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10060174CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10744 BROOKWELL DR
OWNER'S NAME: CATHERINE JOHNSON
NER'S PHONE: 4082552963
l} ) LICENSEED CONTRACTOR'S DECLARATION
License Class C -? ) Lic. # (yt Y3 _1
Contractor c 04� y "} ) Date L — Z g — Z -a ' o
I hereby affirm that I am licensed under the provisions of Chapter 9
(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 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
permit is issued.
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
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
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
9.18.
Signature Date C7 2 Q _Z0
L-1 OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
I, as owner of the property, or my employees with wages as their sole compensation,
will do the work, and the stricture 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
constrict the project (Sec.7044, Business & Professions Code).
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
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
permit is issued.
I certify that in the performance of the work for which this permit is issued, I shall
not employ any person in any manner so as to become subject to the Worker's
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
forthwith comply with such provisions or this permit shall be deemed revoked.
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
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
mnify and keep harmless the City of Cupertino against liabilities, judgments,
, 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
9.18.
Signature Date
CONTRACTOR: CUPERTINO ROOF, INC PERMIT NO: 10060174
1052 KELLY DR DATE ISSUED: 06/28/2010
SAN JOSE, CA 95129 PHONE NO: (408)973-9427
BUILDING PERMIT INFO: BLDG ELECT r— PLUMB
MECH r— RESIDENTIAL r COMMERCIAL I—
JOIN DESCRIPTION: RER-ROOF TEAR OFF SHAKES & INSTALL 7/16 OSB.
INS1 ALL FELT 50YR SHINGLES CLASS A 26SQ
Sq. Ft Floor Area: Valuation: $12800
API\ Number: 36921039.00 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by:
Date:
RE -ROOFS:
All n )ofs shall be inspected prior to any roofing material being installed. If a roof is
insta led without first obtaining an inspection, I agree to remove all new materials for
inspection.
Sign, iture of Applicant ``-- Z-- Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I ham a read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safe, y Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
mair tain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
r—
Ow}ieior uthoriz agent:
�,-� Z�
Date
CONSTRUCTION LENDING AGENCY
I her,;by affirm that there is a construction lending agency for the performance of work's
for w hich this permit is issued (Sec. 3097, Civ C.)
Len( er's Name
Lent er's
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
CITY OF CUPERTINO
2 ITEMS OF 2 PERMIT R];CEIPT OPERATOR: patg
COPY # : 1
Sec: Twp: Rng: Sub: Blk: ].jot:
APN ........: 36921039.00
DATE ISSUED.......: 06/28,2010
RECEIPT #.........: BSO00010721
REFERENCE ID # ...: 10060/74
SITE ADDRESS .....: 10744 BROOKWELL DR
SUBDIVISION ......
CITY .............. CUPERTINO
IMPACT AREA ......
OWNER ............: CATHE]2INE JOHNSON
ADDRESS ..........: 10744 BROOKWELL DR
CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-4609
RECEIVED FROM ....: DAVE :SMITH PRE
CONTRACTOR .......: DAVE ;SMITH LIC # 25701
COMPANY ..........: CUPERTINO ROOF, INC
ADDRESS ..........: 1052 :CELLY DR
CITY/STATE/ZIP ...: SAN JOSE, CA 95129
TELEPHONE ........: (408))73-9427
FEE ID UNIT
QUANTITY AMOiJNT
PD -TO -DT
THIS REC
NEW BAL
-----------------------
1BCBSC VALUATION
--------------------
12,800.00 1.00
----------
0.00
----------
1.00
----------
0.00
1REROOFRES SQ FEET
26.00 338.00
---------
0.00
----------
338.00
----------
0.00
----------
TOTAL PERMIT
339.00
0.00
339.00
0.00
METHOD OF PAYMENT
-----------------
CREDIT CARD
TOTAL RECEIPT :
AMOUNT
---------------
339.00
---------------
339.00
VOICE ID DESCRIPTION
-------- ----------------------------
601 ROOF TEAR OFF
REFERENCE NUMBER
--------------------
Mil
VOICE ID DESCRIPTION
-------- ----------------------------
602 ROOF PLYWOOD NAIL
604 ROOF IN -PROGRESS 605 FINAL REROOF
CITY OF
CITY OF Cv PERTINO
REROOF
CUPERTINO PERMIT APPLICATION
[ (DV-,, k1 7 q
APN # � � c) �
Date: � _ � � �. 2
Building Address: ,
Owner's Name: C 614� ,.4,. w�.� Se --j
Phone #:
HOA: Yes ❑ Nom[] If yes, pMvide letter from HOA
Contractor: � v � � 1 � ` i
Phone #:
`J
Fax #:
Cupertino Business License #:
Contractor License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built -Up Roof y� ❑ Built -Up roof
❑ Asphalt Shingles `-a Asphalt Shingles
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: --� Q ,_ p..Q� ��1--•�1�� 3 vl S j'�� �1 6 D S' rj
Feld- rNS+C0
Reside 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: 1 Z) z o o
Iav ad, Understand and Will Comply with Cup -Irtino's Tear -Off Policy:
7
Signt ture
Revised 02/05/09
CITY or
CITY OF CU PERTINO
REROOF
cUPER INO 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 I'ee
B
ALL PERMIT TYPES
1BSEISMICRE
Seismic Residential
B
1RER00FMRES
Re -roof Multi -Family
B
1MFDWLROOF
1BCBSC
Cal Bldg Standards
Commission Fee
B
ALL PERMIT TYPES
1BSEISMICRE
Seismic Residential
B
1BUSLIC
Business License
B
REROOF TEAR -OFF POLICY
COMMUNITY DEVELOPMENT DEPARTME� T • BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
CUPERTINO 10300 TORRE AVENUE • CUPERTINO, CA f 5014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(kupertino.org
PROJECT ADDRESS 1 N'1
APN,#/^
OWNER NAME. \ I � 1/r0 ,
T©
`l �. 1
PHONE •� r/�-2G1 1'J E-MAIL
STREET ADDRESS ' -) !,y Q I / L`
CITY, STATE, ZIP L' � //. �, tF) ^ u
FAX
CONTRACTOR NAM 1 J
\/ _ _.
