11110070 (2) CITY OF CUPERTINO BUILDING PERMIT
BUILDINt'.ADDRL'SS: 10355 BEARDON DR CONTRACTOR:PAUL&KAREN KWAN PERMIT NO: 11110070
OWNER'S NAME: PAUL&KAREN KWAN 10355 DEARDON DR DATE ISSUED: 11/14/2011
�
ER'S PHONE: 4083145484 CUPERTINO,CA 95014 PHONE NO:
LICENSED CONTRACTOR'S DECLARATION r r
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic.N
MECH r RESIDENTIAL r COMMERCIAL r
Contractor Date
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:RE-ROOF REMOVE&REPLACE ASPHALT SHINGLES
(commencing with Section 7000)of Division 3 of the Business&Professions CLASS A
Code and that my license is In full force and effect. 20SQ
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 fie work for which this Sq.Ft Floor Area: Valuation:$8800
permit is issued.
APPLICANT CERTIFICATION APN Number:32630068.00 Occupancy Type:
I certify that I have read this application and slate 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 ofthis 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 Cade,Section
9.18. �Y—
Ib /
Signature Date Issued Date:
OWNER-BUILDER DECLARATION
RF.-ROOFS:
hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing materiel beitg installed.If a roof is
the following two reasons: installed 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, inspection.
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code) Signature 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
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
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 compliance 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.
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 Calif rmia. If,after making this certificate of exemption,I
become subject to the Worker's Compensation provisions ofthe Labor Code,I must Owner orent:
ar t riled a
forthwith comply with such provisions or this permit shall be deemed revoked. Date:
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
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
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
indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
and expenses which may accrue against said City inconsequence of the
rg of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
V... lnontoucc regulations per the Cupertino Municipal Code,Section9.18. 1 understand my plans shall be used as public records.
Signa Date I �Q �j' Licensed Professional
• CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # . 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32630068. 00
DATE ISSUED. . . . . . . : 11/14/2011
RECEIPT #. . . . . . . . . : BS000015298
REFERENCE ID # . . . : 11110070
SITE ADDRESS . . . . . : 10355 BEARDON DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : PAUL & KAREN KWAN
ADDRESS . . . . . . . . . . : 10355 BEARDON DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : JAMES M OH
CONTRACTOR . . . . . . . : LIC # *OWNER*
COMPANY . . . . . . . . . . : PAUL & KAREN KWAN
ADDRESS . . . . . . . . . . : 10355 BEARDON DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
TELEPHONE . . . . . . . . :
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 8, 800 .00 1. 00 0. 00 1. 00 0.00
1BSEISMICR VALUATION 8, 800 . 00 0. 88 0. 00 0 .88 0. 00
1REROOFRES SQ FEET 20. 00 280. 00 0. 00 280 .00 0. 00
---------- ------- -- ---------- ----------
TOTAL PERMIT 281. 88 0. 00 281 .88 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 281. 88 VISA
---------------
TOTAL RECEIPT 281. 88
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
309 EXTERIOR LATH 311 SCRATCH COAT
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL _
604 ROOF IN-PROGRESS 605 FINAL REROOF
•
III ► � � � �
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 ILJI \\U
® CUPERTINO (408)777-3228• FAX(408)777-3333 • buildingOcuoertino.orD
PROTECT ADDRESS I,'\S '�SS G r c,^ Or APN e ^"W 3-C) O �O
OWNER NAMEY� G FHONE4op-314--4re4 E-MAIL
ADDRESS Cr1Y, STATE,LIP FAX
ATVIq .
APPLICANT NAME PHONE E-MAIL
,,,,STREET ADDRESS CITY,STATE, ZIP FAX '
42`D BR d91OWNBR-BUUZBR ❑ OWNERAOENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHRECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC.0
COMPANY NAME E-MAB. FAX
STREET ADDRESS CrfY,STATE,ZrP PHONE
ARCHrTECT/ENOINEER NAME LICENSE NUMBER BUS.LIC.0
COMPANYNAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF �&SFD Or Duplex ❑ Multi-Family ROOF AREA, VALUATION:
STRUCTURE: ❑ Commercial 2D
EXISITt4G ROOF TYPE: ❑BUB-T-IR ROOF ❑ASPHALT SHINGLES dyy$.W000 SHAKES ❑WOOD S{HINGLBS 11 OTTER(SPECUry)
��
REMOVE/RFPLACE �YE$ IF NO, 1 PLYWOOD UµA" 13PLYWD UCI OSB PITCH: ROOP
❑ p C�JJF ❑ E' ❑
PROPOSED ROOF TYPE: ❑BUB,T-UP ROOF INASPHALT SHA'GLES ❑WOOD SHAKES ❑WOOD SRNGLES ❑OTTER ICC-ES REPORT 0
DESCRIPTION OF WORK
`�cty c -►fi1r -� a _{",r,c uawTJ�. CL', 7�.s1�-e. $Inc �
By my signature below,I certify to each of the fallowing: I am the property owner or authorized agent to act an the property owner's behalf. I have read this
application and the information I have provided is correct I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws building tri 'on. I authorize representatives of Cupertino Lc enter the above-identifd pmperry for inspection purposes.
