10110079 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22442 CARNOUSTIE CT CONTRACTOR:JOSEPH SEGNA PERMIT NO: 10110079
OWNER'S NAME: JOSEPH SEGNA 22442 CARNOUSTIE CT DATE ISSUED: 11/12/2010
OWNER'S PHONE: 4082533979 CUPERTINO CA, 95014-3949 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIAL
License Class Lic.# RE-ROOF 28 SQ,REMOVE EXISTING SHAKES&SKIP
SHEETING CLASS A
Contractor Date
I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000)of Division 3 of the Business&Professions
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$8400
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this
APN Number:35603028.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 D LAX511 CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply Issued by: Date: �� Z
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature Date All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
OWNER-BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
/ California Health&Safety Code,Sections 25505,25533,and 25534. I will
I hereby affirm under penalty of perjury one of the following threg� maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: v Health&Safety Code,Section 25532(a)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sechop 25505,25533,and 25134. l 1
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: « ` Z L D
permit is issued.
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 Worker's
Compensation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed re ked. work's for which this permit is issued(Sec.3097,Civ C.)
/L Lender's Name
APPLICANT CERTIFICATION Lender's Address
I certify that I have read this application and state that the above information is
correct.I agree to comply with all city and county ordinances and state laws relating
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION
s,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
sting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18. 1
Signature Date Z12-0 t 0
July 17, 2010
To Whom It May Concern:
I, Isabella B. Segna, am unwilling to continue to serve as Agent for Joseph J. Segna under
the Limited Durable Power of Attorney for Management and Disposition of Assets dated
December 20, 2000.
Sincerely,
,4�,-�� a-
Isabella B. Segna
22442 Carnoustie Court
Cupertino, CA 95014
(408)253-3979
�� G ITIV
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O.,BUILDING OFFICIAL
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERTINO
(408)777-3228• FAX(408)777-3333•building(d_)cupertino.org
PROJECT ADDRESS 221ty�f �� ���S I �� C� APN#
OWNER NAME SC)S �('�� SL ✓�¢�' PHONE&06 �3 -Gr E-MAIL
STREETADDRESS �f LIYZ_ / �.,P CITY, STATE, � ryn` o GSSG/ FAX
VA L)V
CONTRACTOR NAME L
• �1l► LICENSE NUMBER LICENSE TYPE BUS.LIC.#
COMPANY NAME � E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
I UNDERSTAND AND AGREE TO THE FOLLOWING:
1. The re-roof project shall comply with all applicable provisions of the 2007 California Building Code.
2. You must schedule all needed inspections a minimum of one day before the requested inspection date.
Please schedule inspections online or call (408)777-3228 between 7:30-3:30 (Mon-Fri).
3. Tear-off roof inspection is required. Please call for tear-off inspection after the roof is torn off and all
the nails/fasteners have been removed. Any and all dry-rotted wood shall be replaced prior to this
inspection. A building inspector will be available within one hour.
There are special hours for this service: 7:30 — 10:30am and 1:00—3:30pm (Mon—Thurs);
7:30 — 10:30am and 1:00—2:30pm (Friday).
4. If plywood is installed, a plywood nailing inspection is required.
5. In-Progress roof inspection is required. Call for an in-progress roof inspection to verify building is
weather tight after installation of approximately 25% of the roofing material.
6. New roof coverings shall not be applied without first obtaining all inspections and written approvals
from the building inspector. Any roofing which is applied without first obtaining an approved inspection
will require the removal of all new material down to the sheathing so a proper inspection can be
performed.
7. A final inspection and approval shall be obtained from the building inspector when the re-roofing is
complete. To receive a final sign-off, the following items will be verified:
a. Flat roofs shall have a minimum of 1/4"per foot of slope and must demonstrate there is no ponding.
b. Listings from approved testing agencies for all pre-manufactured products used shall be available
on-site to review at the time of the inspection.
c. Proper spark arrestor installation.
8. NOTE: If you call for a tear-off or plywood nailing inspection and the work is not complete, you will
be charged a re-inspection fee of$126.00. The re-inspection fee shall be paid before another
inspection can be scheduled.
By my signing below, I certify each of the following is true: I am the property owner or authorized agent to act
on the property owner's behalf.,I understand a d agree to comply with the re-roof policy//stated above.
