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10090146 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21044 HAZELBROOK DR CONTRACTOR:ABOVE ALL ROOFING PERMIT NO: 10090146 OWNER'S NAME: REGNER CUNANAN 700 NORTHRUP ST DATE ISSUED:09/16/2010 BIER'S PHONE: 4082538741 SAN JOSE,CA 95126 PHONE NO:(408)2924188 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r License Class �_ 3 I Lic.## f�y �/�S MECH r RESIDENTIAL r COMMERCIAL r Contractor f/`l v d e- �d bi/Ao;;, _Date JOB DESCRIPTION:WALKING DECK ROOF REPAIR(66SQ)/DRYROT I hereby affirm that I am licensed under the provisions of Chapter 9 DAMAGE(72SQ) (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 Sq.Ft Floor Area: Valuation:$11000 Section 3700 of the Labor Code,for the performance of the work for wthi,� permit is issued. which APN Number:32655034.01 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. 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. / Issued byl,;�%--_ V Date: Signatur /,_— y.' �/ .•- Date OWNER-BUILDER DECLARATION RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for the following two reasons: inspection. 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, Signature of Applicant4— Date: Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534. 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 Owner or author a"ent: become subject to the Worker's Compensation provisions of the Labor Code,I muses—' — Date: forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.) correct.I agree to comply with all city and county ordinances and state laws relating; Lender's Name to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address indemnify and keep harmless the City of Cupertino against liabilities,judgments, and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION mg of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. Licensed Professional Signature Date CITY OF CUPERTINO FEE ESTIMATOR -BUILDING DIVISION ADDRESS: DATE: REVIEWED BY: APN: BP#: *VALUATION: Isi1,000 *PERMIT TYPE: Building Permit PL,kN CHECK TYPE: Alteration/Addition/ Repair PRIMARY 101"111; PENTAMATION 1 SFDWLROOF USE: SFD or Duplex h1 00 r J/, is PERMIT TYPE: WORK SCOPE Lfcch, 1,1( t Ch,t k htrrnth.1'Inn C face Lice. 1'i',an C'h,'k k O Jxr a1r kt Inq� F-1 0 ho.Ph,mb In:?> 011 r k,`_°,. l��ip 1ho?, h-v) F"", Y'riw/3 ir�tt. f:�,,., lilcc Ifnw Li /,cc NOTE: These fees are based on the preliminary information available and are only an estimate. Contact the De t or addn7 info. FEE ITEMS (Fee Resolution 09-051 E�. 7%'li/0j FEE QTY/FEE MISC ITEMS Plan Check Fee: 90.00 600 s.f. Re-roof Suppl.PC Fee: 0 Reg. O OT0.0 hrs 90.00 $78.00 IREROOFRES PME Plan Check: 90.00 = s.f. Siding Permit Fee: 90.00 $380.00 IsIDEoTHER All Other Suppl. Insp. Fee-.0 Reg. 0 OT 0.0 hrs 9;0.00 PME Unit Fee: :0.00 PME Permit Fee: $0.00 (`071s0r1W1i017 Tax I Acoustical Fee: 0 Yes No 50.00 0 Work Without Permit? 0 Yes 0 No 50.00 E) Planninp_Fee: 50.00 Select a Non-Residential Building or Structure 0 11-o cl I`(T's': Stron)z Motion Fee: IBSEISMICR :11.10 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC :51.00 SUBTOTALS: 32.10 $458.00 TOTAL FEE: $460.10 Revise k9/14/2010 i' CITY OF CUPERTINO 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 32655034 .01 DATE ISSUED. . . . . . . : 09/16/2010 RECEIPT #. . . . . . . . . BS000011473 REFERENCE ID # 10090146 SITE ADDRESS . . . . . : 21C44 HAZELBROOK DR SUBDIVISION . . . . . . . CITY CUFERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : REGNER CUNANAN ADDRESS : 21044 HAZELBROOK DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : ABOVE ALL ROOFING S CONTRACTOR KEIT SULESKY LIC # 23092 COMPANY ABOVE ALL ROOFING ADDRESS . 