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10090008 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1132 KENTWOOD AVE CONTRACTOR:NELSON YUEN PERMIT NO: 10090008 OWNER'S NAME: NELSON YUEN 1132 KENTWOOD AVE DATE ISSUED:09/02/2010 ?ER'S PHONE: 4084109136 CUPERTINO,CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATIONr BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# MECH r RESIDENTIAL r COMMERCIAL Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:DEMOLITION-SUNROOM(300SQ) (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 declaration: 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. Sq.Ft Floor Area: Valuation:$100 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 permit is issued. APN Number:35931056.00 Occupancy Type: APPLICANT CERTIFICATION 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 PERMIT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter upon the 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, 180 DAYS FROM LAST CALLED INSPECTION. costs,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 Issued b 1--� - �G 9.18. Y�=:.— Date: �- .�. -�------ Signature Date RE-ROOFS: OWNER-BUILDER DECLARATION All roofs shall be inspected prior to any roofing material being installed.If a roof is installed without first obtaining an inspection,I agree to remove all new materials for 19rer y affirm that I am exempt from the Contractor's License Law for one of inspection. the f Ilowl g two reasons: I,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date: will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) I,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: I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the �'Z L� compliance with the Cupertino Municipal Code,Chapter 9.12 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 P Health&Safety Code,Sections 25505,25533,and 25534. I certify that in the performance of the work for which this permit is issued,I shal not employ any person in any manner so as to become subject to the Worker's Ow r or authorized/ nt: / /�� Compensation laws of California. If,after making this certificate of exemption,I /� A r 1 L Date: / ' become subject to the Worker's Compensation provisions of the Labor Code,I m ist forthwith comply with such provisions or this permit shall be deemed revoked. ! CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.) I certify that I have read this application and state that the above information is Lender's Name correct.I agree to comply with all city and county ordinances and state laws relat ng to building construction,and hereby authorize representatives of this city to enter Lender's Address upon the above mentioned property for inspection purposes.(We)agree to save -rmify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION and expenses which may accrue against said City in consequence of the g._.iring of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. ! Licensed Professional Date t Signature �/ L �r OWNER-BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERT NO,CA 95014-3255 CUPERTINO (408)777-3228- FAX(408)777-33:3- build i ng 4)cu pertino.org Dear Property Owner(s): An application for a building permit has been submittec in your name listing yourself as the builder of the property improvements specified at: SITE ADDRESS J 7 _J APN 3 �q © ._ BP# OWNER NAME rl, / y - �1 OWNER ADDRESS DESCRIPTION OF WORK: We are providing you with an Owner-Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner-Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indiimted. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of thy:permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION (DIRECTIONS:Please read and initial each statement below to signify you understand or verify this information.) IU 1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner- tuifder"building permit that erroneously implies that the property owner is providing his or her own labor and.material personally. I, as an Owner-Builder, may be held Iia)le and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees wHie working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner-Builder and am aware of the limits of my insurance coverage for injuries to workers on my p-operty. c2. I understand building permits are not required to be signed by property owners unless they are responsible for th construction and are not hiring a licensed Contractor to assume this responsibility. 