Signature of Applicant/Agent: Date:
A— wl-n 7 ,V\ 6+ `J os(P k 17 547't V-j ReroofPo1icy_2010.doc revised 05/17/10
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
C U P E RT I N O Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: 22gq cW.�vc�tS �ePERMIT# _!�T
OWNER'S NAME: Tv5 /1 S, wt� PHONE# �� Z� ��
GENERAL CONTRACTOR: - d BUSINESS LICENSE#
ADDRESS: CITY/ZIPCODE:
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVEPBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE. �y� V—
I am not using any subcontractors:
Sign ure 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
Painting/Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/ ontractor Signature Date
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35603028 . 00
DATE ISSUED. . . . . . . : 11/12/2010
RECEIPT #. . . . . . . . . : BS000011989
REFERENCE ID # . . . : 10110079
SITE ADDRESS . . . . . : 22442 CARNOUSTIE CT
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER JOSEPH SEGNA
ADDRESS . . . . . . . . . . : 22442 CARNOUSTIE CT
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-3949
RECEIVED FROM . . . . : LARRY SEGNA
CONTRACTOR . . . . . . . : LIC # *OWNER*
COMPANY . . . . . . . . . . : JOSEPH SEGNA
ADDRESS . . . . . . . . . . : 22442 CARNOUSTIE CT
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-3949
TELEPHONE . . . . . . . .
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 8,400 .00 1. 00 0 .00 1. 00 0. 00
1BSEISMICR VALUATION 8,400 . 00 0 . 84 0 .00 0 . 84 0 . 00
1REROOFRES SQ FEET 28 . 00 364 . 00 0 . 00 364 . 00 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 365. 84 0 .00 365 . 84 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 365 . 84 VISA
---------------
TOTAL RECEIPT 365. 84
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
309 EXTERIOR LATH 311 SCRATCH COAT
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
M.Indoor Air Ouality and Finishes
1.1W L006-�AWN 1 IAQ/Health pts y=yes D
2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes D
3.Usa Loaft VOC Adhadim 3 IAQ/Health pts y=yes D
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
6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 0
�; dlltf�lae�6t# 1 41AQ/Health 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 D
10.Install Whole House Vacuum System 3 IAQ/Health pts y=yes D
1 i 1
N.Flooring
1.Select FSC Certified Wood Flooring B Resource pts y=yes 0
�.Use Papdy Plwawawd J90M rag dodos 4 Resource pts y=yes D
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 D
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 ! 1
Total Points—Mal—lablell 1 1401 1301 57
Total Points Project Received: 01 01 7q
G:data/proWgreenbulldngguiderines/remodelers/greenpointsf=12=rDtected.xis
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 22442 carnoustic ct. DATE: 11/12/2010 REVIEWED BY:
APN: BP#: "EVALUATION: 1$8,400
xPERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY . PENTAMATION
SFD or Duplex 1 SFDWLROOF
USE: P �'��( _ -���_ - PERMIT TYPE:
WORK
SCOPE
FEE ID ROOF AREA
s.f.
1REROOFFRES 2,800
7-1"", . Plant Ch iP ib Plo; ( / � _ir>t'. P'..Ft C ilc<
tii���a,.
)rhe r lac ch.
Mv) iLv'
NOTE: Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addn'1 info,
FEE ITEMS (Fee Resolution 09-051 El 7/1,,"10) FEE QTY/FEE MISC ITEMS
Pi"'m Clwck FC(l-
Sliplrl. PC Fcc
Permit Fee: $364.00
Pizrrr�tt.'?1)�t li.-I�'1ec Pc�Fr�rir f�'<°c�:
("onsirw lion 1-ox
'ICOI s iCtll Rcrt'icw
Work Without Permit? 0 Yes E) No $0.00
Plr.ztzrtial�, l°�'t:`�:
Trtr�c>l l}cx rr�r�<��ztu?ir�rt l�cr.i=
Strong Motion Fee: 1BSEISMICR $0.84 Select an Administrative Item
Bldp-Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $365.84 $0.00 TOTAL FEE: $365.84
Revised: 11/08/2010
CITY OF
T
CITY OF CUPERTINO
REROOF
CUPERTINO PERMIT APPLICATION
A - /
APN# � Date:
Building Address: . 2 2 y y Z C�•��N s}
Owner's Name: �To s- f, k S, S-�5►tib Phone #: y08 - ,0,53- 3g7q
HOA: Yes ❑ No ® If Yes, provide letter from HOA
Contractor: Phone#:
Fax#:
l
Cupertino Business License #: Contractor License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles &Asphalt Shingles
q�Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other (Specify) ❑ Other(Specify)
Number of existing coverings 1. ❑ Provide I.C.C.E.S. Report#
2,'ro be Removed ❑ Provide Mfgr. Installation Specs.
Job Description: i�ew&o ve-
TVtS4at1 .nevJ 5L1CC' 4v,_j 4 C_SPjA,j+`
'9$ J
Residential Commercial
Green Building: Please complete relevant portion of the Conf,rmed 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: # 8 I,,Dc) ----
I
I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
Q rtie y- S ,4, J . S! �q
Signature
Revised 02/05/09