09090065CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 6387 ATHERWOOD AVE I CONTRACTOR: LOS GATOS ROOFING PERMIT NO: 09090065
OWNER'S NAME: BOZEK JOHN S AND NANCY L TRUST
,LR'S PHONE: 4082535947
LICENSED CONTRACTOR'S DECLARATION
License Class C /? q Lic. # 9'6'0 -7 v c�
Contractor LGA (�,,� Date g %U
I hereby affirm that 1 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:
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 which this
permit is issued.
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
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
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.
Signature " L — �� Date / ��
V OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
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 work for which this
permit is issued.
I 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, I
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked.
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
upon the above mentioned property for inspection purposes. (We) agree to save
mify and keep harmless the City of Cupertino against liabilities, judgments,
and expenses which may accrue against said City in consequence of the
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.
Signature_
Date
P O BOX 1726
LOS GATOS, CA 95031
DATE ISSUED: 09/10/2009
PHONE NO: (408)298-9399
BUILDING PERMIT INFO: BLDG I— ELECT f— PLUMB r—
MECH f— RESIDENTIAL I— COMMERCIAL
JOB DESCRIPTION: RE -ROOF REMOVE EXISTING COMP ROOF,
INSTALL
FIBERGLASS REINFORCED FELT & DURATION 30 SHINGLES
BY OWENS CORNING CLASS A 31 SQ
Sq. Ft Floor Area: I Valuation: $6870
APN Number: 36916011.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by:
Date:
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, 1 agree to remove all new materials for
inspection. �? a
Signature of Applicant: �/ Date: �i�t�) /
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
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
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should 1 use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District 1 will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
Owner or outh razed ,ent: D G
Date:
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
-
CUPEPTINO
CITY OF CUPERTINO
REROOF
PERMIT APPLICATION
APN #� _ —6 f / c:> �
Date: F/2-7/0
Building Address:
(& ,A1) &0_ ri
Owner's Name:
Phone #:
Contractor:
6
Phone #: OS' c;2
f�
Fax #:
_
Cupertino Business License #:
Contractor License #:
Type of
Roof Covering:
Existing:
Proposed:
❑ Built -Up Roof
❑ Built -Up roof
Asphalt Shingles
X Asphalt Shingles
❑ Wood Shakes
❑ Wood Shakes
❑ Wood Shingles
❑ Wood Shingles
❑ Other (Specify)
❑ Other (Specify)
Number of existing coverings
❑ Provide I.C.B.O. Report #
X To be Removed
, Provide Mfg. Installation Specs.
Job Des ription:
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, Understand and Will Comply with Cupertino's Tear -Off Policy:
Si
Revised 6/16/08
CITY OF CUPERTINO
V.,
REROOF
CUP£kTINO FEE SCHEDULE
Number of
Squares
Fee ID
Fee Description
Fee
Group
Permit Type
1REROOFCOM
Re -roof Commercial
B
1COMMLROQF
1BSEISMICO
Seismic Commercial
B
1RER00FRES '
Re -roof Residential
B
1SFDWLR00F
/
1BSEISMICRE
Seismic Residential
B
1REROOFMRES
Re -roof Multi -Family
B
1MFDWLROOF
1BSEISMICRE
Seismic Residential
B
1BUSLIC
Business License
B
2_. r / J/
Revised 6/16/08
3 ITEMS OF 3
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 36916011.00
DATE ISSUED.......: 09/10/2009
RECEIPT #......... BS000008641
REFERENCE ID # ...: 09090065
SITE ADDRESS .....: 6387 ATHERWOOD AVE
SUBDIVISION ......
CITY CUPERTINO
IMPACT AREA ......