3. 1 understand as an "Owner-Builder" I am tho;responsible party of record on the permit. I understand that I may ipr tett myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. n4u''ti 4. 1 understand Contractors are required by la N to be licensed and bonded in California and to list their license bers on permits and contracts. � , 5. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the to I value of my construction is at least five hundrE!d dollars($500), including labor and materials, I may be considered an"employer" under state and federal I aw. Y �, 1 6. 1 understand if I am considered an "employ�;r" under state and federal law, I must register with the state and fe eraI government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. 7. I understand under California Contractors':state License Law, an Owner-Builder who builds single-family Ite dential structures cannot legally build them witl- the intent to offer them for sale, unless all work is performed by lic nsed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed genera building Contractor. 8. 1 understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for �n financial or personal injuries sustained by any:>ubsequent owner(s)that result from any latent construction defects in the workmanship or materials. OwnerBuilderForm 2010.doc revised 04/14110 9. 1 understand I may obtain more information reciarding my obligations as an "employer"from the Internal keAenue Service,the United States Small Business Administration, the California Department of Benefit Payments, a d the California Division of Industrial Accidents. I al:o understand I may contslct the California Contractors' State License Board (CSLB)at 1-800-321-CSLB (2752)or vrww.cslb.ca.gov for more information about licensed contractors. 10. 1 am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I Fa_ the party legally and financially responsible for pro posed construction activity at the site address listed above. 11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner-Builders as well as employers. 12. 1 agree to notify the issuer of this form immed ately of any additions, deletions, or changes to any of the in rmation I have provided on this form. Licensed cortractors are regulated by laws designed to protect the public. If you contract with someone who does not have a licen:;e, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as z result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important fc r you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner-Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers'compensation insurance coverage. CONSTRUCTION LENDING AGENCY (DIRECTIONS:Please complete the following construction lending agency information.) hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.). Lender Name: Lender Address: Before a building permit can be issued, this form muse be completed and signed by the property owner and returned to the agency responsible for issuing the per-nit. Note:A copy of the property owner's driver's license, form notarization, or other verification acceptable to the cit✓may be required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: — Date: 'L --------------------------------------------------------------------------------------------------------------------------------------------- (NOTE: The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner-Builder). AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s)to act as my agent(s)to z pply for, sign, and file the documents necessary to obtain an Owner-Builder Permit for my project. Scope of Construction Project (or Description of Work):_ Project Location or Address: Name of Authorized Agent: Tel No Address of Authorized Agent: I declare under penalty of perjury that I am the property ova ner for the address listed above and I personally filled out the above information and certify its accuracy. Note:A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be pnasented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: OwnerBuilderFornt 1010.doc revises}04/14/10 CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : _.5931056 . 