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10110006CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10416 PLUM TREE LN CONTRACTOR: SIGNATURE BUILDERS PERMIT NO: 10110006 INC OWNER'S NAME: BRIAN ADEN /NER'S PHONE: 4083148304 C( LICENSED CONTRACTOR'S DECLARATION License Class -6, C 3 Lic. # 6q 666 9 Contractor 5 t J S -?C4. f 3'-'1 1002 S Date It 1 o 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. 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 nthis permit is issued. 6 APPLICANT CERTIFICATION U 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, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non-pointso regulations per the Cupertino nicipal Code, Section 9.18. Signature Z Date % 1 �v ❑ - UILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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. 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 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 become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 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 il-on the above mentioned property for inspection purposes. (We) agree to save .unify and keep harmless the City of Cupertino against liabilities, judgments, s, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date 555 O'NEILL AVE STE 16 BELMONT, CA 94002 JOB DESCRIPTION: RESIDENTIAL DATE ISSUED: 11/01/2010 PHONE NO: (650) 678-5093 COMMERCIAL RE -ROOF 23 SQ TEAR OFF EXISTING COMP NO RE - SHEET INSTALL 40YR COMP CLASS A Sq. Ft Floor Area: I Valuation: $8500 APN Number: 31633115.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Date: RE -ROOFS: 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. Signature of Applicant: Date: ALL ROOF TUMIXINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Cha ter 9.12 and the Health & Safety Code, Sections 25_S05-,'25533, and 2553 Owner or authorized agent: / / / Date: I 1 /) ho CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional wo CITY OF CUPERTINO FEE ESTIMATOR -BUILDING DIVISION FEE ID ROOF AREA s.f. 1 REROOFFRES 2,300 ADDRESS: 10416 plumb tree lane DATE: 11/01/2010 REVIEWED BY: Plolt Check l CCI' APN: I BP#: *VALUATION: $8,500 xPERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re -roof PRIMARY USE: SFD or Duplex i', t r� r PENTAMATION 1SFDWLR00F PERMIT TYPE: WORK reroof tear off existing comp no plywood install 40 year comp SCOPE sup/4. Irish P,Ce FEE ID ROOF AREA s.f. 1 REROOFFRES 2,300 NOTE: These fees are based on the Dreliminary information available and are only an estimate. Contact the De t or addn'1 info. FEE ITEMS (I ee Resohitio» 09-051 Eft' 7.%1./10) � QTY/FEE Plolt Check l CCI' slfpp/7 Pt ' 1"(T Pltfrral�.! 11 Tt.;1 Ic {; Pall C `hu k: NOTE: These fees are based on the Dreliminary information available and are only an estimate. Contact the De t or addn'1 info. FEE ITEMS (I ee Resohitio» 09-051 Eft' 7.%1./10) FEE QTY/FEE MISC ITEMS Plolt Check l CCI' slfpp/7 Pt ' 1"(T Pltfrral�.! 11 Tt.;1 Ic {; Pall C `hu k: Permit Fee: $299.00 sup/4. Irish P,Ce Plrfrrflr.- llc� lz.;"plc°t: j )fif 1,1ee: P(trrilh,"'14cch.%1'lcc Pc'rnlilIT°ee`°: C'oILNO Cfiort KIA <'lc oosli< al Reviciv Work Without Permit? 0 Yes E) No $0.00 Pl(.7nniii" Fc c.N: 11-(wc'11.�oC't?IP7L'l'1 CdlK>Pt 1'c'e's_ Strong, Motion Fee: IBSEISMICR $0.85 Select an Administrative Item 1 __71 — Bldg- Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $300.851 $0.00 TOTAL FEE: $300.85 Revised: 10/17/2010 3 4 ITEMS OF 4 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 31633115.00 DATE ISSUED.......: 11/01/2010 RECEIPT #.........: BS000011887 REFERENCE ID # ...: 10110006 SITE ADDRESS .....: 10416 PLUM TREE LN SUBDIVISION ...... CITY CUPERTINO IMPACT AREA ...... OWNER ............: BRIAN ADEN ADDRESS ..........: 10416 PLUM TREE LN CITY/STATE/ZIP ...: CUPERTINO, CA OPERATOR: SylviaM COPY # : 1 RECEIVED FROM ....: JEFF RAINEY CONTRACTOR .......: GEORGE BELDEN LIC # 30036 COMPANY SIGNATURE BUILDERS INC ADDRESS ..........: 555 O'NEILL AVE STE 16 CITY/STATE/ZIP ...: BELMONT, CA 94002 TELEPHONE ........: (650) 678-5093 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL ---------- ---------- 1BCBSC ------------- VALUATION ---------- 8,500.00 ---------- 1.00 ---------- 0.00 ---------- 1.00 0.00 1BSEISMICR VALUATION 8,500.00 0.85 0.00 0.85 0.00 1BUSLIC FLAT RATE 1.00 114.00 0.00 114.00 0.00 1REROOFRES SQ FEET 23.00 299.00 0.00 299.00 ---------- 0.00 ---------- TOTAL PERMIT ---------- 414.85 ---------- 0.00 414.85 0.00 METHOD OF PAYMENT ----------------- CREDIT CARD TOTAL RECEIPT : AMOUNT --------------- 414.85 --------------- 414.85 VOICE ID DESCRIPTION -------- ---------------------------- 309 EXTERIOR LATH 601 ROOF TEAR OFF REFERENCE NUMBER -------------------- visa VOICE ID DESCRIPTION -------- ---------------------------- 311 SCRATCH COAT 602 ROOF PLYWOOD NAIL 604 ROOF IN -PROGRESS 605 FINAL REROOF 1. Use Low/No-VOC Paint 1 IAQ/Health pts y=yes 2. Use Low VOC, Water -Based Wood Finishes 2 IAQ/Health pts y=yes 3. Use Low/No VOC Adhesives 3 IAQ/Health pts y=yes 4. Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes 5. Use Engineered Sheet Goods with no added Urea 4 Resource pts y=yes Formaldehyde 61AQ/Health pts y=yes 6. Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 7. Seal all Exposed Particleboard or MDF 4 IAQ/Health pts y=yes 8. Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes 9. Use Finger -Jointed or Recycled -Content Trim 1 Resource pts y=yes 10. Install Whole House Vacuum System 3 IAQ/Health pts y=yes N. Flooring 1. Select FSC Certified Wood Flooring 8 Resource pts y=yes 2. Use Rapidly Renewable Flooring Materials 4 Resource pts y=yes 3. Use Recycled Content Ceramic Tiles 4 Resource pts y=yes 4. Install Natural Linoleum in Place of Vinyl 5 IAQ/Health pts y=yes 5. Use Exposed Concrete as Finished Floor 4 Resource pts y=yes 6. Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes Total Points Available: 1 1401 130 57 Total Points Project Received: 0 0 0 46.:ta/progs/gre gguidelines/remodelers/greenpointsfinal2.12.04protected.As CUPERTINO 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 (408) 777-3228 • FAX (408) 777-3333 • building aacupertino.org -F--- PROJECT ADDRESS ) o j f j v^^ TJ d _ ) 1 APN # OWNER NAME' 12 ( A 1 / - 7SE- „ J PHON / q3 o'-1 E-MAIL STREET ADDRESS / ©� I �%� ` � / C' CITGSTATE, i> LIZ%�ti G C ,4 , A.5 o / q FAX CONTRACTOR NAME ' 1&,AJA­7071-_ -by IDelz LICEN E NUMBER X66 LICENSEE TYPE 3 G3 BUS. LIC. # COMPANY NAME E-MAIL FAX 65e) -65,4-3V2_6 STREET ADDRESS OL -D a (/A)7zY ILD . '71. Q CIT STATE, ZIP Ez-M nom- L4 9 4 OvZ PHONE 6y &qa. 7`l 10 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 '/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. y 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 trstand and agree to comply with the re -roof policy stated above. Signature of Applicant/Agent: Date: I � /1 /1G ReroofPolicy_2010.doc revised 05/17/10 CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: ? 0 L4) (e )v M —TSj<t L e PERMIT # OWNER'S NAME: 21 A AJ i nJ PHONE # O 1 qO GENERAL CONTRACTOR:3'),jPC1Z_5 BUSINESS LICENSE # ADDRESS:I ( 00 C-0 U,,J7R 5 TE P I CITY/ZIPCODE: e-7_M6� *Our municipal code requires all businesses working in the city to have a city of uupertmo nusmess ncense. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SU CONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: fLl Signa Date Please check applicable subcontrac/ornd complete the following information: )lb bo Date 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 )lb bo Date CITY OF CUPERTINO REROOF CUPERTINO PERMIT APPLICATION 101jr) 06 Co APN # !(V 3 Ifsr Date: 10/i® Building Address: 10 g r(0 '?!t) M "i� �.� C Owner's Name: j� -12_(A A) A c ,,) Phone #: 51 <? 3 e,) `1 HOA: Yes ❑ No © If yes, provide letter from HOA Contractor: Phone #: get) • 6 q N - 7 q lD ,iso .� S�,/.3q z 6 Fax #: Cupertino Business License #: Contractor License #: 6 S &669 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) Cc -,mi' 5 � r,JC I E X Other (Specify) q D VA -21 66 m p Number of existing coverings cv;,j c ❑ Provide I.C.C.E.S. Report # p( To be Removed ❑ Provide Mfgr. Installation Specs. Job Description:.rZ - 'ft�c,Z o� �X�S--rr..l�j I �� SH��-T , i'-� Lio Y�C7rjt� ResidentialCommercial F-1 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 q I Have Read, Understand and Will Comply with Cupertino's Tear -Off Policy: Signature Revised 02/05/09