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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