LICENSE Nli�
LICENSy Tl
BUS. LIC'_ #
COMPANY NAME*�J^.
E-MAIL
FAX
STREET ADDRESS,. O
CITY, STATE, ZIP .'+ T' 0) � j -LPHON
I UNDERSTAND AND AGREE TO THE FOLLOWING:
1. The re -roof project shall comply with all applicable provisions of the 2007 California Building Code.
2. You must schedule all needed inspections a minimurr of one day before the requested inspection date.
Please schedule inspections online or call (408)777-3 228 between 7:30-3:30 (Mon -Fri).
3. Tear -off roof inspection is required. Please call for tear -off inspection after the roof is torn off and all
the nails/fasteners have been removed. Any and al dry -rotted wood shall be replaced prior to this
inspection. A building inspector tvill be available within one hour.
There are special hours for this service: 7:30 — 10:-,Oam and 1:00 — 3:30pm (Mon — Thurs);
7:30 — 10:_�'Oam and 1:00 — 2:30pm (Friday).
4. If plywood is installed, a plywood nailing inspection is required.
5. In -Progress roof inspection is required. Call for ar in -progress roof inspection to verify building is
weather tight after installation of approximately 25% of the roofing material.
6. New roof coverings shall not be applied without first obtaining all inspections and written approvals
from the building inspector. Any roofing which is applied without first obtaining an approved inspection
will require the removal of all new material down to the sheathing so a proper inspection can be
performed.
7. A final inspection and approval shall be obtained frori the building inspector when the re -roofing is
complete. To receive a final sign -off, the following ii ems will be verified:
a. Flat roofs shall have a minimum of '/4" per foot of slope and must demonstrate there is no ponding.
b. Listings from approved testing agencies for all pre -manufactured products used shall be available
on-site to review at the time of the inspection.
c. Proper spark arrestor installation.
8. NOTE: If you call for a tear -off or plywood nailing nspection and the work is not complete, you will
be charged a re -inspection fee of $126.00. The re -inspection fee shall be paid before another
inspection can be scheduled.
By my signing be ow, I certify eac of the following is true: I am the property owner or authorized agent to act
on the property owner's behalf. I u rstand d agree to comply with the re -roof policy stated above.
Signature of Applicant/Agent: Date: Ln — ^�� A —�_20 1 0
—'" ReroofPolicy_2010.doc revised 05/17/10
M. Indoor Air Quality and Finishes
1. Use Low/No-VOC Paint
1 IAO/Health pts
y=yes
2. Use Low VOC, Water -Based Wood Finishes
2 IA(VHealth pts
y=yes
3. Use Low/No VOC Adhesives
3 IAO/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
61A(VHealth pts
y=yes
6. Use Exterior Grade Plywood for Interior Uses
1 IA(d/Health pts
y=yes
7. Seal all Exposed Particleboard or MDF
4 IA(VHealth. pts
y=yes
B. Use FSC Certified Materials for Interior Finish
4 Re3ource pts
y=yes
9. Use Finger -Jointed or Recycled -Content Trim
1 Re3ource pts
y=yes
1 D. Install Whole House Vacuum System
3 lA XHealth pts
y=yes
-
N. Flooring
1. Select FSC Certified Wood Flooring
8 Reswrce pts
y=yes
2. Use Rapidly Renewable Flooring Materials
4 Res)urce pts
y=yes
3. Use Recycled Content Ceramic Tiles
4 Res )urce 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 Res )urce pts
y=yes
6. Install Recycled Content Carpet with Low VOCs
4 Res wrce pts
y=yes
Total Points Available:
Total Points Project Received:
1401 130 57
01 01 0
G:data/progs/greenbuildn 39uidelines/remodelers/greenpointsfinal2.12.04protected.xis