10100065 CITY OF CUPER'CINO BUILDING PERMIT
CONTRACTOR: PERMIT NO: 10100065
BUILDING ADDRESS: 10430 FINCH AVE7,4 DATE ISSUED:10/07/2010
OWNER'S NAME: AMITA AGARWAL
PHONE NO:
VER'S PHONE: 6509065292 '
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT PLUMB r
License Class � &1-) Lie.# MECH f— RESIDENTIAL
Contractor r— COMMERCIALr
[�/! h�N S?2r �!D t�/ _Date 0 w
JOB DESCRIPTION: RE-ROOF REPAIR ROOF SHINGLES RMOVE SSQ&
I hereby affirm that I am licensed under the provisions of Chapter 9 REPLACE
&NEW 30LB FELT CLASS A 4SQ
(commencing with Section 7000)of Division 3 of the Business&Profession!
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarati ins:
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 wT
Valuation:$3000
Sq.Ft Floor Area:
permit is issued.
APPLICANT CERTIFICATION Occupancy Type:
I certify that I have read this application and state that the above information is APN Number:37540053.00
correct.I agree to comply with all city and county ordinances and state laws re ating
to building construction,and hereby authorize representatives of this city to en.er
upon the above mentioned property for inspection purposes. (We)agree to sa-,e
indemnify and keep harmless the City of Cupertino against liabilities,judgmer ts, PERMIT EXPIRES IF WORK IS NOT START
costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,the applicant understands and will coma ly
with all non-point a regulations per the Cupertino Municipal Code,Secti in 180 DAYS FROM LAST CALLED INSPECTION.
9.18.
Signature
Date 9 Issued b� Date:
iJ
OWNER-BUILDER DECLARATION
RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one ofrsha inspected prior to any roofing material being installed.If a roof is
the following two reasons:
I,as owner of the property,or my employees with wages as their sole compe��sation, first obtainin nspection,I a e to remove all new materials or
will do the work,and the structure is not intended or offered for sale(Sec.70z 4,Business&Professions Code) Date:
I,as owner of the property,am exclusively contracting with licensed contrac�ors tolicant:
construct the project(Sec.7044,Business&Professions Code).
ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I hereby affirm under penalty of perjury one of the following three
declarations: of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE
I have and will maintain a Certificate
Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintl
I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Safety Code,Section 25532(a)should I store or handle hazardous material.
Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air
permit is issued. by the Bay Area Air Quality
agement District I will
I certify that in the performance of the work for which this permit is issued,I shall contaminants
compliance defined h the Cupertino Municipal Code,rCh Chapter 9.12 and the
not employ any person in any manner so as to her subject to the Wemporke ion,
Health&Safety Code,Sections 25505,25533,and 25534.
Compensation laws of California. If,after making this certificate of ex
emp ion,I
become subject to the Worker's Compensation provisions of the Labor Cod e,I must *Wrhorized a t:
forthwith comply with such provisions or this permit shall be deemed revol ed.
Date:_/0"70
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above informatic n is I hereby affirm that there is a construction lending agency for the performance of wo
correct.I agree to comply with all city and county ordinances and state law s relating for which this permit is issued(Sec.3097,Civ C.)
to building construction,and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned property for inspection purposes.(We)agree to save
-inify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
and expenses which may accrue against said City in consequence of the
gi.ating of this permit.Additionally,the applicant understands and will cc mply ARCHITECT'S DECLARATION
with all non-point source regulations per the Cupertino Municipal Code,S xtion
9.18. 1 understand my plans shall be used as public records.
Signature Date —
Licensed Professional
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DE'ARTMENT•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
(ir)cupertino.org
/o / /�� � / � ✓
7APN#
PROJECT ADDRESS IV i^ _ '4
OWNERPNE
> E-MAIL �f� /2 21)2-
t,4 A e � q
CI Y, STATE,ZIP FAX
STREET ADDRESS
CrJ LICENSELICEN#TYPE Z t,✓.� BUiS.LI
CONTR ORNAME
(�
IV 7 C )/Vd
E MAIL FAX
COMP NY NAME Ll,c /,�
V PHONE
STREET ADDRESS CI(Y,STATE,ZIP
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 (4)8)777-3228 between 7:30-3:30 (Mon-Fri).
3. Tear-off roof inspection is required. Plea;e 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 avE ilable 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. Gall for an in-progress roof inspection to verify building is
weather tight after installation of approxim,-.tely 25% of the roofing material.
6. New roof coverings shall not be applied wil hout first obtaining all inspections and written approvals
from the building inspector. Any roofing A hich 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 obi ained 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 per foot of slope and must demonstrate there is no ponding.
b. Listings from approved testing agenciE s 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 e h of the follov49ree
is true: I am the property owner or authorized agent to act
on the property owner's be understand an to comply with the re-roof policy stated above.
