10080113 CITY OF CUPERTINO BUILDING PERMIT
CONTRI,CTOR: ,c •PERMIT NO:10080113
BUILDING ADDRESS: 18860 NEWSOM AVE —n�—.�r/ i DATE ISSUED:08/17/2010
OWNER'S NAME: DRAGOS LUNGEANU i`-ri l� /
PHONE NO:
4ER'S PHONE: 6502106849 +
❑ LICENSED CONTRACTOR'SDECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB r
License Class c �-1
/ /L? Lic.# MECH r RESIDENTIAL COMMERCIAL r
p'l�w 07�'Z Y(J�ate �- /7 c)Contractor JOB D ESCRIPTION:RE-ROOF REMOVE ASPHALT SHINGLES,INSTALL NEW
I hereby affirm lat I am licensed under the provisions of Chapter 9 ASPHALT SHINGLES CLASS A 21 SQ
(commencing with Section 7000)of Division 3 of the Business&Professions
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.
I have and will maintain Worker's Compensation Insurance,as provided for by Valuation:$5900
Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft I i loor Area:
permit is issued.
APPLICANT CERTIFICATION
APN Number:37530021.00 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 PHRMIT EXPIRES IF WORK IS NOT STARTED
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
granting of this permit. Additionally,the applicant understands and will comply 1;30 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulations per the Cupertino Municipal Code,Section T/
9.18. Issued b Date: �� c
Signature Date O
OWNER-BUILDER DECLARATION RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of
All ro As shall be inspected prior to any roofing material being installed.If a roof is
the following two reasons: install A 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, Signa:ure of Applicant: Date:
Business&Professions Code)
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: HAZARDOUS MATERIALS DISCLOSURE
I have and will maintain a Certificate of Consent to self-insure for Worker's
I ha-,a read the hazardous materials requirements under Chapter 6.95 of the
Compensation,as provided for by Section 3700 of the Labor Code,for the
Cali]ornia 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&
I have and will maintain Worker's Compensation Insurance,as provided for by Safe,y Code,Section 25532(a)should I store or handle hazardous material.
Section 3700 of the Labor Code,for the performance of the work for which this Add tionally,should I use equipment or devices which emit hazardous air
permit is issued. cont iminants 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 mail stain 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 Heath&Safety Code,Sections 25505,25533,and 25534.
Compensation laws of California. If,after making this certificate of exemption,I Owt,er or authorized agent: �v
become subject to the Worker's Compensation provisions of the Labor Code,I must - Date:
forthwith comply with such provisions or this permit shall be deemed revoked. —
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is I he eby affirm that there is a construction lending agency for the performance of work's
state laws relating for vhich this permit is issued(Sec.3097,Civ C.)
correct.I agree to comply with all city and county ordinances and
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 Ler der's Address
;ra-mnify and keep harmless the City of Cupertino against liabilities,judgments,
and expenses which may accrue against said City in consequence of the
b.—ting 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 I ut derstand my plans shall be used as public records.
9.18.
Date Licensed Professional
Signature
CITY OF CUPEPTINO
PERMIT RECEIPT OPERATOR: patg
3 ITEMS OF 4 COPY # : 1
Sec: Twp: Rng: Sub: Blk: Lo--:
APN . . . . . . . . : 37530021.00
DATE ISSUED. . . . . . . : 08/17/2010
RECEIPT #. • . • • • • . . : BS000011199
REFERENCE ID # . . . : 10080113
SITE ADDRESS . . . . . : 18860 rEWSOM AVE
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER DRAGOS LUNGEANU
ADDRESS . 18860 NEWSOM AVE
CITY/STATE/ZIP CUPERT::NO, CA 95014
RECEIVED FROM CAL HOTQE IMPROVEMEN
CONTRACTOR TBD - `CO BE DETERMINED LIC # 00096
COMPANY TBD - 'CO BE DETERMINED
ADDRESS . . . . . . . . . .
CITY/STATE/ZIP . . . :
TELEPHONE . . . . . . . . .
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC- --NEW-BAL-
----
---------- -------------
----------
------
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1.000 .00
1BCBSC VALUATION 5, 900 . 00 1 . 60 0 .00 0 .00
1BSEISMICR VALUATION 5, 900 . 00 0 .60 0 .00 0 .60
00
1REROOFRES SQ FEET 21. 00 273 .00 0 .00 273 . 00 ------0_
TOTAL PERMIT
274 .60 0. 00 274 .60 0 .00
VOICE ID
DESCRIPTION VOICE ID DESCRIPTION
--
____
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
CITY OF
CITY OF CUPERTINO
i, s REROOF
, , , PERMIT APPLICATION
CUPEDate- a
�1
Buildin Address: ; .
