09030176 777777
CITY OF CUPERTINO
BUILDING DIVISION PERMITS �� ` '
BUILDING ADDRESS: PERMIT NO.
19358 SAKURA WAY KEVIN S LLIV
PERMIT ISSUE DATE
OWNER'S NAME:
S A CONTROL NO.
^40NE:
(408) 842-1057
BUILDING PERMIT INFO
ARCHITECT/ENGINEER:
BLDG ELECT PLUMB MECH
Q O p LICENSED CONTRACTOR'S DECLARATION Job Description
L U I hereby affirm that I am licensed under provisions of Chapter 9(commencing
Z with Section 70W)ofDivision 3ofthe Business and Profcssio Code. ylicense is RE-RF RMV EXT SHKS INSTL NEW 30#FLT &72#CAP SHT
n'<y in full force and
z License Cl Lle'n CL
E- Date Contractor
ARCHITECTS DECLARATION B HVY SHKS TO FRM A C1 "A" RF SYS 23 SQ
I ondcrstan my plans shall be used as public records
�ulU
W y Licensed Professional
n y OWNER-BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractors License Law for the
p O following reason.(Section 7031.5,Business and Professions Code:Any city or county
R-9 which requires a permit to construct,alter,improve,demolish,or repair any structure
_ prior to its issuance,also requires the applicant for such permit to file a signed statement Ft.Floor Area Valuation
that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq
YH (commencing with Section 7000)of Division 3 of the Business and Professions Code)or 14000
y that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not more than five hundred dollars(5500). 37503019 . 00
I,as owner of the property,or my employees with wages as their sole compensation,
will do dee work,and the structure is not intended or offered for sale(Sec.7044.Business Required Inspections
and Professions Code:The Contractors License Law docs not apply to an owner of
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended or offered for sale.If,
however,the building or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑I•as owner of the property.am exclusively contracting with licensed contractors to
construct the project(Sec.7044.Business and Professions Code:)The Contractors Li-
cense Law does not apply to an owner of property who builds or improves thereon,and
who contracts for such pmjects with a contractor(s)licensed pursuant to the contractors
License Law.
❑I am exempt under Sea B&P C for this reason
Owner D8e
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a Certificate of Consent to self-insure for Workers Compen-
,on,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 Workers Compensation insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Wor s Compensation sura c carrier and Policy number arc:
Cartier Policy No.:
CERTIFI ATE OF EXEMPnON FROM ORK R
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars($100)
or less.)
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 Workers Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Workers Compensation provisions of the Labor Code,you must
Z forthwith comply with such provisions or this permit shall be deemed revoked.
Z O CONSTRUCTION LENDING AGENCY
(4 rte. I hereby affirm that there is a construction lending agency for the performance of
pl the work for which this permit is issued(Sec.3097,Civ.C.)
W Q Lenders Name
Z Lcndees Address
V 0 1 certify that I have read this application and state that the above information is
LL correct.1 agree to comply with all city and county ordinances and state laws relating to
building concoction,and hereby authorize representatives of this city to enter upon the
UWabove-mentionedproperty for inspection purposes.
indemnify and keep harmless the City of Cupertino against
(We)agree to save.
►F-u liabilities,judgments,cos rues which may in any way accrue against said City
V Z in consequence of the g ng q(Ih; Date
►� APP CANT UNDE NDS AND ILL COM Y WITH AL NON o Issued b;
SOU CE G TI
Re-roofs -
Signat ofAplicant/ ntractor D81C Type of Roof
H DOUS MATERIALS DISCLOSURE yP
Will the licant r future building occupant store or handle hazardous material
as defined by the unicipal Code.Chapter 9.12,and the Health and Safety
Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
O Yes °
If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant use equipment or devices which
t hazardous air contami ants as defined by the Bay Arca Air Quality Management all new r laterials for inspection.
.trict?
Yes o
1 have read the hazardous aerials requirements under Chapter 6.95 of the Califor-
niaHeal th&Safety Codc.se Kl�, S�and25 ddtsti[debuilding
docs not rrendy have a en thay respo bility otify the occupant of the
requ;re ich must he riou Ccrtifrca of Oc aney Signature of Applicant Date
All roof coverings to be Class'n"or better
Owner or au orizcd gent D
�j' �1 -7
CITY OF CUPERTINO
RE ROOF
CUPEkTiNO PERMIT APPLICATION
APN # 6f 0 Dater
Building Address: � � �� v1a
Owner's Name: Ph
HOA: Yes ❑ No ❑ If yes, provide letter from HOA
Contractor: r
tC Phone #:
a Vo,, ILO� Fax #:
Cupertino Business License #: Coactor�License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
>1k 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: Re-vnoj�Q-_>
-- � C C`
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: —
I Have Read, U Mstand '11 omply wits Cupertino's Tear-Off Policy:
Signature
Revised 02/05/09
- - CITY OF CUPERTINO
REROOF
CUPEkTINO FEE SCHEDULE
Number of Fee ID Fee Des cription Fee Permit Type
Squares Group
1REROOFCOM Re-roof Commercial B 1COMMLROOF
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commis:,;ion Fee
1BSEISMICO Seismic '—ommercial B
1RER00FRES Re-roof:Zesidential B 1SFDWLR00F
r 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commis Sion Fee
1BSEISMICRE Seismic Residential B
1 REROOFMRES Re-roof Vlulti-Family B 1MFDWLROOF
1BCBSC Cal BWE Standards B ALL PERMIT TYPES
Commis Sion Fee
1BSEISMICRE Seismic Residential B
1BUSLIC 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 buildvlg 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 Ciiy,the following steps are
equired:
Pre-inspection and/or tear off approval.