00 DATE ISSUED. . . . . . . : 09/02/2010 RECEIPT #. . . . . . . . . : BS000011360 REFERENCE ID # . . . : 1.0090008 SITE ADDRESS . . . . . : 1.132 KENTWOOD AVE SUBDIVISION . . . . . . CITY C'UPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : YELSON YUEN ADDRESS 1132 KENTWOOD AVE CITY/STATE/ZIP . . . : C'UPERTINO, CA 95014 RECEIVED FROM . . . . : D'ELSON YUEN CONTRACTOR . . . . . . . : LIC # *OWNER* COMPANY YELSON YUEN ADDRESS 1132 KENTWOOD AVE CITY/STATE/ZIP . . . : C'UPERTINO, CA 95014 TELEPHONE . . . . . . . . FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 100 . 00 2 . 00 0. 00 2 . 00 0 .00 1BSEISMICR VALUATION 100. 00 1 .00 0 .00 1. 00 0 .00 1DEMORES SQ FEET 300. 00 0 .00 0 .00 0. 00 0 . 00 1STAFFTM UNITS 2 . 00 252 .00 0.00 252 . 00 0 .00 ---------- ---------- ---------- ---------- TOTAL PERMIT 255. 00 0. 00 255. 00 0 .00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 255. 00 VISA --------------- TOTAL RECEIPT 255 .00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 704 DEMO v ENTER PROJECT NAME oil 0 1.Pre Plumb for Solar Hot Water Heating 0 ) 4 I i 2.Install Solar Water Heating System 0 10 j t 3.Install Wiring Conduti for future Photovoltaic Installation d Provide 200 If of South Facing Roof 0 2 1 4.Install Photovoltaic(PV)Panels a.3D%c4ledric needs OR 12 kW(total 6 points) LD 6b.60%of electric needs OR 2.01N(total 12 points) 6c.g0%of electric need OR 3.6 kW(total 18 points) 6 Total Available Points in Renewable Energy=28 J.$UII:DING PERFORMANCE ,.`.` `:: ;' 777- Poini."vailatile Per-Mei 1.Diagnostic Evaluations a.House Passes Blower lbw Test 0 b.House Passes Combustion Safety Backdraft Test D r 2 Design and Build High Performance Homes-%above Title 24-minimum 15%tequlr:d 0 i -30 I 5 2 3.House Obtains ENERGY STAR with Indoor Nr Package Certification•Pilot Measun (Total 45 points;read comment) 0 i i Total Available Points In Building Performance=39 0 K FINISHES s r Poitrts:AvagahlePereasiire` 1.Design Entryways to Reduce Tracked In Contaminants Z.Use Low-VOC or Zero-VOC Paint(Maximum 3 Points) a.tow-VOC Interior WaIVCeding Paints(c50 gpl VOCs(Flat)and 150 gpl VOCs(Non-F aq) 0 _ 1 1 j b.Zero-VOC:Interior WaIUCeBng Paints(<5 gpl VOCs(Flat)) `0~ ( 3_ �_. 3•Use Low VOC,Water-Based Wood Finishes(<256 gpl VOCs) 0 2 y 4.Use Low-VOC Caulk and Construction Adhesives(<70 gal VDCs)for All Adhesives 0 ! ! 2 j -. 5.Use Recycled-Content Paint 0 ' 1 6.Use Environmentally Preferable Materials for Interior Finish:A)FSC-Certlliied Wood 8)Reclaimed,C)Rapidly Renewable,D)Recycled-Content or E) Finger-Jointed a.Cabinets(50%Mbdmum) 0 ■ b.Interior Trim(50%Minimum) ` D - c.Shelving(5D%Minimum) d.Doors(50%Minimum) 0 e.Countertops(SD%Minimum) T.Redux Formaldehyde In Interior Finish(CA Section 01350) a.Subfi xx 6 Stair Treads(50%Minimum) b.Cabinets 6 Counlerlo 50%Minimum c.Inledor Trim(50%Minimum) 0 d.Shelving(50%Minimum) 0 1 8.After Installation of Finishes,Test of Indoor Air Shows Formaldehyde Level<27ppb 0 + 3 ( I Total Available Points in Finishes=2 0 L.F'LC►QRING � . , ,„ �`- POirils i4vailable:Per Measure:, .: - 1.Use Environmentally Preferable Flooring:A)FSC-CertKed Wood,8)Reclaimed or f efinished,C)Rapidly Renewable,D)Recycled-Content,E)Exposed Concrete.Flooring Adhesives Must Have 00 gal VOCs. ■ a.Minimum 15%of Floor Area t It.Minimum 3D%of FIDr Area _0 . c.Minimum 50%of Floor Area _ d.Minimum 75%of Floor Area D I 1 2 Thermal Mass Floors:Floor Covering Other than Carpet on 50%or More of Concret r Floors 0 1 3.Flooring Masts Section 01350 or CRI Green Label Plus Requirements(50%Minimur m) 0 2 Total Available Points in Flooring=7 0 M APPLIANCES AND LIG=G " PolnlsAvallable,PerMeasirre 1.Install