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10040094 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 847 SEPTEMBER DR CONTRACTOR:KEVIN SULLIVAN PERMIT NO: 10040094 ROOFING C 'IER'S NAME: KWONG JAMES W AND PRISCILLA S 1696 VALLEY OAKS DR DATE ISSUED:04/15/2010 OWNER'S PHONE: 4082531552 GILROY,CA 95020 PHONE NO:(408)842-1057 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT r— PLUMB F_ License Class G Lic.# [� MECH RESIDENTIAL COMMERCIAL Contractor r �5 ,,1a 71 � Lasey ! —1 I hereby affirm that I am licensed oder the provisions of Chapter 9 REB DESCRIPTION:RE-ROOF TO REMOVE EXISTING COMP SHINGLES& (commencing with Section 7000)of Division 3 of the Business&Professions WITH 40YR COMP CLASS A 15SQ 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 Sq.Ft Floor Area: Valuation:$5000 permit is issued. APPLICANT CERTIFICATION APN Number:36212010.00 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, 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 ce gulations per the Cupertino Municipal Code,Section �� 9.18. Issued bx✓ % Z .�� Date: C' mature Date !✓ OWNER-BUILDER DECLARATION RE-ROOFS: 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 compensation, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Signature of Applicant: Date: T 1,as owner of the property,am exclusively contracting with licensed contractors to j construct the project(Sec.7044,Business&Professions Code). ALL ROC>-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& 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 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 shall 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 Own r u i d agent: become subject to the Worker's Compensation provisions of the Labor Code,I must Date: —/441�0 forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION 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 relating 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 'he above mentioned property for inspection purposes.(We)agree to save nify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address As,and expenses which may accrue against said City in consequence of the .ranting of this pe it.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION with all non-poi ource regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. Signatur Date �{ /S —� Licensed Professional CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 36212010 . 00 DATE ISSUED. . . . . . . : 04/15/2010 RECEIPT #. . . . . . . . . BS000010192 REFERENCE ID # . . . : 10040094 SITE ADDRESS . . . . . : 847 SEPTEMBER DR SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER KWONG JAMES W AND PRISCILLA S ADDRESS 847 SEPTEMBER DR CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4148 RECEIVED FROM . . . . : ROOFSERV ROOFING CONTRACTOR . . . . . . . : KEVIN E. SULLIVAN LIC # 23810 COMPANY KEVIN SULLIVAN ROOFING ADDRESS 1696 VALLEY OAKS DR CITY/STATE/ZIP . . . : GILROY, CA 95020 TELEPHONE . . . . . . . . : (408) 842-1057 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 5, 000 . 00 1. 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 5, 000 .00 0 . 50 0 . 00 0 .50 0 . 00 1REROOFRES SQ FEET 15 . 00 195 . 00 0 . 00 195 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 196 .50 0 . 00 196 . 50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 196 .50 #7745 --------------- TOTAL RECEIPT 196 . 50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 604 ROOF IN-PROGRESS 605 FINAL REROOF CITY OF CITY OF CUPERTINO a] REROOF CUPERTINO PERMIT APPLICATION APN# Date: Building Address: Owner's Name��me5 �,.� ('� ��o,,rel Phone #: HOA: Yes ❑ No D6 If yes, provide letter from HOA Contractor: Phone #: _ 6-'12- - /�,;-7 6��ery .� Fax#: Cupertino Business License #: )c-h-� Contractor License #: _ � t 5-03715 Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof �X' Asphalt Shingles X 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 ` 11 nU CVh7/o 5�1 os.gles G ter 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: # 5, 6)062 I Have Read Underst nd and Will Comply with Cupertino's Tear-Off Policy: Signatu e Revised 02/05/09 CITY OF CUPERTINO a] REROOF CUPERTINO FEE SCHEDULE Number of Fee ID Fee Description Fee Permit Type Squares Group 1REROOFCOM Re-roof Commercial B 1COMMLROOF 1BCBSC Ca1'Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMIC0 Seismic Commercial B f 1RER00FRES Re-roof Residential B 1SFDWLR00F 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee / 1BSEISMICRE Seismic Residential B 1RER00FMRES Re-roof Multi-Family B 1MFDWLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICRE Seismic Residential B 1BUSLIC Business License B REROOF TEAR-OFF POLICY COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION ALBERT SALVADOR, P.E.,C.B.O., BUILDING OFFICIAL" 10300 TORRE AVENUE-CUPERTINO, CA 95014-3255 %:UPERTINO (408)777-3228•FAX(408)777-3333-buildinaCalcuoertino.org FEADDESS APN# WPHONE /�`/ 2>�_ fJ�z E-MAIL JC STATE,7ZIP , ��0FAX ESS /�L. /1>✓ r Com"NAME 00r` � LICENSE NUMBER L[CEN EYP BUS.LIC.# " 3FAX M ESS'V/ (O V i✓�� C/�f�j�TC�� C6'STZIP -)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 insaection 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 — 10:30am and 1:00—3:30pm (Mon—Thurs); 7:30 — 10:30am and 1:00-2:30pm (Friday). 4. If plywood is installed, a plywood nailing inspection is 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 and the job is not ready, you will be charged to a re- inspection fee of$126.00. The re-inspection fee shall be uaid before another inspection can be scheduled. my signature below, I certi t each of the following: I an the property owner or authorized agent to act on we property owner's behalf derst a ee to comply with the re-roof policy stat above. Date: Signature of Applicant/Agent: ReroofPo1icy_M10.doc revised 04114/10 M.Indoor Air Quality and Finishes INPUT Resources Energy 1AD!Heafth 1.Use Low/No-VOC Paint 1 IAQ/Health pts y=yes 0 2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes. 0 3.Use Low/No VOC Adhesives 3 IAQ/Health pts y=yes 0 4.Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes 0 5.Use Engineered Sheet Goods with no added Urea Formaldehyde 61AQ/Health pts y=yes D 6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 0 7.Seal all Exposed Particleboard or MDF 4 IAQ/Health. pts y=yes 0 8.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes 0 9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y=yes 0 10.Install Whole House Vacuum System 3 IAQ/Health pts y=yes 0 1 ! 1 N.Flooring 1.Select FSC Certified Wood Flooring 8 Resource pts y=yes 0 2.Use Rapidly Renewable Flooring Materials 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/Health pts y=yes D 5.Use Exposed Concrete as Finished Floor 4 Resource pts y=yes 0 6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes 0 1 ! ! Total Points 1 1401 130 57 �L Total Points Project Received: ,,. � � 01 01 0 q G:data/progs/greenbuiidingguidelines/remodelers/greenpointsfina1212.D4protected.xls Building Department City Of Cupertino LM 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 CUPERTINO Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: R7 �j ,-� di PERMIT# OWNER'S NAME: g7es iL�--�.� PHONE# zfofS' ZS -4� 2, GENERAL CONTRACTOR: BUSINESS LICENSE# ADDRESS: ��/ *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 SU CONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. /� I am not using any subcontractors: Signature Date Please check applicable subcon ractors 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