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09070205 CITY OF CUPERTIND BUILDING PERMIT BUILDING ADDRESS: 10212 N PORTAL AVE CONTRACTOR:JIM HAGEMAN ROOFING PERMIT NO:09070205 OWNER'S NAME: MORDO ASSETS MGMNT :121 IMPALA DR#B DATE ISSUED:07/30/2009 4 ER'S PHONE: 4082521985 SAN JOSE,CA 95117 PHONE NO:(408)871-2349 LICENSED CONTRACTOR'S DECLARATION 13UILDING PERMIT INFO: BLDG ELECT LUMB r License Class Lic.# MECH RESIDENTIAL COMMERCIAL Contractor Date hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION:RE-ROOF, REMOVE OLD SHINGLES, REPAIR (commencing with Section 7000)of Division 3 of the Business&Professions ANY DAMAGED Code and that my license is in full force and effect. PLYWOOD PANELS, INSTALL NEW TIMBELINE GFK-ELK 50 YR SHINGLES&REPLACE SKYLIGHTS CLASS A 29SQ 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 Sq,Ft Floor Area: Valuation:$10000 permit is issued. APPLICANT CERTIFICATION kPN Number:31628056.00 Occupancy Type: 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 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 9.18. Signature Date 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 ,UI roofs shall be inspected prior to any roofing material being installed. If a roof is the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for 1,as owner of the property,or my employees with wages as their sole compensation, i nspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) `ignature of Applicant: D;nJ`3°C-1_..1(V_ Date: I,as owner of the property,am exclusively contracting with licensed contractors to .3 O . 0 -T construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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 HAZARDOUS MATERIALS DISCLOSURE Compensation,as provided for by Section 3700 of the Labor Code,for the 1 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. I will maintain I have and will maintain Worker's Compensation Insurance,as provided for by t 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 I store or handle hazardous material. permit is issued. kdditionally,should I use equipment or devices which emit hazardous air I certify that in the performance of the work for which this permit is issued,I shall (ontaminants as defined by the Bay Area Air Quality Management District I will 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 I lealth&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 Oj�Y.xtr or 5uthorized ages : r�/1 forthwith comply with such provisions or this permit shall be deemed revoked. /ter /• 3Y1 t.7' Date: '7-3 APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is 1 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 for which this permit is issued(Sec.3097,Civ C.) 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 it ify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address CL,. Jid 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. �,,/ e� 1 understand my plans shall be used as public records. Signature ( 2 E Wa,-Jr —• Date 7'30' 0 / Licensed Professional CITY OF CUPERTINO ` REROOF CUPEkTiNO PERMIT APPLICATION APN # I f f A o Date: 7_46)- 07 ` � r � � Building Address: � / c14 R,� 10212- N. 'Po f 4e . Ctff_�7ho 14 Owner's Name: RDRdo Ag ,t'f j,),),�r'1 t Phone #: (*B) 2�-2, —�f HOA: Yes ❑ No �If Yes, provide letter from HOA Contractor: Phone Ji" "AAG E A414tV ROOFW 6 Fax #: Cupertino Business License #: Contractor License 685"76® Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof to Asphalt Shingles X Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other (Specify) ❑ Other (Specify) Number of existing coverings 2, `j o o ❑ Provide I.C.C.E.S. Report # w To be Removed ❑ Provide Mfgr. Installation Specs. Job Description: �es (;) p;I'v,oe Ord slr,h� IPS �a o Fi'iv .` (L) �'�pa i�' atrv� ��aslz Ply�vc(pars (.3) �i7S�`�.el new T�� l�lr►-c� fir ��' ��1'l� S'hrhg& 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: t�. t a, . I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy: Signature Revised 02/05/09 CITY OF 41UPERTINO RERO CITY OF OF CUPEkTINO 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 n IREROOFRES Re-roof Residential B 1SFDWLR00F I 1 BCBSC Cal Bldg S tandards B ALL PERMIT TYPES Commissicn Fee 1BSEISMICRE Seismic Residential B 1 REROOFMRES Re-roof Multi-Family B 1MFDWLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1 BSEISMICRE Seismic Re;>idential 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 ag-ee 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 appli�d 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 arty 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 nai 1 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 Raid 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 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: MOR-_hO Job Site Address: 102-121 A4 Rokj'/"t Cwek Roofing Company Name: J/A-( HA 6- E MA ly R&D FlW? Applicant's Signature: C5-4rt0e-d'- Date: 7­3 0, Z Greg Casteel Building Official Revisad 07/30/08 INPUT ResDurces Energy [Aa,Heafth M.Indoor Air Quality and Finishes- 1.Use LowINo-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/%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 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 lij 9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y=yes 10.Install Whole House Vacuum System 3 IAQ/Health pts y=yes 0 . 