Water and Energy EfOdent Dishwasher _ i a.ENERGY STAR(total 1 point) 0__ __, ._,_ __� ___•., b.Dishwasher Uses Ni)Mora than 6.5 Gallons/Cyde(total 2 points) 0 1 2.install ENERGY STAR Clothes Washing Machine with Water Factor of 6 or Less a.Meets Energy Star and CEE Tier 2 requirements(modified energy factor 2.0,Water F:dor 6.0)(total 3 points) 0- _ 1 - _- 2 b.Meels Energy Star and CEE Teter 3 requirements(modified energy tactor 22,Water Fs dor 4.5 or less) 2 0 � �! (total 5 points) 3.Install ENERGY STAR Refrigerator a.ENERGY STAR Ouallfied d<25 Cubic Feet Capacity 0 b.ENERGY STAR Qualified 8<2D Cubic Feet Capacity w 0 4.Install Bulti-In Recycling Center 0 a.Built-In Recycling Center 0 4 i 2s 0 ZD07 Build It Green Single Far illy GreenPoint Checklist 2007 Version Page 5 of 7 CITY OFCUPERTINO DEMO CUPEkT1NO PERMIT APPLICATION FORM APN# Date: 31� q I; I 12�;L- ?/,I,- Building Address: . Mailing Address (if different from building ac.dress): Owner's Name: Phone: Y� zf!V- - qo� Contractor: Phone : Fax: Contractor License #: Cupertino Business License #: Contact: Phone: 4 0 - 3 b Fax: Residential ❑/ Sq Footage 3 J Commercial ❑ Sq Footage Job Description: Valuation: - - Project Size: Express �andard ❑ Large ❑ Major ❑ Please complete relevant portions of the Green Building Checklist & attach it to the application or if applicable, include on the plan set & t he sheet index. Quantity Fee ID Fee Description Fee Group Permit Type 1DEMORES Demo-Residential B 1SFDWL-DEM 1DEMOPRES Pool Demo Residential B 1SFP00L-DEM- 1BCBSC Cal B.dg Standards B ALL PERMIT Commission Fee TYPES 1BSEISMICRE Seism.c Residential B Revised 01/07/09 CITY OF CUPER71NO BUILDING PERMIT BUMDING ADDRESS: 10910 KESTER DR CONTRACTOR: PERMIT NO: 10090226 OWNER'S NAME: ROBERTA PANGBORN , t7 �c4 4 �r t 67'__� DATE ISSUED:09/23/2010 .PER'S PHONE: 4088912506 (; )G (� PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PE IT INFO: BLDG ELECT PLUMB License Class C—3 q- Lic.# Q q 9 -Z,t( MECH RESIDENTIAL COMMERCIAL Contractor_<4r.,r C%A S6" � &�- t c.4 tSDate I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:RE-ROOF OVERLAY WITH DURO LAST MEMBRANE (commencing with Section 7000)of Division 3 of the Business&Professions CLASS A Code and that my license is in full force and effect. 22SQ I hereby affirm under penalty of perjury one of the following two declaration s: 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:$12441 permit is issued. APPLICANT CERTIFICATION APN Number:35628019.00 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 sourr,.e regulations per the Cupertino Municipal Code,Section 9.18. \ ;P 7; 2D-Cc. Issued b Date: Date ❑ OWNER-BUILDER DECLARATION RE-ROOFS: I 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 I,as owner of the property,or my employees with wages as their sole compensati m, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Signature of A licant:[L Date: I,as owner of the property,am exclusively contracting with licensed contractors I o - 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 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 shal l 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,1 become subject to the Worker's Compensation provisions of the Labor Co e,I mustner or author d nit: forthwith comply with such provisions or this permit shall be deemed revok 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 relatng 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 anon 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 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. 1 understand my plans shall be used as public records. Signature Date Licensed Professional CITY CF CUPERTINO 3 ITEMS OF 13 PERK= RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: E.lk: Lot: APN : 5628019 .00 DATE ISSUED. . . . . . . : ( 9/23/2010 RECEIPT #. . . . . . . . . LS000011547 REFERENCE ID # . • . : 10090226 SITE ADDRESS . . . . . : 7.0910 KESTER DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . . C'UPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : ROBERTA PANGBORN ADDRESS :_0910 KESTER DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : SORENSON & ASSOC CONTRACTOR SBD - TO BE DETERMINED LIC # 00096 COMPANY SBD - TO BE DETERMINED ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . TELEPHONE . . . . . . . . FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 12,441. 