Date:
Signature of Applicant/Agent:
ReroofPo1icy_2010.doc revised 05/17/10
0
0 n oor rua►ty and Finishes 1 IAQMealth pts y=Yes 0
1.Use LowMo-VOC Paint
2lA(�Mealth pts Y--Yes0
2.Use Low VOC,Water-Based Wood Finishes 3 IAQ/Health pts Y--Yes p
3.Use LOWMo VOC Adhesives 3 Resource pts y--yes4.Use Salvaged Materials for interior Finishes 0
p
5.Use Engineered Sheet Goods with no added Urea 6 IAO/Health pts y=yes
Formaldehyde
1 IAplHealth pts y=yes 0
6.Use Exterior Grade Plywood for Interior Uses 4 IAWWth. pts y=YeS 0
7 Seal aN dosed R ebwd or MDF 4 Resource pts Y=YeS 0
B.9 Use FSCe Inted r R ycled-Content Trim
erior Finish1 Resource pts y=yes 0
9.Use Fing 3 IAGUHealth pts y
10.Install Whole House Vacuum System
0
N.Flooring B Resource pts Y---Yes p
1.Select FSC Certified Wood Flooring 4 Resource pts Y=Yes p
Renewable flooring Materials 0
2.Use Rap► y 4 Resource pts y=yes
3.Use Recycled Content Ceramic Tiles 5 IAQ/Heaith pts y=Yes p
4.Install Natural Linoleum in Place of Vinyl 4 Resource pts Y--Yes p
5.Use Exposed Concrete as Finished Floor 4 Resource pts y=yes 1 ,
6.Install Recycled Content Carpet with Low VOCs
140 130 57
11111111 oints Availa ale: 0 0 p
Total Points Pro'ect Recei�red:
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CMZ^( OF
CITY OF CUPERTINO
R�.JROOF
FERMIT ,4,PPLICATION
CUPERTINO
Date:
I
drGC P IC 7-1 N40 C' v1 Jc-�0/ _/W
Building Address: G� �-
� 1' � Phone #: � �
Owner's Name: J �C 12. W ''� '- lJ
` ] If yes, rovide letter from AOA Phone #: YO
HOA: Yes ❑ No
Contractor: �8 - 0/ 0
C..,.-t�^-� Fax#: y �8' Z
Contractor License #:
Cupertino Business License #: �j g
J 1 k-N
'type of Roof Covering:
Proposed,
Existing: ❑ Built-Up roof
❑ Built-Up Roof ❑ Asphalt Shingles
Asphalt Shingles ❑ Wood Shakes
❑ Wood Shakes ❑ Wood Shingles
❑ Wood Shingles ❑ Other (Specify)
❑ Other (Specify) - ❑ provide I.C.C.E.S. Report#
Number of existing coverings __ — ❑ provide Mfgr. Installation Specs.
❑ To be Removed
175/
Job Description: a Y '� S �'
Commercial
Residential Dept. if
ete relev<<nt portion of the Confirmed nwith_Planning p
Green Building: Please co mpl there are any restrictions: ❑
application or if
Green Building Checklist & attach e sb sheet index.
a licable, include in Ian set &
Valuatioti.
I Have Read,
rstand and Will Com?ly with Cupertino's Tear-Off Policy:
Signature Revised 02/05/09
RTIN1�BUILDING PERMIT PERMIT NO'10100146
CITY OF CU CTOR:JUST WATER HEATERS 1012012010
CONt�RA DATE ISSUED:
