Review Process Work Book Page-12-Revised 3/25/(8 INPUT Resources Energy [AD/Health M.Indoor Air Duality and Finishes 1.UseL*w1ND-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 imposed 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 0 10.Install Whole House Vacuum System 3 IAQ/Health pts y=yes 0 N.Flooring 1.Select FSC Certified Wood Flooring 3 Resource pts y=yes 0 2.Use Rapidly Renewable Flooring Materials 3 Resource pts y=yes 0 3.Use Recycled Content Ceramic Tiles 1 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 1 Resource pts y=yes 0 6.Install Recycled Content Carpet with Low VOCs 1 Resource pts y=yes 0 . 1 1 old Total Points Available: I 14OF 130 57 Total Points Project Received:1 41 01 01 0 �— N &X-�, G:data/progs/grei nbuildingguidelines/remodelerslgreenpointsfina12.12.0 ro ctedxls \ Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 XPE�TINO r � ,�; �� uildin Department JOB ADDRESS: 'a-°r-!—�� "�� PERMIT#D,�--? D a D OWNER'S NAME: 4Q-t k4 R,4 c.) S o U Z PHONE # pg GENERAL CONTRACTOR: C7- FAX # I am not using any subcontractor Signature Date Please check applicable subcontract rs 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