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 1/4 "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: v p1
Roofing Company Name: K
Applicant's Signature: Date:
Greg Casteel
Building Official
RevisEd 07/30/08
Green Points Rating System for Remodeling Projects
Due to the diversity of remodeling project types,assigning a"total points"value to a project to be considered environmentally friendly is
not feasible.However,25 measures have been highlighted to signify that every effort should be made to incorporate them into your
projects. These items have been chosen based upon their impact on the environment and the health of the home in coordination with
ease of implementation and relative low cost. These measures i;an be used as a starting point for"greening"your project.
IAO/HealthINPUT Resources Energy
A.Site
1.Recycle Job Site Construction&Demolition Waste
65%=1 point;75%= 2 points;80%=4 points up to 4 Resource pts 0
2.Salvage Reusable Building Materials I Resource pts y=yes 0
3.Remodel for Mixed Use,Adaptive Reuse,and
Historic Preservation I Resource pts y=yes 0
4.Protect Native Soil ?Resource pts y=yes 0
5.Minimize Disruption of Existing Plants&Trees I Resource pt y=yes 0
6.Implement Construction Site Stormwater Practices ?Resource pts y=yes 0
7.Protect Water Quality with Landscape Design ?Resource pts y=yes 0
8.Design Resource-Efficient Landscapes and Gardens I Resource pts y=yes 0
9.Reuse Materials/Use Recycled Content Materials
for Landscape Areas ?Resource pts y=yes 0
10.Install High-Efficiency Irrigation Systems i Resource pts y=yes 0
11.Provide for On-Site Water Catchment/Retention i Resource pts y=yes 0
B.Foundation
1.Incorporate Recycled Flyash in Concrete
25%Recycled Flyash=2 points;Add 1 point for every 10%
increase of flyash,up to 5 points up to 5 Resource pts 0
2.Use Recycled Content Aggregate 2 Resource pts y=yes 0
3.Insulate Foundation/Slab before backfill 3 Energy pts y=yes 1 0
C.Structural Frame
1.Substitute Solid Sawn Lumber with Engineered Lumber 3 Resource pts y=yes 0
2.Use FSC Certified Wood for framing
(For every 10%of FSC lumber used=2 points,up to 10) up to 10 Resource pts. 0
3.Use Wood I-Joists for Floors and Ceilings 2 Resource pts y=yes 0
4.Use Web Floor Trusses 2 Resource pts y=yes 0
5.Design Energy Heels on Trusses 6"or more 2 Energy pts y=yes 0
6.Use Finger-Jointed Studs for Vertical Applications 2 Resource pts y=yes 0
7.Use Engineered Studs for Vertical Applications 2 Resource pts y=yes 0
8.Use Recycled Content Steel Studs for Interior Framing 2 Resource pts y=yes 0
9.Use Structural Insulated Panels(SIPs)
a.Floors 3 Energy pts y=yes 0
b.Wall 3 Energy pts y=yes 0
c.Roof 3 Energy pts y=yes 0 _
10.Apply Advanced Framing Techniques 4 Resource pts y=yes 0
11.Use Reclaimed Lumber for Non Structural Applications 3 Resource pts y=yes 0
12.Use OSB
a.Subfloors 1 Resource pt y=yes 0
b.Sheathing 1 Resource pt y=yes 0
INPUT Resources Energy •0
M.Indoor Air Quality and Finishes
1.Use Low/No-VOC Paint 1 IAQ/Health pts y=yes D
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 0
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
B.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 1
N.Flooring
1.Select FSC Certified Wood Flooring i Resource pts y=yes 0
2.Use Rapidly Renewable Flooring Materials I Resource pts y=yes 0
3.Use Recycled Content Ceramic Tiles I 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 I Resource pts y=yes 0
6.Install Recycled Content Carpet with Low VOCs I Resource pts y=yes 0
. 1 1 kind
Total Points Available: 1 1401 130 57
Total Points Project Received: 1 01 0
G:data/progs/grei nbuildingguidelines/remodelers/greenpointsfinal2.12.04protected.xls
Community Development
10300 Torre Avenue
,-t
V
;
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
rUPEkTINO
Building Department
JOB ADDRESS: � PERMIT #
OWNER'S NAME: C PHONE # --
GENERAL CONTRACT R: # ` _ (CIk
I am not using any subcontractors: 2J 2?�,10-1
gna a Date
Please check applicable subcontractors and co m the following information:
SUBCONTRACTOR BUSI14ESS 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
:a o,4\ L
ne /Con actor Signature Date