10100131 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 18735 LOREE AVE COr TRACTOR:ROOF ROOFING PERMIT NO: 10100131
OWNER'S NAME: CLIFFORD SZU 5577 VASSAR DR DATE ISSUED: 10/18/2010
JER'S PHONE: 4083548910 SAN JOSE,CA 95123 PHONE NO:(408)265-9270
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lie.# G 817SG
w
� MECH[_ RESIDENTIAL r— COMMERCIAL
Contractor Date r' �
I hereby affirm that I am licensed under the provisions of Chapter 9 5. JOF,DESCRIPTION:RE-ROOF REMOVE THE EXISTING BUILT-UP ROOF OVER
(commencing with Section 7000)of Division 3 of the Business&Professions THE
Code and that my license is in full force and effect. GAR AGE&SMALL PART OF THE HOUSE.RE-ROOF BUILT UP
WIT)I GRAVEL APPRX 1000 SQFT CLASS A
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 workf r i 's
permit is issued. Sq.lit Floor Area: Valuation:$3400
APPLICANT CERTIFICATION
1 certify that I have read this application and state that the above info ation is APr Number:37519016.00 Occupancy Type:
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, :PERMIT EXPIRES IF WORK IS NOT STARTED
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the appliqpt understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR
with all non-point source regulatio per the ertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION.
9.18.
Signatu Date f Issued by: Date`4��d�, ZF
LJ OWNER-BUILDER DECLARATION —
I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS:
the following two reasons: All r oofs shall be inspected prior to any roofing material being installed.If a roof is
I,as owner of the property,or my employees with wages as their sole compensation, inW lled without first obtaining an inspection,I e remove all new materials for
will do the work,and the structure is not intended or offered for sale(Sec.7044, insp action.
Business&Professions Code) Sigr ature of Applicant: l f`6a
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 ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE
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 read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
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&
Section 3700 of the Labor Code,for the performance of the work for which this
Safcty Code,Section 25532(a)should I store or handle hazardous material.
permit is issued. Additionally,should I use equipment or devices which emit hazardous air
I certify that in the performance of the work for which this permit is issued,I shall com aminants as defined by the Bay Area Air Quality Management District I will
not employ any person in any manner so as to become subject to the Worker's mai main compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Compensation laws of California. If,after making this certificate of exemption,I Health&Safety Code,Sec' s 2 5 , 5533,and 25534.
become subject to the Worker's Compensation provisions of the Labor Code,I must
Owl►er o riz age
1.00
forthwith comply with such provisions or this permit shall be deemed revoked. Date:
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
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 I he eby affirm that there is a construction lending agency for the performance of work's
to building construction,and hereby authorize representatives of this city to enter for,vhich this permit is issued(Sec.3097,Civ C.)
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name
•mify and keep harmless the City of Cupertino against liabilities,judgments,
,and expenses which may accrue against said City in consequence of the Lender's Address
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION
9.18.
I un ierstand my plans shall be used as public records.
Signature Date
Lic4 nsed Professional
CITY OF CU:PERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: I TATE: REVIEWED BY:
APN: BP#: *VALUATION: 1$3,400
R*PERMITTVPE: Minor Building Permit PLAN CI[ECK TYPE: Re-roof
PRIMARY ? t r PENTAMATION 1 SFDWLROOF
USE: SFD or Duplex 1.t ,_ �, r._ PERMIT TYPE:
WORK
SCOPE
FEE ID ROOF AREA
s.f.
1REROOFFRES 1,000
Pik, C"fu'c'k
P>
LJ
ly"
NOTE. Thesefees are based on the preliminary in ormation avails ble and are only an estimate. Contact the De t or addn'1 info,
FEE ITEMS (Ue Resohition 09-051 E -7%10) FEE QTY/FEE MISC ITEMS
. '
slippli. 1"t 1 c
Permit Fee: $130.00
SiViTIfl, FCC
j
Perini! Fcc:
Con, Irlwfl O7 I'd
Work Without Permit? Yes E) No $0.00
Stronk Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00
SUBTOTALS: $131.50 $0.00 TOTAL FEE: $131.50
Revised: 9/29/2010
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 37519016 .00
DATE ISSUED. . . . . . . : 10/18/2010
RECEIPT #. . . . . . . . . : BS000011770
REFERENCE ID # . . . : 10100131
SITE ADDRESS . . . . . : 18735 LOREE AVE
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : CLIFFORD SZU
ADDRESS . . . . . . . . . . : 18735 LOREE AVE
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : ROOF ROOFING, INC
CONTRACTOR . . . . . . . : HENRY OLOCKI LIC # 26739
COMPANY . . . . . . . . . . : ROOF ROOFING
ADDRESS . . . . . . . . . . : 5577 VASSAR DR
CITY/STATE/ZIP . . . : SAN JOSE, CA 95123
TELEPHONE . . . . . . . . : (408) 265-9270
FEE ID UNIT QUANTITY AMCUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 3, 400 . 00 1 .00 0. 00 1. 00 0 . 00
1BSEISMICR VALUATION 3, 400 . 00 0 .50 0 . 00 0. 50 0 . 00
1REROOFRES SQ FEET 10 . 00 130 .00 0. 00 130 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 131 .50 0 .00 131 .50 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 131 .50 #2514
---------------
TOTAL RECEIPT 131 .50
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
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
CUPERTINO 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228• FAX(408)777-3333•build inq(@cupertino.org
PROJECT ADDRESS
OWNER NAM t/ PHONE �� E-MAIL
Q
STREET ADDRESS CITY. STATE,i IP FAX
-7
CO ACTOR NAM LICENSE NUMBER LICENSE TYPE BUS.LIC.#
rv� . - 9,ay G .
