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09070213 CITY OF CUPERTIN O BUILDING PERMIT BUILDING ADDRESS: 10435 NORWICH AVE CONTRACTOR:ROOF CRAFT PERMIT NO:09070213 OWNER'S NAME: HARPER JOSEPHINE J TRUSTEE 375 SOUTH 22ND ST DATE ISSUED:07/31/2009 1 ER'S PHONE: 4084553138 ;;AN JOSE,CA 95116 PHONE NO:(408)250-9059 O LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG it ELECT r- PLUMB r License Class C-_3 01 Lic.# 73 9 3 3r MECH RESIDENTIAL COMMERCIAL Contractor An tC C641'f Date ?—-3) -Da- 1 hereby affirm that I am licensed under the provisions of Chapter 9 FOB DESCRIPTION:RE-ROOF;REMOVE 1 LAYER OF SHAKE (commencing with Section 7000)of Division 3 of the Business&Professions WOFING; INSTALL Code and that my license is in full force and effect. )SB&30LB 36INCH FELT&CERTAINTEED PRESIDENTIAL COMPOSITION SHINGLE CLS A ROOFING 29SQ 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. 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 iq,Ft Floor Area: Valuation:$10000 permit is issued. APPLICANT CERTIFICATION %PN Number:31629075.00 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 indemnity 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. Signature Date7� Issued bye - nate: CT OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of %II roofs shall be inspected prior to any roofing material being installed. If a roof is the following two reasons: nstalled without first obtaining an inspection,1a ree to remove all new materials for I,as owner of the property,or my employees with wages as their sole compensation, nspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) signature of Applicant: Date: 1,as owner of the property,am exclusively contracting with licensed contractors to 7 3/_+Uq_ construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS".4"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. -alifornia Health&Safety Code,Sections 25505,25533,and 25534. I will maintain I have and will maintain Worker's Compensation Insurance,as provided for by -ompliance 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 1 store or handle hazardous material. permit is issued. lkdditionally,should I use equipment or devices which emit hazardous air I certify that in the performance of the work for which this permit is issued,1 shall 'ontaminants as defined by the Bay Area Air Quality Management District I will naintain 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. Compe-tsation laws of California. 11"after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must .)wrier nrutl ia �) forthwith comply with such provisions or this permit shall be deemed revoked. Date:01 APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY 1 certify that 1 have read this application and state that the above information is hereby affirm that there is a construction lending agency for the performance of work's correct.1 agree to comply with all city and county ordinances and state laws relating or 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 -ify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address co, _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 the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION 9.18. understand my plans shall be used as public records. Signature _ Date Licensed Professional CITY OF CUPERTINO REROOF CUPEkTiNO PERMIT APPLICATION APN# Date: Building Address: , Owner's Name: ,- Phone#: qoe I ;M HOA: Yes ❑ No If Yes,provide letter from HOA Contractor: abo Ir r Phone#:�j _ZO) -SCC Cl Fax#: Cupertino Business License#: Contractor License #:739-3 33 Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles w Asphalt Shingles A 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: ,. �, f p f' sly-4 e �x-V" ��' �� C B �;. 0'1 �Q�,�� i xvkc'! �i rt 7`�ec� Pr e�1(LE�•'1��.a j Cs,�,�''c��'�rc� ��e h�/F 0A-_,.5A ec or,,� 2q t7 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 Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy: Signature Revised 02/05/09 CITY OF CUPERTINO R.ERDOF OF -'UPEkTINO 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 ,L 1 REROOFRES Re-roof Re,,idential B 1 SFDWLROOF / 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICRE Seismic Residential B 1REROOFMRES Re-roof Multi-Family B 1MFDWLROOF 1 BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1 BSEISMICRE Seismic Re,,idential B 1BUSLIC Business Li,;ense B M.Indoor Air Quality and Finishes INPUT Resources Energy IAQ/Health 1.Use Low/No-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 Exposed Particleboard or MDF 4 IAQ/Health pts y=yes 0 S.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 t=770 . 1 f 1 N.Flooring 1.Select FSC Certified Wood Flooring E Resource pts y=yes 0 2.Use Rapidly Renewable Flooring Materials I Resource pts y=yes 0 3.Use Recycled Content Ceramic Tiles Resource pts y=yes 0 4.Install Natural Linoleum in Place of Vinyl i IAQ/Health pts y=yes 0 5.Use Exposed Concrete as Finished Floor Resource pts y=yes 0 6.Install Recycled Content Carpet with Low VOCs Resource pts y=yes 0 . 1 1nm1 Total Points Available: 140 130 57 Total Points Project Received: 0 01 0 7- 3 G:data/progs/gree ibuildingguidelinWremodelers/greenpointsfinal2.12.D4protected.xls CITY OF CUPERTINO 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk-: Lot : APN . . . . . . . . : 31E29075 . 00 DATE ISSUED. . . . . . . : 07/ 31/2009 RECEIPT # . . . . . . . . . BS(00008327 REFERENCE ID # . . . : 09(70213 SITE ADDRESS . . . . . : 10435 NORWICH AVE SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : HAPPER JOSEPHINE J TRUSTEE ADDRESS 104:35 NORWICH CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2445 RECEIVED FROM . . . . : ROOF CRAFT CONTRACTOR . . . . . . . : PA7RICK GOMEZ LIC # 25488 COMPANY ROOF CRAFT ADDRESS 375 SOUTH 22ND ST CITY/STATE/ZIP . . . : SAPS JOSE, CA 95116 TELEPHONE . . . . . . . . : (408) 250-9059 FEE ID UNIT QUANTITY IXOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- -- ------ ---------- ---------- ---------- 1BCBSC VALUATION 10, 000 .00 1 . 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 10, 000 . 00 1 . 00 0 .00 1 . 00 0 . 00 1BUSLIC FLAT RATE 1 . 00 114 . 00 0 .00 114 . 00 0 . 00 1REROOFRES SQ FEET 29 . 00 377 . 00 0 . 00 377 . 00 0 . 00 -- -------- ---------- ---------- ---------- TOTAL PERMIT 493 . 00 0 . 00 493 . 00 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 493 . 00 --------------- TOTAL RECEIPT 493 . 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 604 ROOF IN-PROGRESS 605 FINAL REROOF Community Development ' 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 cliv OF Fax(408)777-3333 ,-UPEI�TINO Building Department JOB ADDRESS: /C>q5 5 o rW,,Ck Ave PERMIT # OWNER'S NAME: P�r PHONE GENERAL CONTRACTOR: CrA0;t- 73q-b3:3 FAX# I am not using any subcontractors: 7-3 1~m Si;nature 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