701) NORTHRUP ST CITY/STATE/ZIP SAN JOSE, CA 95126 TELEPHONE (4 )8) 292-4188 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC --NEW-BAL - ---------- ------------- ---------- ---------- ---------- ---- 1BCBSC VALUATION 11, 000. 00 1 .00 0 .00 1. 00 0 .0 1BSEISMICR VALUATION 11, 000. 00 1 .10 0 .00 1.10 0 . 00 1REROOFRES SQ FEET 6 . 00 78 .00 0 .00 78. 00 0 . 00 1SIDEOTHER SQ FEET 72 . 00 380 .00 0 .00 380 . 00 - ---- ---------- ---------- ---------- TOTAL PERMIT 460 .10 0 .00 460.10 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- -- --------------- ------ CHECK 460 .10 #19153 --------------- TOTAL RECEIPT 460 .10 VOICE ID DESCRIPTION VOICE ID - DESCRIPTION _ _ ------ ----------------------- -- -- ---------- _ 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 604 ROOF IN-PROGRESS 605 FINAL REROOF jf V% J C;L- C-2 ILI %) 4L 40 fQ. V-11 %J v— .4 I Qf) cc E 2 M Cc: t: 8 0 C, t CIL •v \ y c T > cc ' roo w az _ --t- < u. .1......... Lu 'E m c Oc E;E indoor it Quality an lnts es 12111 1.Use Low/No-V©C Paint 2.Use Lrnv VOC,Water-based Wood Finishes 1 IAQ/Health pts y--yes 21AQ/Healthis es D 3.Use Lflw/f�o VOC Adhesives p y--yes p 4.Use Salvaged Matedais for Interior Finishes 3 IAD-/Health pts yeses D 5.Use Engineered Sheet Goods with no added Urea 3 Resource pts y--yes 0 Formaldehyde B.Use Exterior Grade Ply,vood for Interior Uses 5 IAQ/Health pts y=yes 1 IAQ/Health is y=yes D 7.Seal.all Ex;�osed i',arlioleboard flr h4DF p y-y D B.Use FSC Certified Materials for Interior Finish — 4 IA—Health pts = es 4 Resource pts y=yD P.Use Finger-Jointed orRecycled-Content Trim es 0 10.Install Mole House Vacuum System 1 Resource pts y=yes 0 3 IAQ/Health pts y=yes 0 N.Flooring 1.Select FSC Certified Wood Flooring 2.Use Rapidly RenMable flooring Materials 3 Resource pts y=yes D 3.Use Recycled Content Ceramic Tiles 1 Resource pts y=yes 0 4.Install Natural Linoleum in Place of Vinyl -- }Resource pts y=yes 0 5.Use Exposed Concrete as Finished Floor 'IAQ/Health pts y=yes D S.Install Recycled Content Carpet with Low VOCs Resource pts y=yes 0 Resource pts y=yes 0 Total Points Available: 140 130 57 Total Points Project Received: ` 0 0 0 G:data/progslgreenb SId�_,guidelinestramodaiLrs/greLnpDlntsfinal?-12.D4 ed xis UPERTEv SIM CITY OFC O C17Y Of CUPEkTINO GENERAL BUILDING PERI%MT APPIACATION FORM AP # � .�, �• A .� � Date: Building Address: Mailing Address (if different from building address): Are Hazardous Materials being used as part of this project? Yes No HOA: (Exterior work only) Yes ❑ No K Ij' es, provide letter from HOA Owner's Name: Phone#: J Contractor: Phone: 11 r ; .,��.. Fax: Contractor License#:` `f' �> Cupertino Business License#: t Z Contact: / Phone: V. h i� �- �✓ �i Fax: Y Residential KCommercial Job Description: A. Z,// i� 6 `t�m61 Building Permit Info: Bld Elect ❑ Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy T e- 1-A, :1-A, 1-B ❑ II/=-A ❑ II/VI B, N-HT,V-B _- Valuation: Square Footage: Project Size: Express 0---Standard ❑ Large ❑ Major ❑ Green Building: Please complete relevant portion of the Green Building/LEED Checklist & attach it to the application or if applicable, include in plan set & the sheet index. Points Achieved: For help, contact Build it Green at www.builditgreen.or �f Revised 07/14/09 3