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10050053F CITY OF CUPERTINO BUILDING PERMIT i BUILDING ADDRESS: 20092 JOHN DR OWNER'S NAME: GEORGE GARCIA 1ER'S PHONE: 4082528931 ❑ LICENSED CONTRACTOR'S DECLARATION License Class — 5 `� Lic. #��� ��, '5jjj 6 � 7s —/Ji Contractor �U 4 �)" tDate I hereby affirm that I am licensed under t e 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 <=�' --^ Date—L Zo1 J Signe Signatur LJ 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 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 construct 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, .s, and expenses which may accrue against said City in consequence of the grantingof this permit. Additionally, the applicant understands and will comply with all non-pe'nt source regulations per the Cupertino Municipal Code, Section 9.18. 1 Signature Date CONT 3ACTOR: CUPERTINO ROOF, INC PERMIT NO: 10050053 1052 KELLY DR DATE ISSUED: 05/05/2010 SAN JOSE, CA 95129 PHONE NO: (408)973-9427 BUILDING PERMIT INFO: BLDG ELECT PLUMB r MECH f— RESIDENTIAL r— COMMERCIAL JOB DESCRIPTION: RE -ROOF TEAR OFF SHAKE SHINGLES INSTALL 7/16 OSB INSTA -L 40YR SHINGLES CLASS A 25SQ**SEE NOTES** Sq. Ft Floor Area: Valuation: $10000 APN Plumber: 36934025.00 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 1 SO DAYS FROM LAST CALLED INSPECTION. Issue byr Date'—S RE -ROOFS: All ro As 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 inspe(tion. Signature of Applicant:_ Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I hav - read the hazardous materials requirements under Chapter 6.95 of the Calif )rnia Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain com f liance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air conte minants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Heal h & Safety Code, Sections 25505, 25533, and 25534. -Own -,,r or author' ed agent: , _ _ Z a t n �Date: CONSTRUCTION LENDING AGENCY I her(:by affirm that there is a construction lending agency for the performance of work's for -A hich this permit is issued (Sec. 3097, Civ C.) Len( er's Name Len(ler's ARCHITECT'S DECLARATION I un(erstand my plans shall be used as public records. Licensed Professional 3 ITEMS OF 4 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lct: APN ........: 36934025.00 DATE ISSUED.......: 05/05/2010 RECEIPT #.........: BS000030326 REFERENCE ID # 100500`_3 SITE ADDRESS 20092 �FOHN DR SUBDIVISION ...... CITY CUPERTINO IMPACT AREA ...... OWNER ............: GEORGE GARCIA ADDRESS 20092 JOHN DR CITY/STATE/ZIP ...: CUPERTINO, CA 95014 OPERATOR: patg COPY # : 1 RECEIVED FROM DAVE S141TH CONTRACTOR DAVE SAITH LIC # 25701 COMPANY CUPERTINO ROOF, INC ADDRESS 1052 K"�LLY DR CITY/STATE/ZIP SAN JOSE, CA 95129 TELEPHONE (408)973-9427 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT ---------- THIS REC NEW BAL ----------------------- 1BCBSC VALUATION ---------- 10,000.00 ---------- 1.00 0.00 1.00 1.00 0.00 0.00 1BSEISMICR VALUATION 10,000.00 1.00 0.00 0.00 325.00 1REROOFRES SQ FEET 25.00 325.00 ---------- ---------- ------0_00 ---------- 327.00 0.00 327.00 0.00 TOTAL PERMIT VOICE ID DESCRIPTION -------- ---------------------------- 601 ROOF TEAR OFF VOICE ID DESCRIPTION -------- ---------------------------- 602 ROOF PLYWOOD NAIL 604 ROOF IN -PROGRESS 605 FINAL REROOF CITY OF CUPERTINO CITY OF CUPERTINO REROOF PERMIT APPLICATION Date: Building Address: �_ ---- ID Owner's Name: 'o r.`r i Phone #: '2 S'2 l31 HOA: Yes ❑ __N-o---S_If yes, provide letter fr,)m HOA Contractor: Phone #: 9,13- _ �( 41 C �� �- n u �� a. r ►1 Fax #: Cupertino Business License #: Contractor License #: fit, 4.3-1 Type of Roof Covering: Existing: ❑ Built -Up Roof ❑ Asphalt Shingles \ ❑ Wood Shakes `� Wood Shingles ❑ Other (Specify) Number of existing coverings 'Z �'- --a To be Removed Job Description ` 8 1 Q QY 5k, 1 �� `l twMIIIIIIIIIIIII Proposed: ❑ Built -Up roof ❑ Asphalt Shingles ❑ Wood Shakes ❑ Wood Shingles ❑ Other (Specify) ❑ Provide I.C.C.E.S. Report # ❑ Provide Mfgr. Installation Specs. 