00 1. 00 0. 00 1. 00 0 .00 1BSEISMICR VALUATION 12, 441. 00 1 .30 0 .00 1.30 0 . 00 1REROOFRES SQ FEET 22 . 00 286 . 00 0. 00 286 . 00 0 .00 ---------- ---------- ---------- ---------- TOTAL PERMIT 288 .30 0 .00 288.30 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 CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 7D_ATE: REVIEWED BY: APN: BP#: *VALUATION: 1$12,441 *PERMIT TYPE: Minor Building Permit FLAN CHECK TYPE: Re-roof PRIMARY SFD or Duplex 7<)1,1 PENTAMATION 1SFDWLR00F USE: 1,1�)t;, .t1ti:��: PERMIT TYPE: WORK SCOPE FEE ID ROOF AREA s.f. 1REROOFFRES 2,200 wlb f =rirt 1'c._ Li NOTE: Thesefees are based on the preliminary in ormati m available and are only an estimate. Contact the De t or addn'l info, FEE ITEMS (Fee Resolution 09-051 Elf.7%1:1( FEE QTY/FEE MISC ITEMS Mcm Chock Fc c: .Supp/. PC.'1"Ce �'lzrnzlz �.'tlec:h 'hle�r:f'lu�z C`lrc�c:,�.� Permit Fee: f'lrzznlz :11��c�1z 7el�cf'r�rrl�c�c°: Plzrrrzh �:1-t<�c•lz..I:le,t, l'����zzzrt F`�°al: ('017stz 11C1iu!z 71n- 1c:oustie a/ 1 c' . Work Without Permit? Yes E) No $0.00 1,rovel C)o(tri;ze'fztrctioll Strong Motion Fee: IBSEISMICR $1.24 Select an Administrative Item Bldy,Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $288.24 $0.00 TOTAL FEE: $288.24 Revised: 9/22/2010 nn oor Air Quality and Finishes 1.UseiLwi"C VOG Pao 1 IAQ/Health pts y=yes0 2,Use Low VOC,Water-Based Wood Finishes 2 IAQ/Heah pts y-yes 0 3.,UseLv?Mq Adkswas 31AGMealth pts y=yes 0 4.Use Salvaged Materials for Interior Finishes 3 Resource pts yeses D 5.Use Engineered Sheet Goods with no added Urea Formaldehyde 61AQ/Health pts yeses p 6.Use Exterior Grade Plywood for Interior Uses 1 IAQIHealth pts y--yes p 7 eat +16 eseeli iofdMO*r, )= - 4 IAQ/Healtlh-pts y=yes 0 S.Use FSC Certified Natedals for Interior Finish 4 Resource pts y=yes p 9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y=yes 0 1 D.Install Whole House Vacuum System 3 IAQ1Health pts y=yes p i B D N.Flooring 1.Select FSC Certified Wood Flooring a Resource pts y=yes 0 JJse HPC'ReaewaWe flooring M4?als 4 Resource pts y=yes 0 3.Use Recycled Content Ceramic Tiles 4 Resource pts y=yes 0 4.Install Natural Linoleum in Place of Vinyl 5 IAQ/HBaM pts y=yes p 5.Use Exposed Concrete as Finished Floor 4 Resodree pts y=yes 0 6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes 0 p � i r Total Points Available 140 130 57 Total Points Project Received] 01 01 0 G:data/pra s/greenburldnggddelines/n:modelers/greenpointsflnal21204pro1Wedxls Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 101 Telephone: 408-777-3228 CU PERTI NO Fax: 408-777-3333 CONTRACTOR/ ;-UBCONTRACTOR LIST JOB ADDRESS: y-cPERMIT# d 2 OWNER'S NAME: PHONE# ' ct 1 GENERAL CONTRACTOR: $A. BUSINESS LICENSE# ADDRESS: CITY/ZIPCODE: *Our municipal code requires all businesses working; in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. 1 am not using any subcontractors: `L3 Date 1 � 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 CITY OF r . P ,0 M A` PLANS CITY OF CUPERTINO ;BECKED BY REROOF r;r CUPERTINO PERMIT �0PLICATION APN# Date: 1 C, Building Address: Owner's Name: +z o V Phone #: HOA: Yes [K No ❑ If yes, provide letter from HOA Lto W Contractor: Phone #: q 1S. C z , '"7 G FS Fax#: 91 Cupertino Business License #: Contractor License #: Type of Roof Covering: Existing: Proposed: Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles ❑ Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other (Specify) PV- Other (Specify) --I r, �-�- Number of existing coverings _ ❑ Provide I.C.C.E.S. Report# ❑ To be Removed ❑ Provide Mfgr. Installation Specs. Job Description.: �LekS t L Residential M Commercial Green Building: Please complete relevant portion of the Con_frmed Nith_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 wi-h Cupertino's Tear-Off Policy: Signature Revised 02/05/09