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09070187 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21697 MC CLELLAN RD CONTRACTOR:TBD-TO BE DETERMINED PERMIT NO:09070187 OWNER'S NAME: DEWITT JOHN C AND DEBORAH M DATE ISSUED:07/28/2009 t ?R'S PHONE: 4082526902 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION x _ E UILDING PERMIT INFO: BLDG ELECT PLUMB License Class C3T Lic.# y� /� � � MECH� RESIDENTIAL�OMMERCIAL� Contractor/�tf(oN11;�✓uU/Ctll Date �^2S-d`� I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:RE-ROOF,REMOVE EXISTING WOOD SHAKE (commencing with Section 7000)of Division 3 of the Business&Professions OVER WOOD Code and that my license is in full force and effect. SHINGLE ROOF SYSTEM,REPAIR DRY ROT,INSTALL 1/2" CCSB SHEETING,30#FELT PAPER AND A 40 YEAR COMP. 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. 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 Sq,Ft Floor Area: Valuation:$10000 permit is issued. APPLICANT CERTIFICATION ?.PN Number:35719112.00 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, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section Signatu _ Date--7 Issued by: Date: Q OWNER-BUILDER DECLARATION RE-ROOFS: 1 hereby affirm that 1 am exempt from the Contractor's License Law for one of I'll roofs shall be inspected prior to any roofing material being installed. If a roof is the following two reasons: i istalled without first obtaining an inspection,I agree to remove all new materials for I,as owner of the property,or my employees with wages as their sole compensation, i ispection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) `ignature of Applicant: Date: 1,as owner of the property,am exclusively contracting with licensed contractors to _ construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 1 hereby affirm under penalty of perjury one of the following three declarations: 1 have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain I have and will maintain Worker's Compensation Insurance,as provided for by c ompliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this :safety Code,Section 25532(a)should 1 store or handle hazardous material. permit is issued. kdditionally,should I use equipment or devices which emit hazardous air I certifythat in the performance of the work for which this permit is issued,1 shall (ontaminants as defined by the Bay Area Air Quality Management District I will p p 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 1 Iealth&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,I must I)wner or authorized a ent. ZSO forthwith comply with such provisions or this permit shall be deemed revoked. ( Date: g APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is hereby affirm that there is a construction lending agency for the performance of work's correct. I agree to comply with all city and county ordinances and state laws relating or which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter .ender's Name upon tite above mentioned property for inspection purposes.(We)agree to save it lily and keep harmless the City of Cupertino against liabilities,judgments, ender's Address a. .01d 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 ARCHITECT'S DECLARATION 9.18. understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk:: Lot : APN . . . . . . . . . 35719112 . 00 DATE ISSUED. . . . . . . : 0728/2009 RECEIPT #. . . . . . . . . BS( 00008292 REFERENCE ID # . . . : 09070187 SITE ADDRESS . . . . . : 21697 MC CLELLAN RD SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER DEWITT JOHN C AND DEBORAH M ADDRESS 21697 MC CLELLAN CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4053 RECEIVED FROM . . . . : R L J CONSTRUCTION CONTRACTOR TBI) - TO BE DETERMINED LIC # 00096 COMPANY . . . . . . . . . . : TBI) - TO BE DETERMINED ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : , TELEPHONE . . . . . . . . FEE ID UNIT QUANTITY 1NOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ----------- ---------- ---------- ---------- 1BCBSC VALUATION 10, 000 . 00 1 . 00 0 . 00 1 . 00 0 .00 1BSEISMICR VALUATION 10, 000 . 00 1 . 00 0 . 00 1 . 00 0 .00 1BUSLIC FLAT RATE 1 . 00 114 . 00 0 .00 114 . 00 0 . 00 1REROOFRES SQ FEET 24 .00 312 . 00 0 . 00 312 . 00 0 . 00 - --------- ---------- ---------- ---------- TOTAL PERMIT 428 . 00 0 .00 428 . 00 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 428 . 00 #1448 --------------- TOTAL RECEIPT 428 . 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 604 ROOF IN-PROGRESS 605 FINAL REROOF CITY OF CXPERTINO REROOF CUPEkTiNO PERMIT APPLICATION APN # Date: 00 Building Address: -2/69 7C l�R Owner's Name: ,a-,�,�j 16 /,,mow�' Phone #: Cqb�' HOA: Yes ❑ No If yes, provide letter from HOA Contr actor: Phone #: ?Ot- q , - �dc� (GtiS��'(,�C1/v sor-u(6,c. Fax #: 4/O� 195-3 Cupertino Business License #: Contractor License #: Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Bu -Up roof ❑ Asphalt Shingles Asphalt Shingles P g 'Wood Shakes ❑ Wood Shakes W----w-ood Shingles ❑ Wood Shingles ❑ Other (Specify) ❑ Other (Specify) Number of existing coverings ❑ Provide I.C.C.E.S. Report# be Removed ❑ Provide Mfgr. Installation Specs. Job Description: �� „L-, e X is t>A6 moo of sLia 1(e oW.- woo s�itib /�- /�o.� �eaair 0�� t i� �i a.�/,31��G��iw5� 2 1 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 ind-x. Valuation: a c) �� UQO. �Have ead, Understand and Will Comply with Cupertino's Tear-Off Policy: Signature Revised 02/05/09 CITY OF (:UPERTINO aff __ REIZOOF CITY OF CUPEkTINO FEE SCHEDULE Number of Fee ID Fee Description Fee Permit Type Squares Group 1REROOFCOM Re-roof Cc,mmercial B 1COMMLROOF 1 BCBSC Cal Bldg S tandards B ALL PERMIT TYPES Commission Fee iBSEISMICO Seismic Commercial B 2 y IREROOFRES Re-roof Residential B 1SFDWLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee I BSEISMICRE Seismic Residential B 1 REROOFMRES Re-roof M inti-Family B 1MFDWLROOF (BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1 BSEISMICRE 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 r,�-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 b zilding inspector when the re-roofing is completed. 3. All roofs shall be inspected prior to ar y 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 mzIerial 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 cal 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 or the job site at the time on inspection. I understand and will comply with the above stated policy on re-roofing. ' 1� f'l�� Homeowner s Name: l Job Site Address: 2/6 :l 7 :c e lla ev Roofing Company Name: Applicant's Signatur . _ Date: 7--aFs-CA /�GaC�� Imo sfe�•[ Greg Casteel Building Official Revised 07/30/08 M.indoor Air Quality and Finishes 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 Formaldehyde 61AQ/Health pts y=yes 0 D 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 D 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 D 2.Use Rapidly Renewable Flooring Materials 2 Resource pts y=yes 0 3.Use Recycled Content Ceramic Tiles z 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 0 Total Points Available: I 1401 130 57 Total Points Project Received: 01 0 Ol Oci G:data/progs/gres ibuildingguidelines/remodelers/greenpointsfinal2.12.D4proteoted.xis Community Development 10300 Torre Avenue ' - Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 4..UPEkTINO Building Department JOB ADDRESS: „'1'6S,T yc C�I�Q PERMIT# (?,0 -?0t (d-” OWNER'S NAME: �OQ D�-, +ter H- PHONE # Y 9- T 95 - GENERAL CONTRACTOR: W Lor.sC/�Y�r✓lo4, FAX # ifs I am not using any subcontractors: Signature Date Please check applicable 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 �c� �a t �w Septic Tank Sheet Metal Sheet Rock Tile -7- Owner/Contractor 7Owner/Contractor Signature Date