09120134 (2) CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 1040 BUBB RD CONTRACTOR:TBD-TO BE PERMIT NO:09120134
DETERMINED
OWNER'S NAME: BELLO RENATO R AND ROSARIO S DATE ISSUED: 12/22/2009
�NER'S PHONE: 4084966532 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIAL
License Class Lie.# L/7 �-0-2—1p RE-ROOF TEAR OFF SHAKES,APPLY OSB,CLASS A 21
SQUARES
Contractor Date ��
2
G
1 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:
1 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. Sq.Ft Floor Area: Valuation:$6200
1 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
APN Number:36204017.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct. 1 agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the ? --�_._..- %2
granting of this permit. Additionally,the applicant understands and will comply Issued 6'y—, �� Date:
with all non-point sourceeguI tions per the Cupertino Municipal Code,Section
9.18. .—.-"'—`
l Z 23 G 5 RE-ROOFS:
Signature Date All roofs shall be inspected prior to any roofing material being installed.If a roof is
r
installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
LJ OWNER-BUILDER DECLARATION ��y / 2� U`J
/
I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date:
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1,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)
1,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). 1 have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. 1 will
I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Health&Safety Code,Section 25532(a)should 1 store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533,a d 25534.
Section 3700 of the Labor Code,for the performance of the work for which this � > 2-� -5
permit is issued. Owner or authorized agent: Date:
1 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,1 CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANT CERTIFICATION Lender's Address
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 ARCHITECT'S DECLARATION
mnify and keep harmless the City of Cupertino against liabilities,judgments,
.s,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signatu Date 12 2) c✓�
al"E.
CITY OF CUPERTINO
REROOF
CUPEkT1NO PERMIT APPLICATION
0q', '? )44
APN # Date:
Building A�ess:
Owner's Name: Dlek� 0 Phone #: f3
HOA: Yes ❑ No If Yes, provide letter from HOA 1 q 7 �(-- &
Contractor: Phone #:
C)
r_ ��n
\� S T-0 0K V` r Fax #:
Cupertino Business License #: Contractor License
y
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ B p roof
❑ ,,Asphalt Shingles �t 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:
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: 3-2—c-0
I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
Signature
Revised 02/05/09
CITY OF CUPERTINO
REROOF
CUPEkTINO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1REROOFCOM Re-roof Cor.imercial B 1COMMLROOF
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
1BSEISMICO Seismic Commercial B
1RER00FRES Re-roof Residential B 1SFDWLR00F
2 _
/ 1BCBSC Cal Bldg St,,mdards B ALL PERMIT TYPES
Commission Fee
1BSEISMICRE Seismic Residential B
1 REROOFMRES Re-roof Mu.ti-Family B 1MFDWLROOF
1BCBSC Cal Bldg St�mdards B ALL PERMIT TYPES
Commission Fee
1BSEISMICRE Seismic Residential B
1BUSLIC Business License B
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
Fax: (408)777-3333
Building Department
Subject: Re-roofing policy for the City of Cupertino
1. Prior to permit issuance,you must agree to comply with 2007 IBC Standards
and manufacturers specifications on re-roofing.All roofs are Class "A"per Cupertino
municipal code 16.04.080.
2. New roof coverings shall not be apphad without first obtaining all inspection
and written approval from the building inspector. A final inspection and
approval shall be obtained from the b wilding inspector when the re-roofing
is completed.
3. All roofs shall be inspected prior to any roofing installation.
4. To receive a final sign off from the City,the following steps are
required:
1) Pre-inspection and/or tear off app oval.
2) In-progress inspection approval.
3) Final inspection approval.
a) Spark arrester installation.
5. If plywood is installed,a plywood nail inspection is required.
6. Any roofing which is applied without first obtaining an inspection,
will require the removal of all new material down to the sheathing,
so a proper City inspection can be performed.
7. NOTE: If you call for a plywood nail inspection and the job is not ready,
you will be charged a re-inspection fe,? of$176.18. The re-inspection fee must
be paid before another inspection ca::i be scheduled.
IMPORTANT:
1. Flat roofs must have a minimum of 1/ "per foot slope and demonstrate
that there is no ponding.
2. An I.C.B.O.report is required to be or the job site at the time on inspection.
I understand and will comply with the above stated policy on re-roofing.
Homeowner's Name:
Job Site Address: 10
Roofing Company Name:
Applicant's Signature: Date: / Z 2- G
Greg Casteel
Building Official
Revised 07/30/08
.Indoor it ualrty and Finishes INPUT Resources EneTqY !AQHeafth
1.Use Low/No-VOC Paint 1 IAQ/Health pts y=yes 0
2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes 0
3.Use Low/No VOC Adhesives 3 IAQ/Health pts y=yes 0
4.Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes 0
5.Use Engineered Sheet Goods with no added Urea
FormaJdehyde 61AQ/Health pts y=yes 0
0
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 0
8.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes 0
9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y=yes 0
10.Install Whole House Vacuum System 3 IAQ/Health pts y=yes 0
N.Flooring
1.Select FSC Certified Wood Flooring E.Resource pts y=yes 0
2.Use Rapidly Renewable Flooring Materials Resource pts y=yes 0
3.Use Recycled Content Ceramic Tiles Resource pts y=yes 0
4.Install Natural Linoleum in Place of Vinyl i IAQ/Health pts y=yes 0
5.Use Exposed Concrete as Finished Floor Resource pts y=yes 0
6.Install Recycled Content Carpet with Low VOCs Resource pts y=yes D
. 1 1 !
Total Points Available: 1 1401 130 57
Total Points Project Received: 01 01 0
Gtata/progs/gree ibuildingguidelines/remodelers/greenpointsfinal2.12.04protected.xis