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09060150 CITY OF CUPERTINO BUILDING DIVISION PERMIT � � � ' PERMIT NO. BUILDING ADDRESS: 10776 LA RODA DR LOS GATOS R OF PERMIT ISSUE DATE OWNER'S NAME: SX14ffAgtt2CONTROL NO. INE: (408) 298-9399 BUILDING PERMIT INFO ARCHITECr/ENGTKEER: BLDG ELECT PLUMB MECH u p LICENSED CONTRACTOR'S DECLARATION Job Description m C I hereby affirm that I am licensed under provisions of Chapter 9(commencing .Z, with Section 7000)of Division 3 of the Business and Professions Codc,and my license is =y in full force andel[ RE—RF FMV 2LYRS EXTNG .SHK/SHNGL RFING INSTL Z License ass Lic•g d O© 1Q" ,7/16"0E B ROOFRS SELECT FLT& PRESDNTL SHNGLS BY 3 F a Date�� X•ow r- Conuactar ty ARCHITECTS DECLARATION' �d e 1 understand my plans shill be used as public records C ERTA I D T E ED CLS A 2 6 S Q �aU O y Licensed Professional OWNER-BUILDER DECLARATION e1 1 hereby affirm that I am exempt from the Contractor's License Law for the i p O following reason.(Section 703 1.5,Business and Professions Code:Any city or county K which requires a permit to construct,liter,improve,demolish,or repair any structure prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area x t- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $9235 y that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type not more than five hundred dollars(5500). 369340-- 8 . 00 ❑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 Required Inspections and Professions Code:The Contractor's License Law does 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.). ❑1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044.Business and Professions Code:)The Contractor's Li- cense Law does not apply to an owner of property who builds or improves thereon,and who contracts for such projects with a comractor(s)licensed pursuant to the Contractor's License Law. ❑I am exempt under Sec B&P C for this reason Owner Date 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 Worker's Compen- sation,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 required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Worker's C mpe salion Insurance carrier and Policy number arc: Cartier. Policy No.: '0000 C RTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE ('oris 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 shill 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 Worker's Compensation provisions of the Labor Code,you must ,J O forthwith comply with such provisions or this permit shall be deemed revoked. zCONSTRUCTION LENDING AGENCY [.�0.� 1 hereby affirm that there is a construction lending agency for the performance of �.r> the work for which this permit is issued(Sec.3097,Civ.C.) W QLender's Name ] Lender's Address V C) I certify that I have read this application and sure that the above information is L4 corccL I agree to comply with all city and county ordinances and state laws relating to 0V building construction,and hereby authorise representatives of this city to enter upon the Uabove-mcmtioned property for inspection purposes. W (We)agree to save,indemnify and keep harmless the City of Cupertino against t y to liabilities,judgments,costs and expenses which may in any way accrue against said City V Z in consequence of the granting of this permit ►-t APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued : SOUR REGU TION ���� Re-roofs '--- Signature of Applicant/Contractor °9e T of Roof HAZARDOUS MATERIALS DISCLOSURE Type Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal 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 1�'rm 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 it hazardous air contaminants as defined by the Bay Area Air Quality Management all new r Taterials for inspection. .rstrict? ❑Yes Nu 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building does not currently have a tenant that it is my responsibility to notify the occupant of the require+Wnus w must be met_ �o�sswa� reala Certificate of Occupant. Signature.of Applicant Date h agent - `2 e p All roof coverings to be Class';"or better Owner or authmrix agent Date _yamCITY OF CUPERTINO '`'� � REROOF CITY OF CUPS RZI !NO PEIZMIT ivPPLICATION APN ,4, C) C) Date: Building Address: " 10--77& Z,2 Owner's Name: Phone #: Phone M 6;2 Contractor: Fax#: Cupertino Business License #: Contracior License M Type of Roof Covering: Existing: Proposed: ci Built-Up Roof u Built-Up roof a . Asphalt Shingles4Asphalt Shingles XWood Shakes /�u Wood Shakes • Wood Shingles 0 Wood Shingles • Other (Specify) ci Other(Specify) Number of existing coverings 2, u Provide I.C.B.O. Report# To be Removed Provide Mfgr. Installation Specs. Ano-4 Job Desgription: 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:. 