Signature ofApplicant/A. nt Date: A�14��it
SUPPLE INFORMATION REQUIRED
ELAN-CH�ECTi't:}R77.
If builtiing is associatrd with a Home Owner's Association,provide letter �- -of approval from HOA. �'0aTE, 10Provide Planting approval to verify if there any restrictions. 'FsnA'nNB��.PLv�w r z'(
_Provide copy of Manufacturer's Installation Specifications. r� -
`� ST.`AN1Lt871 ',c. . Q RIHt DR1 .'
Ovide signed copy of Cupertino's Tear-Off Policy.
41,
RercofApp_2011.doc revised 03/02/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
• ADDRESS: 10355 beardon dr. DATE: 11/14/2011 REVIEWED BY: bobs.
APN: BP#: "VALUATION: $8,800
*PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD or Duplex PENTAMATION 1SFDWLR00F
USE: PERMIT TYPE:
WORK remove and replace asphalt shingles.
SCOPE
FEE ID ROOF AREA
(SA.)
1REROOFFRES 2,000
il!",h. 114w Ch,,rk F'Lunb, flan Check Bien.Plan CF,ccA
:Aleck Per;eh Pee: Plunlr. Pern:ir Few: EAec, Permit Fare:
L1 I
Other.11��ch.hap. Otho 1Ph<urh h?sp. O1/xu Ii7ec. hly.
E17-
.1,fech.Imp. Flee: 111wnG. /nate.Fee: Elec.Innp. Fe:
NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanhary Sewer District,School
District,etc. . These ees are based on the prelinina information available and are oniv an estimate. Contact the Dept for addn'l info.
FEE ITEMS(Fee Resohuion 11-05:Eff 7/1111) FEE QTY/FEE MISC ITEMS
Pian Ch'A' Fie:
Sup 1. P(`1,
£'G un lt.;llech.:2i iee
Permit Fee: $280.00
Supp/. hasp.Fee
Pl1onh.:t,1ech./lilec
I'G1mb.'A-trach.%lUec Permit f'i'r:
Consiritetion Tax
Arlminisnalive Fee:
Work Without Permit? O Yes iE) No $0.00
Advanced Alantin;;F ces:
Trarvel Docmntenfation Peen :
Slrone Motion Fee. IBSEISMICR $0.88 Select an Administrative Item
• Bldg Stds Commission Fee: IBCBSC $1.00
"SUBTOTALS: $281.88 $0.001TOTAL FEE: $281.88
Revised: 10/01/2011
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION
• ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
CUPERTINO 10300 TORRE AVENUE -CUPERTINO, CA 95014-3255
(408)777-3228- FAX(408)777-3333-buildincic5cuoertino.orD
PROJECT ADDRESS t13Ss APN0
I 6CPYC1LV\ Or
OWNER NAME PHONE E-MAIL
�i� 4-0Y-314-5964
STREET ADDRESS CITY, STATE,ZIP FAX
Cl) Q a J tri Cta gSo14
CONTRACrORNAME �^ _ LICENSE NUMBER LICENSE TYPE BUS.LIC.N
COMPANY NAME f 1 E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
I UNDERSTAND AND AGREE TO THE FOLLOWING:
1. The re-roof project shall comply with all applicable provisions of the 2010 California Codes.
2. An inspection request can be scheduled up to the day before the inspection date. Please call (408)777-
3228 from 7:30 - 3:30pm (Mon-Thurs) or 7:30 - 2:30pm (Friday) to schedule the next day inspection.
For Tear-Off and Nailing Inspections, you must also call on the day of the inspection only after that
phase of the work is completed. The building inspector will be available within one hour. Progress
and Final Inspections will be given a two hour window.
• 3. Tear-Off Inspection is required. Any and all dry-rotted wood shall be replaced prior to this inspection.
Unless new plywood roof sheathing is proposed throughout, all the nails/fasteners shall be either
completely knocked-down or removed prior to this inspection.
4. If plywood is installed, a plywood Nailing Inspection is required.
5. Roofing shall not be applied without first obtaining all prior inspection and written approvals from the
building inspector. Any roofing which is applied without first obtaining an approved inspection will
require the removal of all new material down to the sheathing so a proper inspection can be performed.
6. Progress Inspection is required when approximately 50%of roof covering is installed.
7. A Final Inspection and approval shall be obtained from the building inspector when the re-roofing is
completed. To receive a final sign-off, the following items will be verified:
a. Flat roofs shall have a minimum of/<" per foot of slope and demonstrate there is no ponding.
b. Listings from approved testing agencies for all pre-manufactured products used shall be
available on-site to review at the time of the inspection.
c. Proper spark arrestor installation, vents painted, gutter/downspouts installed, debris removed.
