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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