10010144 CITY
OF CUPERTINO BUILDING PERMIT 4
` CONTRACTOR:TBD-TO BE DETERMINED PERMIT NO:1001014
BUILDING ADDRESS: 10264 RICHWOOD DR DATE ISSUED:01/27/2010
OWNER'S NAME: MYERS MELINDA PHONE NO:
"'VNER'S PHONE: 9259321603
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO.
BLDG ELECT PLUMB
►J -S COMMERCIAL
G
MECH RESIDENTIAL
License Class
' '= DESCRIPTION:RE-ROOF CLASS A 27SQ SOLID DECKING EXISTING 30YR
JOB
Contractor � TITANIUM UNDERLAYMENT-CONTRCTR(WINE
LANDMARK,
I hereby affirm that I am licensed under 00)of ion 3 of the Business&he provisions of tProfessions COUNTRY ROOFING)PD FOR BUS LIC 1/26/10
(commencinmhlscen ens On full force and effect.
Code and thaty
I hereby affirm under penalty of perjury one of the following two declarations:
insure for
I have and will maintain a certificate of consent to self-- k r'
Compensation,as provided for by Section 3700 of theLabor Code,fo
he
it
performance of the work for which this pe�at.is Insurance,as provided for by Valuation:$8675
I have and will maintain Worker's Comp Nnbe
Area:
ation is
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Occupancy Type:
APPLI
CANT CERTIFICATION r:36908024.00
I certify that I have read this application and
ordinan ethat the s and stave te laws relating
correct.I agree to comply with all city and county IS NOT STARTED
to building construction,and hereby authorize ion nt (es We)agcity to saverMIT EXPIRES IF WOE OR
for inspection purposes. ud ments, IT ISSUANCE
upon the above mentioned property WITHIN 180 DAYS OF PERM
indemnify and keep harmless the City of Cupertino against liabilities,judgments, T CALLED INSPECTION.
costs,and expenses which may accrue1, ainst said City in consequence of the. applicant unders and will comply 180 DAYS FROM LAS
granting of this permit. Additional pp unici al Code,Section
with all non-point source regula' ns per the Cupe p ........................
Date
9.18. Issued
4 z-- Date
_/
Signature
RE-ROOFS:
OWNER-BUILDER DECLARATION of roofs shall be inspected prior to any roofing material being installed.If a roof is
from the Contractor's License Law for one All rwithout first obtaining t inspecti I agree to remove all new materials for
I hereby affirm that I am exempt installed
the following two reasons:
as owner of the property,or my employees with wages as their sole compensation, inspection. � Date:
Signature of Applicant:
will do the work,and the structure is not intended or offered for sale(Sec.704 ,
Business&Professions Code)
I as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE
5 of the
declarations:
Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements
25533 annder d 2553pter 4.9I will maintain
I have and will maintain a Code,Sections 25505,
Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Chapter 9.12 and the Health&
f the work for which this permit is issued. b compliance with the Cupertino Municipal Code,
performance o urance,as provided for y Safety Code,Section 25532(a)should I store or handle hazardous material.
S ty
I have and will maintain Worker's Compensation Ine of the work for which this it Quality Management District I will
c Additionally,should I use equipment or devices which emit hazardous air
Section 3700 of the Labor Code,for the performance contaminants as defined h the Cuthe py Area ertino ertino Mun�ipal Co Chapter 9.12 and the
permit is issued. fiance with P �,--�
Code,Sections 25505,25533,and 2 4•
certify that in the performance of the work for which this permit is
issued, Healthl&Safety � _
I ce fy
not employ any person in any manner so as to become subject to the California. If,after making this certificate of exemption,I Owner or authorized agent: Z G
Compensation laws of Date*
subject to the Worker's Compensation provisions of the Labor Coked must
become subs
forthwith comply with such provisions or this permit shall be deemed revo CONSTRUCTION LENDING AGENCY
APPLICANT CERT I hereby
IFICATION affirm that there is a construction lending agency for the performance of work'!
that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.)
I certify with all city and county ordinances and state laws relating Lender's Name
correct.I agree to comply
to building construction,and hereby authorize representatives of this o save for inspection purposes.(We)agreeLender's Address
upon the above mentioned property
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
ity in consequence
f the
and expenses which may accrue against said understands and will oDECLARATIONcomply ARCHITECT'S
ing of this permit.Additionally,the applicant
' o Munici al Code,Section I understand my plans shall be used as public records.
wim all non-point source regu a dns der the Cu p
9.18. Licensed Professional
.�L-- Date
L2:f�l `
CITY OF CUPERTINO
IT RECEIPT OPERATOR: patg
PERM COPY # 1
3 ITEMS OF 3
--------------
Sec: Twp: Rng: Sub: Blk: Lot:
APN 36908024 .00
DATE ISSUED. • • • • " 01/27/2010BS000009623
RECEIPT # . . . . " 10010144
REFERENCE ID # • • -
SITE ADDRESS 10264 RICHWOOD DR
SUBDIVISION
CITY • • • • • • • . CUPERTINO
IMPACT AREA . . . . . .
