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CITY OF CUPERTINO
BUILDING DIVISION PERMIT
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BUILDING ADDRESS:
PERMIT NO.
10387 AVENIDA LN
WOODS RDOFING
OWNER'S NAME.
PERMIT ISSUE DATE
'"ON
A CONTROL NO.
(831)637-5576
ARCHITEC IENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 a
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business and Professions Code, and my license is
in full foreeandeffec -� 2 �3
RE -RF T/0 EXTNG WDSHK RF 1LYR& INSTL BATTR SYS&
License ass tic *
Dale w Contractor
STEEL TILE CLS A 28SQ CLS A
ARCHITECTS DECLARATION
I understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the
following mason. (Section 7031.5, Business and Professions Code: Any city or county
which requires a permit to construct. alter, improve, demolish, or repair any structure
prior to its issuance, also requires the applicant for such permit to file a signed statement
that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9
Sq. Ft. Floor Area
Valuation
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
$18465
that he is exempt therefrom and the basis for the alleged exemption. Any violation of
APN Number
Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars (5500).
34245040 . 0 0
❑ 1, as owner of the property, or my employees with wages as their sole compensation,
Required Inspections
will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business
and Professions Code: The Contractor's License Law does not apply to an owner of
property who builds or improves thereon, and who does such work himself or through his
own employees, provided that such improvements are not intended or offered for sale. If,
however, the building or improvement is sold within one year of completion, the owner -
builder will have tete burden of proving that he did not build or improve for purpose of
sale.).
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. 7044, Business and Professions Code:) The Contractor's Li-
cense Caw does not apply to an owner of property who builds or improves thereon, and.
who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's
License Law.
❑ I am exempt under Sec B & P C for this reason
OwnerDate
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
'have and will maintain a Certificate of Consent to self -insure for Worker's Compen-
.m, as provided for by Section 3700 of the Labor Code, for the performance of the
work for which this permit is issued.
have and will maintain Worker's Compensation Insurance, as required by Section
3700 of the Labor Code, for the performance of the work for which this permit is issued
My Worker's Compensation Insurance carrier and Policy number am:
Carrier. 1140 I'A 9'14V_iTVj' 1'e f PolicyN6! -s - S 10 00,' v /
r
CER171KCATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100)
or less.)
I certify that in the performance of the work for which this permit is issued, 1 shall not
employ any person in any manner to be me subject to the Workcrs' Compensation
- �".91
Laws of Calif i;, Date r
Applicant ':Y 9'141&] Kwi i
NOTICE TO APPLICANT: If, atter making dfis Certificate of Exemption, you should
become subject to the Worker's Compensation provisions of the Labor Code, you must
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
the work for which this permit is issued (Sec. 3097, Civ. C.)
Lender's Name
Lender's Address
j 1 certify that I have mad 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
1 above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of Cupertino against
1 liabilities, judgments, costs and expenses which may in any way accrue against said City
in consequence of the granting of this permit
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
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Issued by: Date - -f
SOUR 3tEGULATIONS.
os
Date
Re -roofs _
Signature of Applicant/Contractor
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety
Code, Section 25532(a)?
❑ Yes o
All roofs :;hall be inspected prior to any roofing material being installed.
If a roof is;installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupant use equipment or devices which
hazardous air contaminants as defined by the Bay Area Air Quality Management
all new m iterials for inspection.
rich?
Q Yeso
1 have read the hamnkws materials mquircmcnts under Chapter 6.95 of the Califor-
nia Health & Safely Code, Sections 25505.25533 and 25534.1 understand that if t he building
does not currently have a tenant that it is my responsibility to notify the occupant of the
t�ements which must met prior to issuance of a Certificate of Occupancy.
