09090133CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10834 E ESTATES DR
CONTRACTOR: ALLEGIANCE ROOFING
PERMIT NO: 09090133
OWNER'S NAME: ACKER KIM
1566 HARVEST DR
DATE ISSUED: 09/17/2009
C _�R'S PHONE: 6502692888
SAN JOSE, CA 95127
PHONE NO: (408)937-9757
LICENSED CONTRACTOR'SDDECLLARATION
I—
'0
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class ✓/ Lc, # ('I7
f— r— �
Q
Contractor Date / � 9
MECH RESIDENTIAL COMMERCIAL
1 hereby affirm that I am lice s d under the provisions of hapter 9
JOB DESCRIPTION: RE -ROOF REMOVIGN SHAKE ROOFS
(commencing with Section 70 ) of Division 3 of the Business & Professions
INSTALLING OSB
Code and that my license is in full force and effect.
SHEATHING 30LB FLT 50 YR PRESIDENTIAL SHINGLES
CLASS A 20SQ
I hereby affirm under penalty of perjury one of the following two declarations:
1 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
Sq. Ft Floor Area:
Valuation: $8000
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION
APN Number: 36922007.00
Occupancy Type:
1 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 C' of Cupertino against liabilities, judgments,
costs, and expenses which may acc a gainst said City in consequence of the
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this pe ddul nail the applicant understands and will comply
180 DAYS FROM LAST CALLED INSPECTION.
with all non -poi source regulations et t Cupertino Municipal Code, Section
9.18.
Signature ` Date /
Issued b _...__. Date:
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
RE- OFS:
the following two reasons:
All roofs shall be inspected prior to any ro ng material being installed. If a roof is
I, as owner of the property, or my employees with wages as their sole compensation,
installed without first obtaini nl'nsp i n, I agree to remove all new materials for
will do the work, and the structure is not intended or offered for sale (Sec.7044,
Business & Professions Code)
inspection.
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 CO E INGS 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.
permit is issued.
Additionally, 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, I shall
contaminants as defined y the Bay Area Air Quality Management District I will
maintain mpliance w' h 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
Owner $uthor' ent: Q ��
' Date: 7
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION
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
mify and keep harmless the City of Cupertino against liabilities, judgments,
Lender's Address
L , 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.
I understand my plans shall be used as public records.
Signature Date
Licensed Professional
3 ITEMS OF 3
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN .........: 36922007.00
DATE ISSUED.......: 09/17/2009
RECEIPT #.........: BS000008705
REFERENCE ID # ...: 09090133
SITE ADDRESS .....: 10834 E ESTATES DR
SUBDIVISION ......
CITY CUPERTINO
IMPACT AREA ......
OPERATOR: patg
COPY # : 1
OWNER ACKER KIM
ADDRESS 10834 E ESTATES DR
CITY/STATE/ZIP ...: CUPERTINO CA, 95014-4534
RECEIVED FROM ....: ALLEGIANCE ROOFING
CONTRACTOR .......: SUSAN TANUPO LIC # 23080
COMPANY ALLEGIANCE ROOFING
ADDRESS 1566 HARVEST DR
CITY/STATE/ZIP ...: SAN JOSE, CA 95127
TELEPHONE (408)937-9757
FEE ID UNIT
QUANTITY
AMOUNT
PD-TO-DT
THIS REC
----------
NEW BAL
----------
-----------------------
1BCBSC VALUATION
----------
8,000.00
----------
1.00
----------
0.00
1.00
0.00
1BSEISMICR VALUATION
8,000.00
0.80
0.00
0.80
0.00
1REROOFRES SQ FEET
20.00
260.00
0.00
260.00
----------
0.00
----------
TOTAL PERMIT
----------
261.80
----------
0.00
261.80
0.00
METHOD OF PAYMENT
-----------------
CASH
TOTAL RECEIPT
AMOUNT
---------------
261.80
---------------
261.80
VOICE ID DESCRIPTION
-------- ----------------------------
601 ROOF TEAR OFF
REFERENCE NUMBER
--------------------
VOICE ID DESCRIPTION
-------- ----------------------------
602 ROOF PLYWOOD NAIL
604 ROOF IN -PROGRESS 605 FINAL REROOF
1 7 aT
CITY OF
CUPEkT1NO
CITY OF CUPERTINO
REROOF
PERMIT APPLICATION
APN # � q d C7 , �
Building Address: S'
C MP
Owner's Name: K!"�
HOA: Yes ❑ No T If yes, provide letter from HOA
Contractor: -A
` 2 C) Mi
CA. 9 �.
