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09090124 CITY OF CUPERTINO BUILDING PERMIT B1111,0ING ADDRESS, 11667 PALM SPRING CT CONTRACTOR:ADAMS BROTHERS PERMIT NO:09090124 CONSTRUCTION '^ER'S NAME: DEBBIE CONTRA 10100 TORRE AVE DATE ISSUED:09/16/2009 OWNER'S PHONE: 4087770770 CUPERTINO, CA 95014 PHONE NO:(408)564-5207 I LICENSED CONTRACTOR'S DECLARATIONr BUILDING PEkMiT INFO: BLDG ELECT PLUMB License Class_ Lie.# :�(j�"� F—/ MECH RESIDENTIAL COMMERCIAL Contractor Awx:1�r DateAl_ _ i hereby affirm that 1 am licensed under the provisions lof Chapter 9 JOB DESCRIPTION: RE-ROOF 27SQ CLASS A TEAR OFF DRY (commencing with Section 000)of Division 3 of the Business&Professions ROT REPLACEMENT, Code and that my license is in full force and effect. GUTTERS, ETC.;ADAMS BROTHERS RENEWD BUS LIC 9/16/9 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 Corrp-nsation,as provrd°d 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:$7300 1 have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the rubor Code,for the performance of the work for which this APN Number:36654107.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION 1 cert+.ty that I have rear;this application and state that the atove information is PERMIT EXPIRES IF WORK IS NOT STARTED correct I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to b'ii!Jing 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. indermify and keep hannlcss the City of Cupertino against liabilities,judgments, costs,and expenses whr;h may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply Issued by: Date: with::II non-point so-14c regulations per the Cupertino Municipal Code,Section 9 18. RE-ROOFS: 1 irtureK _ Date All roofs shall be inspected prior to any roofing mater-1 being ipstailed. If a roof is installed without first obtaining an i spection,i agree to remove all new materials for inspection. C7 OWNER-BUILDER DECLARATIONDate' V� _ 1 hereby affirm that i am exempt from the Contractor's License Law for one of Signature of Applicar� __ _ 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, 1 wail J,)the work,and the structure is not intended or offered for sale(Sec.7044, Busi:ress&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE corstnrct the project(Sec 7044,Business&Professions Cade). 1 have read the hazardous mawials requirements under Chapter 6.95 of tMe California Health&Safety C(,de,Sections 25505,25533,and?5534. 1 will 1 hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the dechni ations: Health&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should 1 use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labo!Code,for the air contaminants.as defined by the Bay Area Air Quality Management District I performance of the.�oik for which this permit is issued. will maintain compliance with the Cu erti o Municipal Code,Chapter 9.12 and 1 have and will maintain Worker's Compensation Insurance,as provided for oy the Health&Safety Code,Sect' Ifs 5533,and 25534. Section 3700 of the yah:r Code,for the perfermance of the work for which this *qT permit is issued. Owner or authorized agen Date: 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 CONSTRUCTION LENDING AGENCY beco.re subject to the Worker's Compensation provisions o the Labor Code,I mus! 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:`or which this permit is issued(S,c.3097.Civ C.) Lender's Name .APPLICANT CERTIFICATION !ender's.Address_ 1 ceniN that i have rea:this application and state that the aoove information is c,rre,.:.i agree to comNry with all city and county ordinance.;and state laws relating wilding construcuoo,and hereby authorize representau res of this cites to enter I n-lie above mentiorlad property for inspection purposes.(We)agree to save indetanify and keep harmless the City of Cupertino against liabilities,judgments, ARCldll'ECT'S DECLARATION cost dnd expenses which may accrue against said City in consequence of the i understand my plans shall be used as public rec:crds. granting of this permit Additionally,the applicant understands and will comply v:ah all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. I Signature ___ Date_ CITY OF CUPERTINO 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN 36654107 . 00 DATE ISSUED. . . . . . . : 09/16/2009 RECEIPT #. . . . . . . . . BS000008699 REFERENCE ID # . . . : 09090124 SITE ADDRESS . . . . . : 11667 PALM SPRING CT SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER DEBBIE CONTRA ADDRESS 11667 PALM SPRINGS CT CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5142 RECEIVED FROM . . . . : ADAM BROTHERS CO CONTRACTOR STEVE ADAMS LIC # 22207 COMPANY ADAMS BROTHERS CONSTRUCTION ADDRESS 10100 TORRE AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 TELEPHONE . . . . . . . . : (408) 564-5207 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 7, 300 . 00 1 . 00 0. 00 1 . 00 0 . 00 1BSEISMICR VALUATION 7, 300 . 00 0 .80 0 .00 0 . 80 0 . 00 1BUSLIC FLAT RATE 1 . 00 114 . 00 0. 00 114 . 00 0 .00 1REROOFRES SQ FEET 27. 00 351 . 00 0 . 00 351. 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 466 .80 0 . 00 466 . 80 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 466 . 80 200 --------------- TOTAL RECEIPT 466 .80 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 604 ROOF IN-PROGRESS 605 FINAL REROOF -�, CITY OF CUPERTINO 0109 REROOF CITYCUPE(�T1NO PERMIT APPLICATION APN # � � � 6 � , � Date: I �� Building Address: r G�w Owner's Name: �� `� �� A Phone #: HOA: Yes [jZNo ❑ If es provide letter from HOA — Contractor: � '� ` CABS-Vf VU`�1� Phone #: L.�( j ��0 A- 1,.A 5 Fax #: Cupertino Business License #: Contractor License #: Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Buroof ❑ Asphalt Shingles Asphalt Shingles u,-W_6`o_d 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: 2 C( s 1A__ C� S Residential Co ercia ❑ 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: jusW_;)P� 1�7� o� I Have Read, Unde stand and Will Comply with Cupertino's Tear-Off Policy: Signature Revised 02/05/09 CITY OF CUPERTINO a REROOF CUPEl�T1NO FEE SCHEDULE Number of Fee ID Fee Description Fee Permit Type Squares Group 1REROOFCOM Re-roof Commercial B 1COMMLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICO Seismic Commercial B 2� 1RER00FRES 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 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 1/4 "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. 1 _ Homeowner's Name: �� ` - Job Site Address: Roofing Company Name: Applicant's Signature: Date: Greg Casteel Building Official Revised 07/30/08 INPUT Resources Energy 1AQf'Hafth M.Indoor Air Qua hty and intshes 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 LowMo VOID 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 Formaldehyde 61AQ/Health pts y=yes D 6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 0 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 LOlid 1 1 N.Flooring 1.Select FSC Certified Wood Flooring 8 Resource pts y=yes 0 2.Use Rapidly Renewable 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 0 5.Use Exposed Concrete as Finished Floor 4 Resource pts y=yes 0 6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes 0 1 f 1 Total Points Available: 1 1401 130 57 Total Points Project Received: -01 01 -01 G:data/progs/greenbuildingguidelines/remodelers/greenpointsfinal2.12.04protected.xls Community Development sbg 10300 Torre Avenue 11, Cupertino CA 95014 Telephone(408)777-3228 CIV OF Fax(408)777-3333 .,UPEkTINO Buildin De artment JOB ADDRESS: PERMIT # S OWNER'S NAME: PHONE # - b GENERAL CONTRACTOR FAX # Lto —0 Gowsr, C--�J I am not using any subcontractors: ti IJ o-7- Signature 7 Dat Please check apphcable 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 Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Til Owner/ ontractor Signature Dale