9 5 /01\ I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy: Revised 6/16/08 J� CITY OF +CUPERTINO RER0 OF OF CUPS INO FEE S+CHI-TDULE Number of Fee ID Fee Description Fee Permit Type Squares Group 1REROOFCOM Re-roof Commercial B 1COMMLROOF 1BSEISMICO Seismic Commercial B 1REROOFRES ' Re-roof Residential B 1SFDWLROOF r 1BSEISMICRE Seismic Resic.ential B 1REROOFMRES Re-roof Multi-Family B 1MFDWLR OOF 1BSEISMICRE Seismic Residential B 1BUSLIC Business LicEnse B Revised 6/16/08 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 app Lied without first obtaining all inspection and written approval from the building inspector. A final inspection and approval shall be obtained from the 'Juilding inspector when the re-roofing is completed. 3. All roofs shall be inspected prior to zny 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 fi!e 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 liE "per foot slope and demonstrate that there is no ponding. 2. An I.C.B.O. report is required to be o:1 the job site at the time on inspection. I understand and will comply with the abo'7e stated policy on re-roofing. ' Homeowner's Name: Job Site Address: y o ! Roofing Company Name: r Applicant's Signature: �'1 A,"� D te: Cj q Greg Casteel Building Official Revised 07/30/08 Ili,' . t.— .I:o•�. !i -r.iir I.Windows 1.In=_iall EFHCg'-EffilCient 1'��inoos a.Double-Paned 1 Energy pt y=yes C b. 2 Energy pts y=Yes C c.L01;'.Conductivity f=rames 2 Energy pts y=yes 0 2.Install Low Heat Transmission Glazing 1 Energy pt y=yes 0 J.Heating Ventil_don and Air Conditlaning 1.Use Duct Miastic on All Duct Joints 2 Energy pts y=yes 0 2.Install Ductwork within Conditioned Space 3 Energy pts y=yes 0 3.Vent Range Hood to the Outside 1 IAQ/Hsalth pt y=yes 0 4.Clean all Ducts Before Occupancy 2[AD/Health pts y=yes 0 5.Install Solar Attic Fan 2 Energy pts y=yes 0 6.Install Attic Ventilation Systems 1 Energy pt y=yes 0 7.Install Whole House Fan 4 Energy pts y=yes 0 8.Install Sealed Combustion Units a.Furnaces 3 IAQ/Health pts y=yes 0 J.Water Heaters 3 IAQ/Health pts y=yes 0 9.Replace Wall-Mounted Electric and Gas Heaters with Through-the-Wall Heat Pumps 3 Energy,pts Y=yes 0 10.Install 13 SEER/11 EER or higher AC with a TXV 3 Energy pts y=yes 0 11.Install AC with Non-HCFC Refrigerants 2 Resource pts y=yes 0 12.Install 90%Annual Fuel Utilization Efficiency(AFUE)Furnace 2 Energy pts y=yes 0 13,Retrofit Wood Burning Fireplaces a.Install EPA certified wood stovesAnserts 1 IAQ/Health pt y=yes 0 b. Install/Replace Dampers 1 Energy pt y=yes 0 c,Install Airtight Doors 1 Energy pt y=yes 0 14.Install Zoned,Hydronic Radiant Heating 3 Energy pts y=yes 0 15.Install High Efficiency Filter 4 IAQ/Health pts y=yes 0 16,Install Heat Recovery Ventilation Unit(HRV) 5 IAQ/Health pts y=yes 0 17.Install Separate Garage Exhaust Fan 3 IAQ/Health pts y=yes 0 I1 E t K.Renewable Energy and Roofing 1.Pre-Plumb for Solar Water Heating 4 Energy.pts y=yes 0 2.Install Solar Water Heating System 10 Energy pts y=yes 0 3.Pre-Wire for Future Photovoltaic(PV)Installation 4 Energy pts y=yes 0 4.Install Photovoltaic(PV)System (1.2 kw=6 points,2.4 kw=12 points,3.6 kw=18 points) Up to 18 Energy pts 0 6.Select Safe and Durable Roofing Materials 1 Resource pt y=yes 0 7.Install Radiant Barrier 3 Energy pts y=yes D L.Natural Heating and Cooling 1,Incorporate Passive Solar Heating 5 Energy pts y=yes 0 2.Install Overhangs or Awnings over South Facing Windows 3 Energy pts . y=yes 0 3.Plant Deciduous Trees on the West and South Sides 3 Energy pts y=yes 0 E t ! LL D 1 ,T cve op Beni Co 10300 Toiie Avenue Cupe1�o CA 9014 Telephone408 (. ) 777-3228 CI!Y OF Fax(408) 777-3333 {� � P1 ANO Build-bag De- EOBDDR;E;SS; PERMITR'S Nom: PHONE GENE A- i ER _L COIF 11 -ACTOR: F, X am not using any subcon acMrs: 117 Sig_Zature D to Please check applicable subcontractors and complete the following information: I SUBCONT UCTOR BUSIM-ESS NAME I BUSINESS LICENSE Cabinets O"z Millwork Cement finishing Electrical IExcavadon Fencing IFl_oori��g: Carpeting Linoleum/ Wood Glass/ Glazing IHeating insulation I Landscaping I I Lathing . I Masonry Ornamental Sheet Metal IEng/ Wa-Upape_rgr?ngbing ng Septic Tani: Sheet Metal (--Sheet Rock Tile Owne ntractor Signature Da