Cupertino Busi ess License #:
Existing:
❑ Built -Up Roof
❑' Asphalt Shingles
Wood Shakes
Wood Shingles
❑ Other (Specify)
Number of existing coverings
❑ To be Removed
Job Description:
Residential
�,A4v/M(r U,
,570 IR RF
Typeof f Roof Covering:
'JAL
Date: 911yt/7
D9 0
Phone Ar, 2 �_
Phone
Fax #:
Contractor License #:
C?1g612 -
Proposed:
❑ Built -Up roof
Asphalt Shingles
❑ Wood Shakes
❑ Wood Shingles
❑ Other (Specify)
❑ Provide I.C.C.E.S. Report #
❑ Provide Mfgr. Installation Specs.
Commercial
Green Building: Please complete relevant portion of the
he application or if
Green Building Checklist & attach it to t
applicable, include in plan set & the sheet index.
Valuation:
I Have
Confirmed with Planning Dept. if
there are any restrictions:
Und an ,an�._WLll Comply with Cupertino's Tear -Off Policy:
Signature \� /
\.� / Revised 02/05/09
aL
CITY OF CUPERTINO
REROOF
OF
CUPEkT]NO FEE SCHEDULE
Number of
Squares
Fee ID
Fee Description
Fee
Group
Permit Type
1REROOFCOM
Re -roof Commercial
B
1COMMLROOF
1BCBSC
Cal Bldg Standards
Commission Fee
B _
ALL PERMIT TYPES
1BSEISMICO
Seismic Commercial
B
1REROOFRES
Re -roof Residential
B
1SFDWLROOF
'
1BCBSC
Cal Bldg Standards
Commission Fee
B
ALL PERMIT TYPES
J
1BSEISMICRE
Seismic Residential
B
.
1REROOFMRES
Re -roof Multi -Family
B
1MFDWLROOF
1BCBSC
Cal Bldg Standards
Commission Fee
B
ALL PERMIT TYPES
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. e re -inspection fee must
be Raid before another ins ection can be schedule
d.
IMPORTANT:
1, Flat roofs must have a minimum of 1/4 per foot slope and demonstrate
that there is no ponding.
be on the job site at the time on inspection.
2. An I.C.B.O. report is required to
I understand and will comply with the above stated policy on re -roofing.
Homeowner'sName:
Job Site Address:
Roofing Company
Applicant's Signat
Greg Casteel
Building Official
Revised 07/30/08
1. Use LowMo-VOC Paint
1 IAQ/Health pts
y=yes
2. Use Low VOC, Water -Based Wood Finishes
2 IAQ/Health pts
y=yes
3. Use LowMo VOC Adhesives
3 IAQ/Health pts
y=yes
4. Use Salvaged Materials for Interior Finishes
3 Resource pts
y=yes
5. Use Engineered Sheet Goods with no added Urea
Formaldehyde
6 IAQ/Health P is
y-y es
6. Use Exterior Grade Plywood for Interior Uses
1 IAQ/Health pts
y=yes
7. Ssal all Exposed P *Jaboard or MDF
4 IAQ/Health pts
y=yes
8. Use FSC Certified Materials for Interior Finish
4 Resource pts
y=yes
9. Use Finger -Jointed or Recycled -Content Trim
1 Resource pts
y=yes
10. Install Whole House Vacuum System
3 IAQ/Health pts
y=yes
N. Flooring
0
1. Select FSC Certified Wood Flooring
8 Resource pts
y=yes
0
2. Use Rapidly Renewable Flooring Materials
4 Resource is
P
Y=Y es
0
3. Use Recycled Content Ceramic Tiles
4 Resource pts
y=yes
L[
0
4. Install Natural Linoleum in Place of Vinyl
5IAQ/Health is
P
- es
Y-Y
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
Total Points Available:
140 If 130 57
Total Points Project Received:
0
_
p 0
/ "
q
7// A/'f
G:datalprogslgreenbuildingguidelines/remodelerslgreenpointsfinal212.D4protected.xls
JOB ADDRESS:
OWNER'S NAME: Kt/L4
GENERAL CONTRACTOR:
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Buildin De artment
Ed' PERMIT #
jA
HONE #
1A FAX #
I am not using any subcontractors: _
Signature
Please check applicable subcontractors and com lete the follow
SUBCONTRACTOR BUSINESS NAME
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Ornamental Sheet Metal
Painting / Wallpaper
Plastering �
r ..
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature
�X
4-
Date
information:
BUSINESS LICENSE #
Date