INC
VESTMENT BLVD p1l0NE NO:(510)293-9901
11112 FIRETHORNE DR 3400 IN �,,,.
BUILDING ADDRESS'- THRYN O CA 94545 PLUMB
HAYW�' ELECT r
E ROBERT A AND ' V""
PER'S NAME: PAYN O: BLDG
F IT INF COMMERCIAL
4087731854 TION BUILDING PER1�I RESIDENTIAL
OWNER'S PHONE: IS DECLARA
RACTOR MECH GAS WATER HEATER
❑ LICENSED CUNT CE EXISTING 40 GALLON
Lic•# JOB DESCRIPTION:/tEPLA
License Class Date ter 9
LOCATED IN AN INTERIOR CLOSET'
provision'of Chap
Contractor the p usiness&professions
that I am lice°sed under of the B
1 hereby affirm of Division 3
(commencing with Section 7000) declarations:
Code and that my license is in full force and effect'
of per one of the following Worker's Valuation,$1032
under penalty p for the
1 hereby affirm Certificate of consent to self-in'boi Code,
will maintain a Secti0113100.of the Sq.Ft Floor Area:0
1 have and Pro" Ch for bypermit s issued• for by Occupancy Type
Compensation, p which this p ensation Insuranpe,as provided
performance of the work for COr
in Worker's ance of the work for which ttu' APN Number•32345005.00
will maintain
Labor
Code,for the pe1dp11r' D
1 have and of the La S'r ARTE
Section 3700 TION S IF WORKIS NOT CE OR
permit is issued. T CERTIFICA ation s IT EXPIRE RMIT ISSUAN
AppLICAN d state that the above inform .elating PEP
yS OF pE CTION'
telaws , LAST CALLED INSPE
lication an ordinances and state to ,iter WITHIN 180 DA
that 1 have read this app and county
1 certify to comply with all cityuthorize representatives of this
to ,ave DAY
FROM
correct-1 agreeand hereby purposes, ( 180 D
ction, ection pure a of i lents,
constru ropertY for insp O a ainst liabilities,J Date:
uponithe above mentioned p of Cupertm g uence of i he
ess the City ainst said City in conseA
and keep 1 ''"l accrae against understands an
d will cc mptY
indemnify ch may the app Municipal Code,S xtion
enses which ed. r1 Issued by
costs,and ftp. permit. Additionally,per the Cup
granting of this p e regulations
with all non-point sours
ROOFS: installed.if a roof i'
918
Date—= R terialbeing materials
prior to any roofing remove all new
lure meted p inspection,
agree to rem
_ DECLARATION All roofs shall be insp
for one of installed without first obtaining a"
OwNER_BUILDER Date:
❑ t from the Contractor
's License Law inspection.
exempt nsation, licant: TIER
a{firm that I am es�their sole c ompe Signature of App A OR BE
I hereby s with wag 7044, CLASS"
two reasons:or my employee or offered for sale(`
the following r0 arty,
I as owner of the Pana the structure is not intended ALL ROOF COVERINGS TO B
the work, sting with licensed ,Ontractors to CLOSURE
will do contra TERIALS DIS
Business&Professions Cod
exclusively HAZARDOUS AIA Chapter 6.95 of
Owner of the property' Business&Professions Code). airements under 25534. 1 wit
1,as est(Sec•7044, thi•ee materials req 25533,and the Hl
construct the prof the hazardous Code,Sections 25505,Chapter 9.12 and
of perjury one°t the following have read Sa{ety al Code, materi
pen N Jorker's ealth& no Municip or handle hazardous
I hereby a%,rm under p California Hvith the Cupertino t hazardous a
for the Cp1npliance a should I store ement Dist
declarations: of the Labor Code. Code,Section 255320 ent or devices whichMa ag
d will maintain a Certif'cate of Consent to self insure ° Safety Area Air Quality Chapter 9.12
I have an provide( for by Section 3700 r>vided for by Additionally,should I usebeahpBay unicipat Code,
Compensation,as p it is issued• as nants as defined Y Cupertino M
Comp work for which this p erm tion Insurance, which this co liaise with the Cup 25533,and 25534.
Perform' of the worker's Comp e work for maintain comp Sections 25505,
1 have and will maintainbor Code,for the p
erfOnnance of the Safety Code,
Of the La is issued,l shall Health&
Section 37� ed agent: Date:—
which this perm worker's
permit is issued• ance of the work for become subject tc the Owner or authoriz
erform as to bec tion,I IN-AGENCY
1 certify that in the p in any manner so this certifica e of exemP 1 must LEND
loy any person making Labor Code, CTION erforr
not emp ia. If,after m rovisions of th: CONSTRU agency
for the p
of Californ COmpensation p d�emect revoked.
Compensation taws workers it shall be construction lending g
e subject to the or thus perm affirm that there is a 3097 Civ C.)
b�0m 1 with such provisions 1 hereby
for which thus permit is issued
forthwith comp Y TIFICATION n is Lender's Name
AppLICAN I CER
lication an and state laws relating
d state that the abc ve informatio to enter
this app county ordinance. Lender's Address— TION
I certify that 1 have readl with all city anoriZe representative, this
to save ARCHITECT'S DECLARA
t 1 agree to OOl. yand hereby auth ection pulp. ( udgments, records
correc• erty for insp public res
to building construction, ertino against'iabilituence of the used
the above mentioned ptOp O f Cup in consequence plans shall be
and keep harmless the Ci e against said City will comply 1 understand my
uiify which may accru licant understa Ods andode gecuon
and exper►ses the app Cupertino MU nicipal professional—
costs, Of thus permit.Additionally,Per
the p Licensed
granting oint source regulations p
with all non-p
9.18. Dat:—
c;anature