OWNER MYERS MELINDA
ADDRESS . . . . . . . . . . : 10264 RICHWOOD DR
95014
A ; CUPERTINO, CA
CITY/STATE/ZIP . • •
ANGEL E VERA 00096
DETERMINED
RECEIVED FROM LIC #
CONTRACTOR . . . . . . . : TBD - TO BE
COMPANY TBD - TO BE DETERMINED
ADDRESS . . . . . . • . . .
CITY/STATE/ZIP
TELEPHONE . . . . . . . .
PD-TO-DT
THIS REC NEW BAL
__
y AMOUNT PD-T --
FEE ID UNIT QUANTITY ---------- ------ --- --------- ----0 . 00
_ VALU
______ ------------- - _-- 1. 00 0 .00 0 . 00
ATION 81675 '00 0 .00 0 .90
0 . 00
1BCBSC 8 675 .00 0 . 90 351.00
1BSEISMICR VALUATION 351 . 00 0 .00 -----------__-_-- -_-______-
27 .00
1REROOFRES SQ FEET ---------- ------ 352 . 90 0 .00
352 .90 0 . 00
TOTAL PERMIT :
AMOUNT REFERENCE NUMBER
METHOD OF PAYMENT _______________ --------------------- --
----------------- 352 . 90 MC
CREDIT CARD _______________
352 .90
TOTAL RECEIPT DESCRIPTION
TION VOICE ID ----------------
VOICE ID DESCRIPTION -------- ------------
________ ---------------- 602 ROOF PLYWOOD NAIL
601 ROOF TEAR OFF
605 FINAL REROOF
604 ROOF IN-PROGRESS
oI �
CITY OF
CUPERTINO
REROOF
n of
CU
PERMIT APPLICATION
Date:
APN #
c�
Building Address: + � r l
8 1 �" 7 Phone #:
Owner's Name'. �G
-�� `t 5
�c '��� �' Ovide letter from HOA
� No � If es r
• Yes Phone# 1�
HOA.
Contractor* r
.
Fax #: -�c►`7 6'c75,11111d`f ,
Contractor icense #:
Cupertino
Business License #:
Type of Roof Covering:
Proposed:
Existing: ❑ Built-Up roof
❑ Built-Up Roof asphalt Shingles
Asphalt Shingles ❑ Wood Shakes
❑ Wood Shakes ❑ Wood Shingles
❑ Wood Shingles ❑ Other (Specify)
Other Specify) ❑ Provide I.C.C.E.S• Report#
Number of existing coverings ❑ Provide Mfgr. Installation Specs.
To be Removed
tion: � �� �--�
Job Descrip 99
J
Commercial
Residential Dept. if
• Confirmed with Planning p
• complete relevant portion of the are an restrictions: El
Green Building: Please p application or if there Y
Building Checklist & attach it to the app
Green Bul g
include in lain set & the sheet index.
a
lie-able inc .
V aluat 10
with Cu ertino's Tear-Off Policy:
I Have Read,
Under ,f d and Will Comply p
Sign tore Revised 02/05/09
CITY OF CUPERTINO .
PROOF
FEE SCHEDULEULE
`STM T1N0
CU PEf�.
Fee Permit Type
Fee Description
Fee ID Group
Number of 1COMMLROOF
Squares Commercial BII 'I"ll" I��I
...................................................
Re-roof Comm B ALL PERMIT TYPES
1REROOFCOM Cldg gtandards
al B
1BCBSC Commission Fee
1Bsmic Commercial B
SEISMICO Sei
]SFDwLROOF
Re-roof Residential B
1RER �,LL PERMIT TYPES
OOFRES B
Cal Bldg Standards
1BCBSC Collimission Fee B
SMICRE Seismic Residential
1BSEI
............ Re-roof Multi-Family B 1MFwDLROOF ...............................................................