COMPANY NAME E-MAIL FAX
STREET ADDRESS�t CITY,STAT�rZ WONE
P� �l
I UNDERSTAND AND AGR 3E TO THE FOLLOWING:
1. The re-roof project shall comply with all applicable )rovisions 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-:1228 between 7:30-3:30 (Mon-Fri).
3. Tear-off roof inspection is required. Please call fc r 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 w.thin 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 250/, of the roofing material.
6. New roof coverings shall not be applied without firs. obtaining all inspections and written approvals
from the building inspector. Any roofing which is a)plied 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 :)f slope and must demonstrate there is no ponding.
b. Listings from approved testing agencies for all lire-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 tru(: I am the property owner or authorized agent to act
on the property owner's behalf. I s agree to comply the re-roof policy stated above.
Signature of Applicant/Ag Date:
/t)'
ReroofPolicy_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 / SUBC1ONTRACTOR LIST
JOB ADDRESS: PERMIT# Ir
OWNER'S NAME: iL� PHONE
GENERAL CONTRACTOR BUSINESS LICENSE# ra 5CK
ADDRESS: 5S7Z 's5 L CITY/ZIPCODE: a, Sm« Q� `i tt Fl
*Our municipal code requires all businesses working in thf 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 HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
Signai 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 T Date
INPUT ReSDUT-Ces Energy 1ADIHeafth
M.Indoor Air Quality and Finishes
1.Use Low/No-VOC Paint 1 IAD/Health pts y=yes 0
2.Use Low VOC,Water-Based Wood Finishes 2 IA])/Health pts y=yes 0
3.Use Low/No VOC Adhesives 3 IA /Health pts y=yes 0
4.Use Salvaged Materials for Interior Finishes 3 Ri source pts y=yes 0
5.Use Engineered Sheet Goods with no added Urea
Formaldehyde 6 IA /Health pts y=yes 0
0
6.Use Exterior Grade Plywood for Interior Uses 1 IA)/Health pts y--yes
7.Seal all Exposed Partiokiboard or MDF 4 IA)/Health, pts y--yes 0
8.Use FSC Certified Materials for Interior Finish 4 R+:source pts y=yes 0
9.Use Finger-Jointed or Recycled-Content Trim 1 R:source pts y=yes 0
10.Install Whole House Vacuum System 3 l/O/Health pts y--yes 0
1 t 1
N.Flooring
1.Select FSC Certified Wood Flooring 8 Re;;ource pts y=yes 0
2.Use Rapidly Renewable Flooring Materials 4 Re:;ource pts y=yes 0
3.Use Recycled Content Ceramic Tiles 4 Re;;ource pts y=yes 0
4.Install Natural Linoleum in Place of Vinyl 5 IAO/Health pts y=yes 0
5.Use Exposed Concrete as Finished Floor 4 Re!;ource pts y=yes 0
6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes 0
1 1 1
Total Points Available: 1 1401 1301 57
Total Points Project Received:1 gkezro 1 0
r�
G:data/progs�greenbuild igguidelines/remodelerslgreenpointsfina1212.04prolected.xls
CITY OF
10 CITY OF CU.PERTINO V
REROOF
CUPERTINO PERMIT APPLICATION
APN # Date:
Building Address: _
Owner's ame: 2 ; Phone #:
itv�s`3 5 r '5V)P
HOA: Yes ❑ No If yes, provide letter f rom HOA
Contractor: Phone #:
Fax#: S
Cupertino Business License #: Contractor License #:
C-,'y5'73_6 25-
Type of Roof Covering:
Existing: Propose :
wilt-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: a :.� �� � �,�;v� -c\,,` �,�, G_ J?_
,lt
U0,0 0
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 Have Read, Und s d and Will Comply with Cupertino's Tear-Off Policy:
SigfAireu
Revised 02/05/09