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09090193CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS, 10171 VICKSBURG DR CONTRACTOR: AHMED SALLAM PERMIT NO: 09090193 OWNER'S NAME: AHMED SALLAM 10171 VICKSBURG DR DATE ISSUED: 09/28/2009 ER'S PHONE: 4086446338 CUPERTINO, CA 95014 PHONE NO: r— F PLUMB ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT License Class Lic. # MECH f— RESIDENTIAL r— COMMERCIAL Contractor Date JOB DESCRIPTION: RE -ROOF REMOVE EXISTING WOOD SHINGLES, I hereby affirm that I am licensed under the provisions of Chapter 9 INSTALL NEW (commencing with Section 7000) of Division 3 of the Business & Professions OSB BOARDS, INSULATION PAPER AND ASPHALT Code and that my license is in full force and effect. SHINGLES.(30 POUNDS PAPER), 40 YEARS SHINGLES 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 Section 3700 of the Labor Code, for the performance of the work for which this Sq, Ft Floor Area: Valuation: $5000 permit is issued. APPLICANT CERTIFICATION APN Number: 36907006.00 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 the above mentioned property for inspection purposes. (We) agree to save PERMIT EXPIRES IF WORK IS NOT STARTED upon 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 180 DAYS FROM LAST CALLED INSPECTION. with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Issued by.- Dater 7... Signature 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 inspection, I agree to remove all new materials for the following two reasons: 1, as owner of the property, or my employees with wages as their sole compensation, installed without first obtaining an inspection. will do the work, and the structure is not intended or offered for sale (Sec.7044,� Date: Business & Professions Code) Signature of Applicant: 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 1 hereby affirm under penalty of perjury one of the following three declarations:HAZARDOUS Certificate of Consent to self -insure for Worker's MATERIALS DISCLOSURE I have and will maintain a 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 California Health & Safety Code, Sections 25505, 25533, and 25534. 1 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 Safety 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 Additionally, should I use equipment or devices which emit hazardous air Bay Area Air Quality Management District I will permit is issued. I certify that in the performance of the work for which this permit is issued, I shall contaminants as defined by the 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 Owne or authorized agent. Date: �u/ 09 forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I 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 Civ C.) certify correct. I agree to comply with all city and county ordinances and state laws relating for which this permit is issued (Sec. 3097, 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 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-poin source regulations per the Cupertino Municipal Code, Section I understand my plans shall be used as public records. 9.18. Signatur Date__J / v Licensed Professional 3 ITEMS OF 3 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 36907006.00 DATE ISSUED.......: 09/28/2009 RECEIPT #......... BS000008773 REFERENCE ID # 09090193 SITE ADDRESS 10171 VICKSBURG DR SUBDIVISION CITY CUPERTINO IMPACT AREA ...... OWNER AHMED SALLAM ADDRESS 10171 VICKSBURG DR CITY/STATE/ZIP CUPERTINO, CA 95014 RECEIVED FROM AHMED CS#SALLAM CONTRACTOR ....... COMPANY AHMED SALLAM ADDRESS . 10171 VICKSBURG DR CITY/STATE/ZIP CUPERTINO, CA 95014 TELEPHONE ......... OPERATOR: Patg COPY # : 1 FEE ID UNIT QUANTITY AMOUNT -- PD -TO -DT ---------- THIS REC- ----- -- NEW -BAL- ---------- ------------- 1BCBSC VALUATION 1BSEISMICR VALUATION 1REROOFRES SQ FEET ---------- 5,000.00 5,000.00 20.00 -------- 1.00 0.50 260.00 0.00 0.00 0.00 1.00 0.50 260.00 0.0 0.00 ------ ---- TOTAL PERMIT 261.50 0.00 261.50 0.00 METHOD OF PAYMENT ----------------- CHECK TOTAL RECEIPT : AMOUNT --------------- 261.50 --------------- 261.50 VOICE ID DESCRIPTION -------- ----------------- 601 ROOF TEAR OFF 604 ROOF IN -PROGRESS REFERENCE NUMBER -------------------- #683 VOICE ID DESCRIPTION -------- ---------------------- 602 ROOF PLYWOOD NAIL 605 FINAL REROOF _� � aN CITY OF CUPEkTINO CITY OF CUPERTINO REROOF PERMIT APPLICATION APN # 3 ( O -1 k_-, (0. v v Date: 9 12-t A) 3 Building Address: /,,' -7/ �/ i C K s ,(3 iU(�-.