Signature of Applicant U U Date
�- _ ass
All roof coverings to be Class ''j" or better
Owner or authorixcd gent Date
Lj
CITY OF C.UPERTINO
RE_ ORF
PERMIT APPLICATION
APN #
Date:
L-aY zCIO 1�
Building Address :. �8 � �
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Owner's Name:
Phone #:
Contractor: ��
Phone #: YO J_ 6�i�--
Fax#: K9,?- Z67- "9S
Cupertino Business License #:
Contractor License M
3Z -5-/3i
Type of Roof Covering:
Existing:
.Proposed:
❑ Built -Up Roof
❑ Built -Up roof
❑ Asphalt Shingles
❑ Asphalt Shingles
Wood Shakes
❑ Wood Shakes�-
❑ Wood Shingles
❑ Other (Specify)
❑ Wood Shingles
�< Other (Specify)
Number of existing coverings
VProvide I.C.B.O. Report # I y%%
To be Removed
❑ Provide Mfgr. Installation Specs.
Job Description: v�chi c l-
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—4- ��1-� �� a C,ls-
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: / _
/ y �6
I Have Read, Understand and Will Comply with ,Zupertino's Tear -Off Policy:
-11Aj L,7
Signature
Revised 6/16/08
CITY OF CUPERTINO
REROOF
CUPEI�TINO FEE SCHEDULE
Number of
Squares
Fee ID
Fee Description
Fee
Group
Permit Type
1REROOFCOM
Re -roof Commercial
B
1COMMLROOF
1BSEISMICO
Seismic Commercial
B
1REROOFRES
Re -roof Residential
B
1SFDWLROOF
/
1BSEISMICRE
Seismic Residential
B
CA- Oil) �
1 REROOFMRES
Re -roof Mu [ti -Family
B
1MFDWLROOF
1BSEISMICRE
Seismic Residential
B
1BUSLIC
Business License
B
Revised 6/16/08
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 r:! -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 b-Ading inspector when the re -roofing
is completed.
3. All roofs shall be inspected prior to ar.y 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 mz terial 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
jjthe above stated policy on re -roofing.
Homeowner's Name: n 1W
Job Site Address: 7 A L' L'- /t i d c�_ L,. ani
Roofing Company Name: W 0 v s t' J d,, 4,c
Applicant's Signature: dVIZIJ C Date:
Greg Casteel
Building Official
Reviscd 07/30/08
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-7 ./03 _4
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Plan Review Process Work Book Page -12-Revised 3/25/03
