10010156CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10700 CLUB HOUSE LN I CONTRACTOR: KEITH ROOFING CO INC PERMIT NO: 10010156
OWNER'S NAME: TODD ANDERSON
JER'S PHONE: 4089963967
w—_ LICENSED CONTRACTOR'S DECLARATION
License Cla Lic. #
Contr for Date
I h e A6
it that I anlicensed 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 pe t. Additionally, the applicant understands and will comply
with all non- nt urce regulations per the Cupertino Municipal Code, Section
9.18. h
Si ature Date / �U
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 contract*",*,
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
nnify 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 -poi o ce regulations per the Cupertino Municipal Code, Section
9.18. > X
Sign re Date
920 LINCOLN AVE I DATE ISSUED: 01/27/2010
SAN JOSE, CA 95126 1 PHONE NO: (408)295-8616
BUILDING PERMIT INFO: BLDG I— ELECT F PLUMB I—
MECH F RESIDENTIAL F COMMERCIAL F
JOB DESCRIPTION: MAINTENANCE HOUSE GOLF COURSE - REMOVE SHAKE
ROOF,
INSTALL 7/16" OSB, INSTALL 30YR COMP W/30LB
UNDERLAYMENT CLASS A 13SQ;
Sq. Ft Floor Area:
Valuation: $7440
APN Number: 35604042.CLBHS I 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 roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining nspection, I agree to remove all new materials for
inspection.
Signature of Applic t: Date:
l G
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have 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 &
Safety 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
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
Ow r or thorized agent:
�7 r Date:�IZ-7ka
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
3 ITEMS OF 3
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 35604042.CLBHS
DATE ISSUED.......: 01/27/2010
RECEIPT #.........: BS000009631
REFERENCE ID # ...: 10010156
SITE ADDRESS .....: 10700 CLUB HOUSE LN
SUBDIVISION ......:
CITY CUPERTINO
IMPACT AREA .......
OWNER ............: TODD ANDERSON
ADDRESS ..........: 10700 CLUB HOUSE LN
CITY/STATE/ZIP ...: CUPERTINO, CA 95014
OPERATOR: patg
COPY # : 1
RECEIVED FROM ....: ROGER BRIGHT
CONTRACTOR .......: BRIGHT, ROGER LIC # 21477
COMPANY ..........: KEITH ROOFING CO INC
ADDRESS ..........: 920 LINCOLN AVE
CITY/STATE/ZIP ...: SAN JOSE, CA 95126
TELEPHONE ........: (408)295-8616
FEE ID UNIT
QUANTITY
AMOUNT
PD -TO -DT
THIS REC
----------
NEW BAL
----------
-----------------------
1BCBSC VALUATION
----------
71440.00
----------
1.00
----------
0.00
1.00
0.00
1BSEISMICR VALUATION
71440.00
0.80
0.00
0.80
0.00
1REROOFRES SQ FEET
13.00
169.00
0.00
169.00
----------
0.00
----------
TOTAL PERMIT
----------
170.80
----------
0.00
170.80
0.00
METHOD OF PAYMENT
-----------------
CREDIT CARD
TOTAL RECEIPT :
AMOUNT
---------------
170.80
---------------
170.80
VOICE ID DESCRIPTION
-------- ----------------------------
601 ROOF TEAR OFF
REFERENCE NUMBER
--------------------
VISA
VOICE ID DESCRIPTION
-------- ----------------------------
602 ROOF PLYWOOD NAIL
604 ROOF IN -PROGRESS 605 FINAL REROOF
- - aei
CITY OF
CUPEkTINO
CITY OF CUPERTINO
REROOF
PERMIT APPLICATION
t vI C)(��n
APN #3 --t, 0
C) L+
Date:
Building Address:
Owner's Name:--�"� ..�1
Phone #:
HOA: Yes El No Q If yes, provide letter from HOA
Contractor: a
Phone #:oe-.)
Fax #:
Cupertino Business License #: W_ s
Contractor License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built -Up Roof ❑ Built -Up roof
❑ Asphalt Shingles �sphalt 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 Descrition:'~?,M ,,��,� � �- �7� L,
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: ,...
4
I Ha��a�Xnders and
S' a 7V
Will Comply with Cupertino's Tear -Off Policy:
Revised 02/05/09
CITY OF CUPERTINO
REROOF
CuvE�nNo FEE SCHEDULE
Number of
Squares
Fee ID
Fee Description
I
Fee
Group
Permit Type
1REROOFCOM
Re -roof Commercial
B
1COMMLROOF
1BCBSC
Cal Bldg Standards
Commission Fee
B
ALL PERMIT TYPES
1BSEISMICO
Seismic Commercial
B
l�
1 REROOFRES
Re -roof Residential
B
1 SFDWLROOF
i
1 BCBSC
Cal Bldg Standards
Commission Fee
B
ALL PERMIT TYPES
1 BSEISMICRE
Seismic Residential
B
1 REROOFMRES
Re -roof Multi -Family
B
1MFDWLROOF
1BCBSC
Cal Bldg Standards
Commission Fee
B
ALL PERMIT TYPES
1 BSEISMICRE
Seismic Residential
B
1 BUSLIC
Business License
B
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/ " 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:
job Site Address: % JCAO�qko4tc,/
Roofing Company Name. 1
y l'_
Applicant's Signatu . �- Date:
Greg Casteel
Building Official
Revised 07/30/08
1. Use Low/Ni:40C Paitt
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
5 IAQ/Health 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 P'l or MDF
is
4 IAQ/HealthY=Y
P
es
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 Rapicly 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 Avai a e:
Total Points Project Received:
0
F' 1401 1301 57
_4�2 1 01 0 0
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CITY OF
U P E kT I N 0
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Building Department
JOB ADDRESS: �ul �Uu �
v Io
PERMIT O� C,
OWNER'S NAME:
PHONE # Z
GENERAL CONTRACTOR:
FAX #
I am not using any subcontract s:
-' . & , - �—� I / ,//,o
Signature Date
Please check annlicable subc ctors and complete the following information:
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
Owner/ Contractor Signature
Date