1 1 N.Flooring 1.Select FSC Certified Wood Flooring E Resource pts y=yes 0 2.Use Rapidly Renewable Flooring Materials 4 Resource pts y=yes D 3.Use Recycled Content Ceramic Tiles z 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 � Resource pts y=yes 0 6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes 0 Total Points Available: [ 1401 1301 57 Total Points Projec 1 01 01 0 -7. 3j. oc G:datalprogslgreei buildingguidelines/remodelers/greenpointsfinal2.12.o4proteoted.xls C ,5 G CITY OF CUPERTINO h# REPIPE/SEWER/MAIN SERVICE CUPEkTINO PERMIT APPLICATION FORM APN# �3,59 a J„� Date: Building Address: .. t4 e-v , " Owner's Name: � 7 , Phone#: Wlitrgctor: ti hone L Fax#: Contact: V Phone#: log�r Fax #: Contractor License#: Cupertino Business License#: Job Description: C Qft--f p t.,, 110� t v o4-.q�,v- five \ r� Q l,L�� �. .r0 ,,t(� 1" -di4-cl-f Residential Commercial ❑ Valuation: Project S e: Expre tandard Large El Major El Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the application or if applicable, include in plan set& the sheet index. Green Building Points: Quantity Fee ID Fee Description Fee Permit Type Group__ 1PCSEWER Commercial building P 1CPSS sewer/sanitary sewer 1BPREPIPE Commercial re-pipe per fixture P 1CPRP 1PGASCOM Commercial Gas Piping System P 1-4 Outlets 1BCBSC Cal Bldg Standards Commission B ALL PERMIT Fee TYPES 1BSEISMICOM Seismic Commorcial P Revised 01/07/09 o Community Development 10300 Torre Avenue _4 ' Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 ''UPEI�TINO Building Department JOB ADDRESS: PERMIT # O R'S N PHONE p Q� GENERAL CONTRACTO FAX # I am not using any subcontractors: Si inatur Date Please check applicable subcontractors and com�i:)lete 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 Tile Owner/Contractor Signature Date CITY OF C'UPERTINO ZIF' REPIPE/SEWEItJMAIN SERVICE CUPEtZTINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group 1BCBSC Cal Bldg Standar is Commission B ALL PERMIT Fee TYPES 1BSEISMICR Seismic Residential P 1PRSEWER Residential building P 1RPSS sewer/sanitary sever 1PRREPIPE 'Residential re-pile per fixture P 1RPRP 1BPWSVCS Water Service P 1CPWS or 1RPWS 1 PPRSEWG Private Sewage Disposal System P 1 PCESS Cesspool P 1BPWATER Install/alter Wates-Pipe P 1 BPFIXTURE Plumbing Fixture P 1PGASRES Residential Gas Piping System P 1-4 Outlets 1 BPGAS Gas Piping System 5+ Outlets P / 1 PPERMITFEE Plumbing Permit Fee Issuance P 1 PLMBLNCK Plumbing Plan Check P 1 PLMBINSP Other Plumbing/g as Insp. P / Z41A I" 1 TRAVDOC Travel & Documcntation Fee 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 . . . . . . . . : 31628056 . 00 DATE ISSUED. . . . . . . : 07/30/2009 RECEIPT # . . . . . . . . . BSC00008316 REFERENCE ID # . . . : 09C70205 SITE ADDRESS . . . . . : 10212 N PORTAL AVE SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER MOFDO ASSETS MGMNT ADDRESS 10212 N PORTAL AVE CITY/STATE/ZIP . . . : CUFERTINO CA, 95014-2354 RECEIVED FROM . . . . : DAVID MORDO CONTRACTOR HACEMAN, JIM LIC # 21258 COMPANY JIN: HAGEMAN ROOFING ADDRESS 3121 IMPALA DR #B CITY/STATE/ZIP . . . : SAD JOSE, CA 95117 TELEPHONE (4C8) 871-2349 FEE ID UNIT QUANTITY FMOUNT 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 1REROOFRES SQ FEET 29 .00 377 . 00 0 . 00 377 . 00 0 . 00 -- -------- ---------- ---------- ---------- TOTAL PERMIT 379 . 00 0 .00 379 . 00 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 379 . 00 VISA --------------- TOTAL RECEIPT 379. 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 604 ROOF IN-PROGRESS 605 FINAL REROOF Community Development st 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 XPERTINO Building Department JOB ADDRESS: �� ����� PERMIT�, ,70 Z 6S' 0 2� � � 1pok V �(1 OWNER'S NAME: /� 0PDO SSS . PHONE # 252 jqjRS GENERAL CONTRACTOR ; JAd-av FAX # I am not using any subcontractors: Si;;nature 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 ^ V Roofing Septic Tank 85 7 Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date