Green Budding Plan Check
Index of Green Building Points/Categories
A. Category
Example of an Index or Table of C reen
Plan Sheet or Page
Points
Building Points Categories that mist be
shown and referenced on the Prc ject
Plans See below
B. Site
9. Install H.E. Irrigation, (details/sp,:c)*
L-1
2 points
11. Permeable Paving, Note
L-1
2 points
C. Foundation
1. Use 15 % Flyash Concrete, (nota)
S-1
5 points
D. Structural
3. Uses Wood I -Joist, (See Spec.)
S-2
2 points
5. Use Truss with heels, (detail)
S-2
2 points
6. B. OSB Sheathing, detail
S-2
2 points
E. Ext. Finish
1. Composite Decking, (Note/Spec.)
A-3
2 points
4. B. Fiber Cement Siding, (Note/Spec.
A-4
2 points
F. Plumbing
1. Insulate all H.W. pipes, (Note/Spec.)
P-1
2 points
5. Tankless W.H., (Note/Spec.)
A-2
2 points
11. A 2500 Gal. Tank, (Note/Spec
L-1
10 oints
G. Electrical
4. E. Ceiling Fans, (Note/Spec.)
A-3
4 points
H. Appliances
1. Energy Star Dishwasher, (Note/3pec.)
A-3
1 point
3. Energy Star Refrigerator, Note/3 ec.
A-3
of
P. Other
1. List Green Features on Plans
A-1
1 point
TOTAL POINTS
40 points
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-7 ./03 _4
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Ccis
Plan Review Process Work Book Page -12-Revised 3/25/03
1. Install Energy-EfficierA whbw
a. Double -Paned 1 Energy pt
b. tar-9ftsivity (LoNr-E) 2 Energy pts
c. Low. Conductivity 2 Energy pts
2. Install Low Heat Transmission Glazing 1 Energy pt
J. Heating Ventilation and Air Conditioning
2 Energy pts
y=yes
1. Use Duct blastic on Ail Duct Joints
2 Energy pts
y=yes
2. Install Ductwork within Conditioned Space
3 Energy pts
y=yes
3. Vent Range Hood to the Outside
1 IAQ/Health pt
y --yes
4. Clean all Ducts Before Occupancy
2 IAQ/Health pts
y=yes
5. Install Solar Attic Fan
2 Energy pts
y=yes
6. Install Attic Ventilation Systems
1 Energy pt
y=yes
7. Install Whole House Fan
4 Energy pts
y=yes
8. Install Sealed Combustion Units
3 IAQ/Health pts
y=yes
a. Furnaces
3 IAQ/Health pts
y=yes
b. Water Heaters
3 [AD/Health pts
y=yes
9. Replace Wall -Mounted Electric and Gas Heaters with
Through -the -Wall Heat Pumps
3 Energy pts
y=yes
10. Install 13 SEER/11 EER or higher AC with a TXV
3 Energy pts
y=yes
11. Install AC with Non -HCFC Refrigerants
? Resource pts
y=yes
12. Install 90% Annual Fuel Utilization Efficiency (AFUE) Furnace
2 Energy pts
y=yes
13. Retrofit Wood Burning Fireplaces
0 Energy pts
y=yes
a. Install EPA certified wood stoves/inserts
1 IAQ/Health pt
y=yes
b. Install/Replace Dampers
1 Energy pt
y=yes
c. Install Airtight Doors
1 Energy pt
y=yes
14. Install Zoned, Hydronic Radiant Heating
3 Energy pts
y=yes
15. Install High Efficiency Filter
4 IAQ/Health pts
y=yes
16. Install Heat Recovery Ventilation Unit (HRV)
5 IAQ/Health pts
y=yes
17. Install Separate Garage Exhaust Fan
3 IAQ/Health pts
y=yes
K. Renewable Energy and Roofing
1. Pre -Plumb for Solar Water Heating
4 Energy pts
y=yes
2. Install Solar Water Heating System
0 Energy pts
y=yes
3. Pre -Wire for Future Photovoltaic (PV) Installation
4 Energy pts
y=yes
4. Install Photovoltaic (PV) System
(1.2 kw = 6 points, 2.4 kw = 12 points, 3.6 kw = 18 points)
Up to 18 Energy
pts
6. Select Safe and Durable Roofing Materials
Resource pt
y=yes
7. Install Radiant Barrier
3 Energy pts
y=yes
L. Natural Heating and Cooling
1. Incorporate Passive Solar Heating i Energy pts y=yes
2. Install Overhangs or Awnings over South Facing Windows 3 Energy pts . y=yes
3. Plant Deciduous Trees on the West and South Sides 3 Energy pts y=yes
1. Use Low/No-VOC Paint
1 IAQ/Health pts
y --yes
2. Use Low VOC, Water -Based Wood Finishes
2 IAQ/Health pts
y=yes
3. Use Low/No 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
t 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 all Exposed Particleboard 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
1. Select FSC Certified Wood Flooring -
i Resource pts
y=yes
2. Use Rapidly Renewable Flooring Materials
t Resource pts
y=yes
3. Use Recycled Content Ceramic Tiles
t 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
t Resource pts
y=yes
6. Install Recycled Content Carpet with Low VOCs
t Resource pts
y=yes
Total Points Available:
Total Points Project Received:
1401 1301 57
01 0_ 0
G:data/progs/gree nbuildingguidelines/remodelerslgreenpointsfina121204protected.xis
,7-,),/'-zc'Os
CITY OF
`;UPEkTINO
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Building Department
JOB ADDRESS:
L/ ea d� ,,�
PERMIT
: moo � - o 0 �
OWNER'S NAME: �j I Z- I,. 4-L S g
PHONE #
GENERAL CONTRACTOR: i ,,
FAX #
v
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
Owner/ Co-14ractqr ignature
c9-Ozil- 741621
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
f./
Roofing
�,t1 D s -� •t
2 0 l 1-2
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/ Co-14ractqr ignature
c9-Ozil- 741621
Date