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09090052
CITY OF CUPERTINO BUILDING PERMIT BUILDINGADEE: DO 1020EGH ANEY AVE gg JOHN HENRY ROOFING PERMIT NO:09090052 RD DATE ISSUED:09/09/2009 OWNER'S NARTHYNG PHONE NO:(408)241-1334 NER'S PHONE: 4087770317 5127 p LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.#_/�l5 c 6 MECH RESIDENTIAL COMMERCIAL Contractor-IC9>h/V � to q JOB DESCRIPTION:RE-ROOF REMOVE ROOF TO DECK INSTALL A I hereby affirm that I am licensed under the provisions of Chapter 9 1/2"OSB PLY (commencing with Section 7000)of Division 3 of the Business&Professions INSTALL A 30LB FELT INSTALL A 40YR GAF ALL NEW Code and that my license is in full force and effect. VENTS&JACKS CLASS A 23 SQ 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. 1 have and will maintain Worker's Compensation Insurance,as provided for by Valuation:$9200 Section 3700 of the Labor Code,for the performance of the work for which this Sq,Ft Floor Area: permit is issued. APPLICANT CERTIFICATION APN Number:31631026.00 Occupancy Type: I certify that I have read this application and state that the above information is correct.1 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 PERMIT EXPIRES IF WORK IS NOT STARTED 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 granting of this permit. Additionally,the applican }understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-po t source regulations ,t Cu ,luno Municipal Code,Section 9.18. — Date: vA Issued ny:� Date Signature Li O ER BUILDER DECLARATION RE-ROOFS: I hereby affirm that 1 am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is installed without first obtaining an inspection,I agree to remove all new materials for the following two reasons: 1,as owner of the property,or my employees with wages as their sole compensation, inspection. / rl will do the work,and the structure is not intended or offered for sale(Sec.7044, Signature of App Date: ,.,rf Business&Professions Code) (, 6` 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF VERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE I have and will maintain a Certificate of Consent to self-insure for Worker's CaliforniaHealhh&Safety Code,azardous Sections 25505 requirements25533,and 25534.91 willh Chapter 6. 5 of te Compensation,as provided for by Section 3700 of the Labor Code,for the Ihaveread th 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. Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534. Compensation laws of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,t must Own r or a Date: forthwith comply with such provisions or this permit shall be deemed revoked. \ CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's state laws relating for which this permit is issued(Sec.3097,Civ C.) correct.I agree to comply with all city and county ordinances and to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save nify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. Signature Date__. Licensed Professional Oq 09 �:�� mrt CITY OF CUPERTINO . REROOF CUPEkTiNO PERMIT APPLICATION APN # Da 3 ( �0 3 1?1 Building Address:!- Owner's Name: f�© �- h �, , Phone #: n HOA: V61W No If yes, provide letter from HOA Contractor: Phone -, 0 Fax Cupertino Business License #: Contractor License #: Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles 1K Asphalt Shingles 4/-Wood Shakes ❑ Wood Shakes 4-11-wood Shingles ❑ Wood Shingles ❑ Other (Specify) ❑ Other (Specify) Number of existing coverings ❑ Provide I.C.C.E.S. Report# &A196 ❑ To be Removed ❑ Provide Mfgr. Installation Specs. Job Description: r✓�z f2 v�J S-� '�"o �� N � l �'T 2 o S Residential O Commercial El 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: P 00 I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy: Signature Revised 02/05/09 m/n, CITY OF CUPERTINO "ROOF CITY OF FEE SCHEDULE CUPEkTINO Number of Fee ID Fee Description Fee Permit Type Squares Group 1RER06FCOM Re-roof Commercial B 1COMMLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICO Seismic Commercial B 1REROOFRES Re-roof Residential B 1SFDWLR00F 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee ` 1BSEISMICRE Seismic Residential B 1 REROOFMRES Re-roof Multi-Family B 1MFDWLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICRE Seismic Residential B 1BUSLIC Business License B CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 31631026 . 00 DATE ISSUED. . . . . . . : 09/09/2009 RECEIPT #. . . . . . . . . BS000008632 REFERENCE ID # . . . : 09090052 SITE ADDRESS . . . . . : 10200 N BLANEY AVE SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER DORTHY GHENG ADDRESS 10200 N BLANEY CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : JOHN HENRY ROOFING CONTRACTOR . . . . . . . : JEROD M OLEKI LIC # 25872 COMPANY . . . . . . . . . . : JOHN HENRY ROOFING ADDRESS 12780 CLAYTON RD CITY/STATE/ZIP . . . : SAN JOSE, CA 95127 TELEPHONE (408) 241-1334 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 9, 200 . 00 1 . 00 0. 00 1. 00 0 . 00 1BSEISMICR VALUATION 9, 200 . 00 1 . 00 0. 00 1 . 00 0 . 00 1REROOFRES SQ FEET 23 . 00 299 . 00 0 . 00 299 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 301 .00 0 . 00 301 . 00 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 301 . 00 #2459 --------------- TOTAL RECEIPT 301 .00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 604 ROOF IN-PROGRESS 605 FINAL REROOF 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: z Roofing Company Name: e P Applicant's Signature: 11L�Y4,41 Date: Greg Casteel Building Official Revised.07/30/08 . ` M.1ndDDr Air Quaftty and Flinisnes 0 1.Use i_owRdo-VDC Paint 1 IAOJHealth pts y=Yes 0 2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts Mes 3.Use IowNo V�OC Adhesives 3 IAQ/Health pts y=yes D 3 Resource Y-yes 4,Use Salvaged Materials for Interior Finishes p 5.Use Engineered Sheet Goods with no added Ursa 6 IAQ/HeaJth pts Mes D Formaldehyde 0 6.Use Exterior Grade Plywood for lnterior Uses 1 IAQ/Health pts Y=yes 0 7.Ssali!_ oleTo6artti3r MDF 41AQ/Healthyts y= es 4 Resource is eS 0 B.Use FSC Certified Materials for Interior Finish P Y=Y 0 9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts Mes 0 10.Install Whole House Vacuum System 3 IAQ/Health pts Y=yes 1 1 1 N.Fiaoring - 0 B Resource pts Y=yes 1.Select FSC Certified Food Flooring 0 2.Use Rapidly 13eneW4ble Flooring Materials 4 Resource pts Y=Yes 0 3.Use Recycled Content Ceramic Tiles 4 Resource pts Y=yes 0 4.Install Natural Linoleum in Place of Vinyl 5 IAQ/Health pts Y=yes 4 Resource is Y=yes 0 5.Use Exposed Concrete as Finished Floor p 0 6.Install Recycled Content Carpet with Low VOCs 4 Resource pts Y-Yes 1 1 1 Total Points Available: 140 130 57 9 Total Points Project Received: p p G:datalprogslgreenbuildngguidelin ra delerslgreenpointsfina1212 Mproleotad.xls Community Development 10300 Torre Avenue Cupertino CA 95014 /'. Telephone(408)777-3228 Fax(408)777-3333 CITY OF ,;UPEkTINO Buildin De artment JOB ADDRESS: PERMIT # IV OWNER'S N �k PHONE # GENERAL CONTRACTOR: FAX # I am not using any subcontractors: Si ae Date for Please check applicable subcontractors and com lete the followin information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass/ Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Date Owner/C actor Signature