�l
Phone #:
Owner's Name: � c�.ti �s`� �to
HOA: Yes No If es, rovide letter fr[ HOA O
Contractor: Phone #: �S"� Y6� �
i ``� =Contractor
#: �S`C1 6l 00O
License #;
Cuperti Business License
Type of Roof Covering:
Existing: P roposed:
❑ Built-Up Roof ❑ Built-Up roof
,Asphalt Shinglesft
sphalt 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.
t�e
Job Description:
r �
Residential C ercial ❑
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: /l 01
I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
Signa ut re
Revised 02/05/09
M.lndDDr Air Qu ity and FinisheS
1.use� o-vbc p 1 IAQ Health pts Yeses 0
0
2.Use Low VOC,Water-Based Wood Finishes 2 IAQHealth pts Yeses
3IAQ'Health es 0
3.Use Lt�>nr�ifOC Adkresives pts Y=y .
4.Use Salvaged Materials for Interior Finishes 3 Re`ource pts Y--yes 0
5.Use Engineered Sheet Goods with no added Urea D
Formaldehyde 61AC/Health pts Y--yes
B.Use Exterior Grade Plywood for Interior Uses 1 IAC/Health pts Y—yes
7,Beal� 0
FSg( 41 /Health s Y---Yes 0
e1 �' ------ -
B.Use C Certified Materials for Interior Finish 4 Re source pts y=yes D
9.Use Finger-Jointed or Recycled-Content Trim 1 Re source pts Y--yes0
10.Install Whole House Vacuum System 3 W)II-1ealth pts Y--yes 0
1 1 1
N.Flooring
1.Select FSC Certified Wood Flooring B Resource pts Yeses 0
2.Use Rapi 13ecte�rat�ie F7cjoripg Ilatena�s 4 Resource pts yeses 0
3.Use Recycled Content Ceramic Tiles 4 Resc ource pts Y--yes D
4.Install Natural Linoleum in Place of Vinyl 5 IA[I/Health pts Y--yes 0
5.Use Exposed Concrete as Finished Floor 4 Re,'ource pts Y--yes 0
6.Install Recycled Content Carpet with Low VOCs 4 Re source pts Y--yes 0
1 1 1
Total Points Available: U01 130 57
Total Points Project Received: '1 01 01 0
G:datelproogreenbuil fiingguiderinesln;modelerslgrnenp6intsiinW2.12D4proteeled.xl5
REROOF TEAR-OFF POLIGIF
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
ALBERT SALVADOR, P.E.,C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERTINO (408)777-3228• FAX(408)777-3333•building a(�cupertino.org
PROJECT AD E APN#
OWNER NA PHONE,. D/rim E-MAIL
STREET ADDRESS CITY, STATE,Z11 FAX
CO C O N6E� ,/J _ LICENS�.jJUMB LIC E TYPE - ,+� BUS.LIC#
COMPANY N EG �E-MAIL
STREET E CITY,STA - // PHONE/
z� � v
I UNDERSTAND AND AGREE TO THE FOLLOWING:
1. The re-roof project shall comply with all applicable provisions of the 2007 California Building Code.
2. You must schedule all needed inspections a minimum of one day before the requested inspection date.
Please schedule inspections online or call (408)777-3228 between 7:30-3:30 (Mon-Fri).
3. Tear-off roof inspection is required. Please call foi tear-off inspection after the roof is torn off and all
the nails/fasteners have been removed. Any and all dry-rotted wood shall be replaced prior to this
inspection. A building inspector will be available wi hin one hour.
There are special hours for this service: 7:30 — 10::30am and 1:00— 3:30pm (Mon—Thurs);
7:30 — 10::30am and 1:00—2:30pm (Friday).
4. If plywood is installed, a plywood nailing inspection is required.
5. In-Progress roof inspection is required. Call for an in-progress roof inspection to verify building is
weather tight after installation of approximately 25% of the roofing material.
6. New roof coverings shall not be applied without first obtaining all inspections and written approvals
from the building inspector. Any roofing which is applied without first obtaining an approved inspection
will require the removal of all new material down to the sheathing so a proper inspection can be
performed.
7. A final inspection and approval shall be obtained fro n the building inspector when the re-roofing is
complete. To receive a final sign-off, the following tems will be verified:
a. Flat roofs shall have a minimum of 1/4"per foot of slope and must demonstrate there is no ponding.
b. Listings from approved testing agencies for all F re-manufactured products used shall be available
on-site to review at the time of the inspection.
c. Proper spark arrestor installation.
8. NOTE: If you call for a tear-off or plywood nailing inspection and the work is not complete, you will
be charged a re-inspection fee of$126.00. The re-in ipection fee shall be paid before another
inspection can be scheduled.
By my signing below, I certify each of the following is truf: I am the property owner or authorized agent to act
on the property owner's behalf. I understand and agree to comply with the re-roof policy stated ove.
Signature of Applicant/Agent: Cw`, — 1 Date: / v
ReroofPolicy_2010.doc revised 05/17/10
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
CUPERTINO Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: f
4PERMIT#
OWNER'S NAME: NE# �
GENERAL CONTRACTOR. l9'tti INESS LICENSE#
ADDRESS: (S Y/ZIPCODE:
"Our municipal code req fres all businesses working in the Aty to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INS11ECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE. --__� F X.7Z')
I am not using any subcontractors: to
Signature
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
Painting/Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date