OPERATOR: patg
COPY # : 1
OWNER BOZEK JOHN S AND NANCY L TRUST
ADDRESS ..........: 6387 ATHERWOOD AVE
CITY/STATE/ZIP ...: CUPERTINO CA, 95014-4615
RECEIVED FROM ....: LOS GATOS ROOFING
CONTRACTOR .......: RANDY BROWN LIC # 23481
COMPANY LOS GATOS ROOFING
ADDRESS P O BOX 1726
CITY/STATE/ZIP ...: LOS GATOS, CA 95031
TELEPHONE ........: (408)298-9399
FEE ID UNIT
QUANTITY
AMOUNT
PD -TO -DT
THIS REC
NEW BAL
----------
-----------------------
1BCBSC VALUATION
----------
6,870.00
----------
1.00
----------
0.00
----------
1.00
0.00
1BSEISMICR VALUATION
6,870.00
0.70
0.00
0.70
0.00
1REROOFRES SQ FEET
31.00
403.00
0.00
403.00
----------
0.00
----------
TOTAL PERMIT
----------
404.70
----------
0.00
404.70
0.00
METHOD OF PAYMENT
-----------------
CHECK
TOTAL RECEIPT
AMOUNT
---------------
404.70
---------------
404.70
VOICE ID DESCRIPTION
-------- ----------------------------
601 ROOF TEAR OFF
REFERENCE NUMBER
--------------------
#2816
VOICE ID DESCRIPTION
-------- ----------------------------
602 ROOF PLYWOOD NAIL
604 ROOF IN -PROGRESS 605 FINAL REROOF
1. Install Energy -Efficient Windows
a. Double -Paned
b. Low -Emissivity (Law -E)
c. Low. Conductivity Frames
2. Install Low Heat Transmission Glazing
J. Heating Ventilation and Air Conditioning
1. Use Duct Mastic on All Duct Joints
2. Install Ductwork within Conditioned Space
3. Vent Range Hood to the Outside
4. Clean all Ducts Before Occupancy
5. Install Solar Attic Fan
6. Install Attic Ventilation Systems
7. Install Whole House Fan
8. Install Sealed Combustion Units
a. Furnaces
b. Water Heaters
9. Replace Wall -Mounted Electric and Gas Heaters with
Through -the -Wall Heat Pumps
10. Install 13 SEER/11 EER or higher AC with a TXV
11. Install AC with Non -HCFC Refrigerants
12. Install 90% Annual Fuel Utilization Efficiency (AFUE) Furnace
13. Retrofit Wood Burning Fireplaces
a. Install EPA certified wood stoves/inserts
b. Install/Replace Dampers
c. Install Airtight Doors
14. Install Zoned, Hydronic Radiant Heating
15. Install High Efficiency Filter
16. Install Heat Recovery Ventilation Unit (HRV)
17. Install Separate Garage Exhaust Fan
K. Renewable Energy and Roofing
1. Pre -Plumb for Solar Water Heating
2. Install Solar Water Heating System
3. Pre -Wire for Future Photovoltaic (PV) Installation
4. Install Photovoltaic (PV) System
(1.2 kw = 6 points, 2.4 kw =12 points, 3.6 kw =18 points)
6. Select Safe and Durable Roofing Materials
7. Install Radiant Barrier
L. Natural Heating and Cooling
1. Incorporate Passive Solar Heating
2. Install Overhangs or Awnings over South Facing Windows
3. Plant Deciduous Trees on the West and South Sides
1 Energy pt
y=yes
2 Energy -pts
y=yes
2 Energy pts
y=yes
1 Energy pt
y=yes
2 Energy pts
y=yes
3 Energy pts
y=yes
1 IAQ/Health pt
y=yes
21AQ/Health pts
y=yes
2 Energy pts
y=yes
1 Energy pt
y=yes
4 Energy pts
y=yes
31AQ/Health pts y=yes
31AQ/Health pts y=yes
3 Energy.pts y=yes
3 Energy pts y=yes
2 Resource pts y=yes
2 Energy pts y=yes
1 IAQ/Health pt
y=yes
1 Energy pt
y=yes
1 Energy pt
y=yes
3 Energy pts
y=yes
41AQ/Health pts
y=yes
5 IAQ/Health pts
y=yes
31AQ/Health pts
y=yes
4 Energy pts y=yes
10 Energy pts y=yes
4 Energy pts y=yes
Up to 18 Energy pts
1 Resource pt y=yes
3 Energy pts y=yes
5 Energy pts y=yes
3 Energy pts y=yes
3 Energy pts y=yes
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 applied without first obtaining all inspection
and written approval from the building inspector. A final inspection and
approval shall be obtained from the building 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 approval.
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 fee of $176.18. The re -inspection fee must
be paid before another inspection can be scheduled.
IMPORTANT:
1. Flat roofs must have a minimum of 1/ " per foot slope and demonstrate
that there is no ponding.
2. An I.C.B.O. report is required to be on the job site at the time on inspection.
I understand and will comply with the above stated policy on re -roofing.
Homeowner's Name:
Job Site Address:
Roofing Company Name:
K
Applicant's Signature: De: dt(ll
9
Greg Casteel
Building Official
Revised 07/30/08
Cl►YOF
(UPEfC1INO
JOB ADDRESS -
OWNER'S NAME: Q
GENERAL CONTRACTOR:
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Building Depaetment
PERMIT r
e.
PHONE=,,' E� .
S L `
1 am not using any subcontractors: _ Z
Signature ale-
Please check apphcable suhrnnf-rarin-rc and C'MM111=4-1:1 i-lIo
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$�
SUBCONT13ACTOR
BUSINESS NAME I BUSINESS LICENSE.
41,
Cabinets Millwork
Cement Finishing
Electrical
(Excavation
Fencing
Flooring: Carpeting
Linoleu-n / Wood
Glass / Glazing
Heating
insulation
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