1►�s+air 1�I� �s3 d "4 2 Commercial Green Building: Please complete relevant portion A 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: 1b, c -- f• Read, Understand and Will Comply with Cupertino's Tear -Off Policy: i ature Revised 02/05/09 CITY OF CITY OF CUPERTINO REROOF CUPERTINO FEE SCHEDULE Number of Squares Fee ID Fee Description=Group Permit Type 1REROOFCOM Re -roof Commercial B 1COMMLROOF 1BCBSC Cal Bldg Standard Commission Fee B ALL PERMIT TYPES 1BSEISMICO Seismic Commercial B % 1REROOFRES 1BCBSC Re -roof Residential Cal Bldg Standarc.s Commission Fee B B 1SFDWLROOF ALL PERMIT TYPES 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 1. Use Low/No-V©C Paint 2. Use Low VOC, Water -Based VYood Finishes 3. Use Low/No VOC Adhesives 4. Use Salvaged Materials for Interior Finishes 5. Use Engineered Sheet Goods with no added Urea Formaldehyde B. Use Exterior Grade Plywood for Interior Uses 7. S" aj EVe-,W +par4oleoard or WDF B. Use FSC Certified Materials for Interior Finish 9. Use Finoer-Jointed or Recycled -Content Trim 10. Install Whole House Vacuum System H. Flooring 1. Select FSC Certified Wood Flooring 2. Use Rapidly Flanewahie Flooring Materials 3. Use Recycled Content Ceramic Tiles 4. Install Natural Linoleum in Place of Vinyl . 5. Use Exposed Concrete as Finished Floor 6. Install Recycled Content Carpet with Low VOCs 1 IAQ/I ealth pts y=yes 2 IAO/F ealth pts y=yes 3 [AD -IF ealth pts y=yes 3 Reso uroe pts y=yes 61AQ/Haalth pts y=yes 11AQ/ilealth pts y=yes 4IAQ/Health. pis y=yes 4 Resc urce pts y=yes 1 Ram urce pts y=yes 3 IAa Healtn pts y=yes Total Points Availaale: Total Points Project Received: 8 Resource pts y=yes 4 Reso lrce pts y=yes 4 Reso irce pts y=yes 5 IAQ/liealth pts ygac 4 R 83 JMe pts y=yeE 4 ReSDJrDB pts y=ye: C MW IM a:datalprogslgreenbuildir gguidelines/ramodelerslgreenpointsfina1212.D4prote--ted.xls D 0 4 MW IM a:datalprogslgreenbuildir gguidelines/ramodelerslgreenpointsfina1212.D4prote--ted.xls CUPERTINO REROOF TEAR -OFF POLICY COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING JFFICIAL 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildin a'�cupertino.orq "S b r N `� 2 v o � 2, �'1 t APN tl PHONE E-MAIL rEADDRESS ESS� C��Nen Z v C �— a,� J CITY, STATE, ZIP L 9 FAX LICENSE p U CBER� LICENSE? P NAME e��iAME BUS. LIC. N E-MAIL FAX STREET ADDRESS Z (� It p<__ CITY, STATE, ZIP �G�'1 '� (� 5' Q Coq 1'f)2_ PHON 2_ 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. An inspection request shall be scheduled the day before the inspection date. Please call (408)777- 3228 between 7:30 - 3:30pm (Mon -Fri) to schedule the next day inspection. 3. After the roof is torn off and the nails/fasteners have been removed and all the dry -rotted wood has been replaced, you must call for a roof inspection. A building inspector will be available with one hour. There are special hours for the service: 7:30 — 10:30 m. and 1:00 — 3:30pm (Mon — Thurs); 7:30 —10:30 m. and 1:00 — 2:30pm (Friday). 4. If plywood is installed, a plywood nailing inspection I's required. 5. New roof coverings shall not be applied without first obtaining all inspection 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. 6. A final inspection and approval shall be obtained from the building inspector when the re -roofing is completed. To receive a final sign -off, the following item will be verified: a. Flat roofs shall have a minimum of/" per foot of slope and demonstrate there is no ponding. b. A listing from an approved testing agency shall be available on-site to review at the time of the inspection. c. Proper spark arrestor installation. 7. NOTE: If you call for a plywood nailing inspection :ind the job is not ready, you will be charged to a re- inspection fee of $126.00. The re -inspection fee sha: l be paid before another inspection can be scheduled. -1y my signature below ,�- I certify to each of the following: I am the property owner or authorized agent to act on rne property owner's beh If. understan and agree to comply with the re -roof policy stated above. Signature of Applicant/Agent:� Date: —_ I g ReroofPolicy_2010.doc• revised 04114110 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST o JB ERMIT # JOB ADDRESS: 2 r/ c' �- J O �� per'HONE # Z Z — `' OWNER'S NAME: eo f �L� � USINESS LICENSE #GENERAL CONTRACTOR: `•- � ITY/ZIPCODE: ADDRESS: 1 D S"2 (mac ( - *Our municipal code requires all businesses working in the c ty to have a City of Cupertino business license. UNTIL THE NO BUILDING FINAL OR FINAL OCCUPANCY [SPECSPECC'T0RSIHAVE OBTAINED AWILL BEHCITY OF CUPERTINO GENERAL CONTRACTOR AND ALL SUBCONTRACT JR BUSINESS LICENSE. 1 I am not using any subcontractors: Signature Please check applicable subcontractors and complete tLe following information: BUSINESS N Date Owner / Contractor Signature Date