� G u P E 12 T/Nd�, CA Owner's Name: A N_0 S f\ L,&AM Phone M -b- 6335 4o 64-y-- HOA: Yes ❑ No ® If yes, provide letter from HOA Contractor: Phone #: Fax #: Cupertino Business License #: Contractor License #: Type of Roof Covering: Existing: Proposed: ❑ Built -Up Roof ❑ Built -Up roof ❑ Asphalt Shingles Asphalt Shingles 1 -1 1 ❑ Wood Shakes Wood Shingles ❑ Other (Specify) Number of existing coverings ❑ To be Removed 11 VV VVU ollaava Wood Shingles Other (Specify) Provide I.C.C.E.S. Report # Provide Mfgr. Installation Specs. Job Description: ?-e wo ✓e cA �� w00 d S K41A,3C & . -144fi&jZt Aje-W e69<16 boar-,& "tirljda�or P J l0 �� PA fW —' 4b aY� S(�►i'v, -�l.O — IS X32 $X 8 rd6blowl _ 0 S� Residential Commercial Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the application or if applicable, include in plan set & the sheet index. Valuation: T fia/ Nous_ 51 14t jtLW,q A6 -o 6000 Confirmed with Planning Dept. if there are any restrictions: ❑ I Have Read, Understand and Will Comply with Cupertino's Tear -Off Policy: Signature � du� Revised 02/05/09 al -, CITY OF CUPEkTINO CITY OF CUPERTINO REROOF FEE SCHEDULE Fee ID Fee Description Fee Group Permit Type Number of Squares 1REROOFCOM Re -roof Commercial B 1COMMLROOF 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICO Seismic Commercial B n A 1RER00FRES Re -roof Residential B 1SFDWLROOF f I 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES / 1BSEISMICRE Seismic Residential B 1 REROOFMRES Re -roof Multi -Family B IMFDWLROOF 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICRE Seismic Residential B 1BUSLIC Business License B 1. Use Low1No-VOG Paint 1 IAQ/Hsalth pts y=yes 2. Use Low VOC, Water -Based Wood Finishes 2 IAQ/Health pts y=yes 3. Use Low/No VOID Adlux ives 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 4 Resource pts y=yes Formaldehyde 61AQ/Health pts y=yes 6. Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 7. Seal aU Exposed Par#ideboaWo NSF 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 1. Select FSC Certified Wood Flooring 8 Resource pts y=yes 2. Use Raocly Renewable Flooring Materials 4 Resource pts y=yes 3. Use Recycled Content Ceramic Tiles 4 Resource pts y=yes 4. Install Natural Linoleum in Place of Vinyl 5 IAQ/Health pts y=yes 5. Use Exposed Concrete as Finished Floor 4 Resource pts y=yes 6. Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes Total Points Available: Total Points Project Received: 1401 130 57 �)1 0 0 0 i� q G:datalprooslgreenbuildingguidelineslremodelerslgreenpointsfina12.12.D4proteoted.xls 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. The re -inspection fee must be paid before another inspection can 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 on the job site at the time on inspection. I understand and will comply with the above stated policy on re -roofing. Homeowner's Name: A N Me o SQ LcPP " Job Site Address: 10t-11 Roofing Company Name: W NVQ Applicant's Signature: Date:JO (�9 Greg Casteel Building Official Revised 07/30/08 OWNER—BUILDER VERIFICATION 1. (Check one) I or my immediate family (parent, spouse or child) will perform: A. ✓ _ All the work authorized by this permit B. _ A portion of the work C. None of the work If B or C is checked, complete 2 or 3 below. 2. A state licensed contractor will be hired to do: A. _ All of the work B. _ A portion of the work (complete section below) Contractor Address/City. Phone # State License # Type of work to 3. _ I will utilize unlicensed person(s) other than my immediate family to perform all or portions of the authorized work. I understand that I may be an employer (see reverse side). A Certificate of Insurance covering workers' compensation must be on file at the City of Cupertino Building Department office. Person/Firm Address/City Phone Number I Type of work to be I declare under penalty of perjury that the above is true and correct. I have read and understand the Owner -Builder Information (re a side). Property Owner's Signature: Date: g 12-910 9 Job Address: 1 O 1-7 l V I GKS $ A6, O k ;o Gu PEge T/A/0 Permit # Any changes to the information provided on this form shall be submitted to the City of Cupertino Build Department. f; CITY OF XPEkTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS: 01-71 VteKS L4f& 04-•.6 P6�/NO PERMIT # 0��3 OWNER'S NAME: g Meo SA LL.A M PHONE # 4018— 6 q4t 633$ GENERAL CONTRACTOR: �2 1 FAX # I am not usingany subcontractors: 'f`�'" �I d �. 312,9105 Signature Date nip— -"AL— -z„hrn-nf-rarf-nrc and rr,mnlete the followinLy information: 9�L9 /a9 Owner/ Contractor Signature Date 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 9�L9 /a9 Owner/ Contractor Signature Date