8. NOTE: ,If you call for a tear-off or plywood nailing inspection and the work is not complete, you will be
charged a re-inspection fee of$126.00. The re-inspection fee shall be paid before another inspection
can be scheduled.
By my signing below, 1 certify each of the following is true: I am the property owner or authorized agent to act on the
property owner's behalf. I understand and agree to comply with the re-roof policy stated above. 1 also understand that
• smoke detectors and carbon mo 1 dete rs are required to be installed in accordance with Sections R314 and R315 of
the 2010 California Residenti Cod . //'/yam�/
Signature of Applicant/Agent: Date:
RerooJPo1icv_2011.doc revised/12/16/11
OWNER-BUILDER DISCLOSURE FORM
COMMUNITY DEVELOPMENT DEPARTMENT- BUILDING DIVISION
• 10300 TORRE AVENUE - CUPERTINO,CA 95014-3255
CUPERTINO (408)777-3228- FAX(408)777-3333- building(a)cuoertino.oro
Dear Property Owner(s):
An application for a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified at:
SITE ADDRESS [gS.S � Or APN BP#
// D()7 b
OWNERNAME � 0\,\ I
OWNER ADDRESS QtiwC.
DESCRIPTION OF WORK: _ Om 0
We are providing you with an Owner-Builder Acknowledgment and Information Verification Form to make you aware of
your responsibilities and possible risk you may Incur by having this permit issued in your name as the Owner-Builder. We
will not Issue a building permit until you have read, Initialed your understanding of each provision, signed, and
returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless
you, the property owner, obtain the prior approval of the permitting authority.
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION
(DIRECTIONS:Please read and initial each statement below to signify you understand or verify this information.)
&1. 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-
der" building permit that erroneously implies that the property owner is providing his or her own labor and material
• personally. I, as an Owner-Builder, may be held liable and subject to serious financial risk for any injuries sustained by
an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not
provide coverage for those injuries. I am willfully acting as an Owner-Builder and am aware of the limits of my
insurance coverage for injuries to workers on my property.
_t_2. I understand building permits are not required to be signed by property owners unless they are responsible for
the construction and are not hiring a licensed Contractor to assume this responsibility.
1�3. I understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that I may
protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her
name instead of my own.
_P_4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license
numbers on permits and contracts.
-10 5. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the
to I value of my construction is at least five hundred dollars ($500), including labor and materials, I may be
considered an "employer" under state and federal law.
t�ft 6. 1 understand if I am considered an "employer" under state and federal law, I must register with the state and
federal government,withhold payroll taxes, provide workers'compensation disability insurance, and contribute to
unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject
me to serious financial risk.
t_7. 1 understand under California Contractors'State License Law, an Owner-Builder who builds single-family
residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by
licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work
• is performed under contract with a licensed general building Contractor.
o B. I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for
any financial or personal injuries sustained by any subsequent owner(s)that result from any latent construction
defects in the workmanship or materials.
OirnerBuilderFornr 1010.doc revised 04/14/10
9. I understand I may obtain more information regarding my obligations as an "employer"from the Internal
Revenue Service,the United States Small Business Administration, the California Department of Benefit Payments,
and the California Division of Industrial Accidents. I also understand I may contact the California Contractors'State
• License Board(CSLB)at 1-800-321-CSLB (2752)or www.cslb.ca.gov for more information about licensed
contractors.
-&�10. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I
am the party legally and financially responsible for proposed construction activity at the site address listed above.
by11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide
—all applicable laws and requirements that govern Owner-Builders as well as employers.
k12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the
in rmation I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If
you contract with someone who does not have a license, the Contractors' State License Board may be unable to
assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed
Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or
employee of that individual or firm is injured while working on your property,you may be held liable for damages. If
you obtain a permit as Owner-Builder and wish to hire Contractors,you will be responsible for verifying whether or not
those Contractors are properly licensed and the status of their workers'compensation insurance coverage.
CONSTRUCTION LENDING AGENCY
(DIRECTIONS:Please complete the following construction lending agency information.)
I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued
(Sec 3097 Civ.)
Lender Name: Lender Address:
Before a building permit can be issued,this form must be completed and signed by the property owner and
• returned to the agency responsible for Issuing the permit. Note:A copy of the property owner's driver's license,
form notarization, or other ve on acceptable to the city may be required to be presented when the permit is issued
to verifythe roe owne si a re
Property Owner's Signatu e: Date: Zal
(NOTE: The following Authorzation Form is required to be completed by the property owner only when designating an
agent of the property owner to apply for a construction permit for the Owner-Builder).
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby
authorize the following person(s)to act as my agent(s)to apply for, sign, and file the documents necessary to obtain an
Owner-Builder Permit for my project.
Scope of Construction Project(or Description of Work):
Project Location or Address:
Name of Authorized Agent: Tel No
Address of Authorized Agent:
I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the
above information and certify its accuracy. Note:A copy of the property owner's driver's license, form notarization, or other
verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's
signature.
• Property Owner's Signature: Date:
OwnerBuilderForm 2010.doe revised 04/14/10