......--.1 RERO
,B ALL
OFMRES Y
PERMIT TPES
Cal Bldg Standards
1BCBSC Commission Fee B
1BSEISMICRE Seismic Residential
1BUSLIC Business License
B
• Development Department
community Building Division
City of Cupertino
10300 Torre Avenue
40 -322
• Telephone: ( 8)777_3333
Fax: (408)777
llding
Department
Bu
. o f Cupertino
• lic for the C1tY
• . Re-roofing po Y Standards
Subject' oin 1 with 2007 IBC per Cupertino
you must agree to c p Y
ce, •All roofs are Class A
Prior to permit issuan Y
ecifications on reroofing
1• and manufacturers sp ah inspection
code 16.04.080. .ed with
first obtaining tion and
municipal rings s shall not be appli final inspection
New roof cove g building inspector. A when the re-roofing
2. Ne approval from theinspector w
and written app ed from the building
approval shall be obtain installation.
.
p om leted. roofing nista
is c p 11 be inspected prior to any steps are
11 roofs shall in the City,the following
3• �' al sign off from
To receive a fin
4• .
required: •on andI Or tear off approval
1) Pre-inspects inspection approval.
2) In-progress msp royal.
3) Final inspection approval.installation.• aired.
a Spark arrester ins ood nail inspeCtion is Yeq inspec) p ut first obtaining an p
ood is installed a Ply" without 5. If plyW hick is applied wi •al down to the sheathing,
6. Any roofing W of all new maters
req the removal be erformed• .ob is=ready,
Will q inspection can P d the l
o a roper City ood nail inspection . re-inspection fee m
s P you call for a plyW 176.18. The
NOTE: If Y reinspection fee of$scheduled
7• be charged a be shed
YOU will g other ins ection can......
before �'
be aid
11111
t slope and demonstrate
TANT: um of 1/4" per foo p
IMPOR roofs must have a n'num ection•
1. Flat onding• 'ob site at the time on insp
that there is no P is re aired to be on the
An I.C.B.O.report q .c on re-roofing.
2• oVe stated poli y r. ��'
will comp1Y with the ab ��-��' q'i
I understand and wi L 1 5 ���
Q �
er's
e I G^j
Homeown Name
job Site Address:
Company
Name' '� ,`� -=� ' ate•
Roofing C om p . .
ant's Signature.
Applic
Greg Casteel
Building Official
Revised 07/30/08
oor Air Quality and Finishes 0
M.fn 1 IADJHea1th pts Y=yes 0
1.Use LowNo-VOC Paint 2 IAOIHealth pts Mes p
2.Use Low VOC,Nater-Based Wood Finishes 3 IAD-(Health pts y--Yes
3.Use LowNo VOC AdhesivesD
' s for Interior Finishes 3 Resource pts Y--Yes
ri
4.Use Salvaged Materials D
5.Use Engineered Sheet Goods with no added Urea 6 IAQIHealth pts Me' D
Formaldehyde 1 IAQ/Healzh pts Y=Yes p
6.Use Exterior Grade PINNood for Interior Uses 4 IAQJHealth..pts = es
7.Saal BoFimsed of MDF D
4 Resource pts Y=YeS D
B.Use FSC Certified Materials for Interior Finish 1 Resource pts Y—yeS p
9.Use Finger-Jointed or Recycled-Content Trim 3 IAQ/Health pts Y--Yes
10.Install Whole House Vacuum System 1
N.Flooring 0
Certified Wood Flooring 6 Resource pts Y=YeS 0
1.Select FSC 4 Resource pts Y=yes
Renevvat�le Flooring Materials 0
2.Use l�a}� ► 4 Resource pts y=yes 0
3.Use Recycled Content Ceramic Tiles l 5 IAQ/Health pts y=yes
4.Install Natural Linoleum in Place of V�ny D
4 Resource pts Y=yeS D
5.Use Exposed Concrete as Finished Floor VOCs 4 Resource pts y=yes
6.Install Recycled Content Carpet with P
140 130 57
Total Points Available: 0
0 01
Total Points Project Received: 1
12.D4protected.xls
G:datalprouigslgreenbl�inoguidelinesi2m�delerslgreenpointsfinal2
Community Development
10300 Torre Avenue
Cupertino CA 9501
777-3229
Telephone(408)
< �}�a Fax(408)777-3333
a
CIT1f�OF
TINO ent
rtm
1 din
De a
Bui
PERMIT #
jOB A DR SS• 017
L
L/j.0 PHO # _ n
O�1Z�S N FAX#
CONTRACTOR:
r
GENERAL C OR �
,,-rz Date
an subcontractors: �°'�/`
I am not using y si afore information:
complete the f ollowin #
e subcontractors and BUSINESS LICENSE
Please check a licabl BUSINESS NAME
SUBCONTRACTOR
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 —.
Date
er/ ntractor Signature