09070014 CITY OF CUPERTINO7 A
BUILDING DIVISION PERMIT � R�� l� Ml7I� �
BUILDING ADDRESS: PERMIT NO.
20189 APPLE TREE LN TBD — TO BE DETERMINED 0 9.0.7—aO 14
OWNER'S NAME: PERMIT ISSUE DATE
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PHONE: AAIfA1(tY0?9 G 9 CONTROL NO.
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ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 (�
u0 0 LICENSED CONTRACTOR'S DECLARATION Job Description
p 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 Code,and my license is RE—RF E:QT I RE HSE I NSTD OF PRTL 1/2 PLYWOOD 30#
Z y in full force and q§feFt L i
j�J? Lie.
yya Date b.%A Contractor, jh�(]i✓ FLET 183Q COMP CLS A — JOHN MCCUNE CONSTRUCTION
ARCHITECTS DECLARATION PD
R< I understand my plans shall be used as public records
Dyd FOR BUS LIC
U.y Licensed Professional
n y OWNER-BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the
r 0 O following reason.(Section 7031.5,Business and Professions Code:Any city or county
429 which requires a permit to Conswct,alter,improve,demolish,or repair any structure
'I;- prior to its issuance,also requires the applicant for such permit to file a signed statement
_< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation
Y.F (commencing with Section 7000)of Division 3 of the Business and Professions Code)or 3 O 0 0
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). 31633095 . 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 Conuactoes License Law docs not apply to an owner of Ll P
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 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 contractcr(s)licensed pursuant to the Contractor's
License Law.
❑1 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 3710 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 Compensation Insurance carrier and Policyn)u hher are: n
Cartier.&MZ—�Q/N f Policy No.:/ 7 I I
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollar($100)
or less.)
1 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'Compensadon
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
Oforthwith comply with such provisions or this permit shall be deemed revoked.
Z, CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
a. the work for which this permit is issued(Sec.3097,Civ,C.)
WGL A Lender's Name
]Z Lender's Address
V 1 certify that 1 have read this application and state that the above information is
LL ' correct.I agree to comply with all city and county ordinances and state laws relating to
0 V building construction,and hereby authorize representatives of this city to enter upon the
a above-mentioned property for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
liabilities,judgments,toss and expenses which may in any way steric against said City
U Z in conseque a of the granting of this permit.
0'" APPLIC UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by Date
SO REGULATIONS.
Re-roofs
ignature of Applicant/Contractor Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
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 ;,hall be inspected prior to any roofing material being installed.
C3 Yes PO4o
If a roof i;installed without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes
I have read the hazardous materials requirements under Chapter 6.95 of due Califor- /'i/
nia Health&Safety Cede,Sections 25505,25533 and 25534.1 understand that if the building US
does not c rfendy have a tenant,that it is my responsibility to notify the occupant of the
mquim#hLs which must be met prior to issuance of a Cenific!"O �� gnatur App Leant Date
/ All roof coverings to be Class'A`'or better
Owner orauthorized agcm Date
nr
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
CUPEkTINO
Building Department
JOB ADDRESS: PERMIT #
OWNER'S NAME: -STT/ PHONE #
GENERAL CONTRACTOR: 1` )) tljoC U1✓L r&An FAX # 7 -,4
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
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
O r Contractor i e Date
:.i
CITY OF CUPERTINO
4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blh: Lot :
APN 31633096 . 00
DATE ISSUED. . . . . . . : 07/06/2009
RECEIPT #. . . . . . . . . : BS000008117
REFERENCE ID # . . . : 09070014
SITE ADDRESS . . . . . : 20189 APPLE TREE LN
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : REPETTI STEVEN J AND PRISCILLA
ADDRESS 20189 APPLE TREE LN
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2001
RECEIVED FROM . . . . : JOHN MCCUNE CONS IN
CONTRACTOR . . . . . . . : TBI) - TO BE DETERMINED LIC # 00096
COMPANY . . . . . . . . . . : TBI) - TO BE DETERMINED
ADDRESS . . . . . . . . . .
CITY/STATE/ZIP . . . : ,
TELEPHONE . . . . . . . .
FEE ID UNIT QUANTITY 2NOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ----------- ---------- ---------- ----------
1BCBSC VALUATION 3 , 000 .00 1 . 00 0 . 00 1 . 00 0 .00
1BSEISMICR VALUATION 3 , 000 . 00 0 .50 0 . 00 0 .50 0 .00
1BUSLIC FLAT RATE 1 . 00 114 . 00 0 . 00 114 . 00 0 .00
1REROOFRES SQ FEET 18 . 00 234 . 00 0 . 00 234 . 00 0 . 00
----------- ---------- ---------- ----------
TOTAL PERMIT 349 . 50 0 .00 349 . 50 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 349 .50 #11317
---------------
TOTAL RECEIPT 349 .50
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
0ac)7301q
-�, CITY OF CUPERTINO
REROOF
CUPEkTINO PERMIT APPLICATION
APN #-?/ 3 v Date:
Building Address:
�►
1,-f 7 a 71'151 (.
Owner's Name: (4-1('CI Lc 7-!',/ Phone #: L&-)f j
HOA: Yes ❑ No 3 If Yes, provide letter from HOA
Contractor: Phone #:
U11MCLS C �I�CI� �1 Fax #: ,:Z��
Cupertino Business License #: Contractor License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles Asphalt 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 Description:
✓1)00 Ac T-
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 Hav . e �Ijnderstand and Will Comply with Cupertino's Tear-Off Policy:
igna
Revised 02/05/09
CITY OF CUPERTINO
REIzo
CITY OF OF
CUPEkTINO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1REROOFCOM Re-roof Commercial B 1COMMLROOF
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commissic n Fee
I BSEISMICO Seismic Cc mmercial B
1 REROOFRES '" Re-roof Re 3idential B 1 SFDWLROOF
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commissioa Fee
1BSEISMICRE ; Seismic Rec;idential B
1 REROOFM EES Re-roof Multi-Family B 1MFDWLROOF
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
1 BSEISMICRE Seismic Re:idential 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 a&,ee to comply with 2007 IBC Standards
and manufacturers specifications on r 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 b-iilding inspector when the re-roofing
is completed.
3. All roofs shall be inspected prior to ar.y 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 mz.terial down to the sheathing,
so a proper City inspection can be per Formed.
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: -� 10 f CI
Job Site Address: )D W9 JIPLi TAF
Roofing Company Name: Jo Nr„ M C �'N�' �Cs�✓�;/�y'�'�/�✓
Applicant's Signature: Date:
Greg Casteel
Building Official
Revised 07/30/08
M.Indoor Air-Quality and Finishes
1,Use Low No-VOC P&4 1 IAQ/Health pts y=yes D
2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes 0
3.Use LowJNo 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 D
0
6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes
7.Seal9 ed Partidebowd or MDF 4 IAOJHealth. pts y=yes 0
B.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes D
9,Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y=yes 0
10.Install Whole House Vacuum System 3 IAQ/Health pts-yeses 0
1 i o
N.Flooring
1.Select FSC Certified Wood Flooring 8 Resource pts y=yes 0
2.Use iaapidly flanewable Flooring Materials 4 Resource pts y=yes 0
3.Use Recycled Content Ceramic Tiles 4 Resource pts y--yes 0
4.Install Natural Linoleum in Place of Vinyl 5 IAQ/Health pts y=yes 0
5.Use Exposed Concrete as Finished Floor 4 Resource pts y=yes 0
6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes 0
1 i i
Total Points Available: 1401 1301 57
Total Points Project Received: 01 0 0
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