12070197 CITY OF CUPERTINO BUILDING PERMIT
ISl11LUING,\DIIRIitiS:-829 LONNA LN CONTRACTOR:LIU TUNG-CHIEN NI AND PERMIT NO: 12070197
IISIU-FEN
O\VNIiR'S NAME: LIU TUNG-CHIL•N NI AND IISIU-FEN 829 LONNA LN DATE ISSUED:07125/2012
OWNER'S PI ION E: 4086662460 CUPIiRTINO.CA 950144324 PHONE NO:
❑ LICENSED CONfRACI"OR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT 1- PLUMB
License Class Lie.H
AtECII r RF.SIDIiNTIAL - COMMERCIAL
Contactor Date
herehy affirm that I am licensed under the pryisions of Chapter') •1013 DESCRIPTION:TEAR OFF EXISTING ASPHALT ROOFING AND INSTALL
(cum menti ng with Section 7000)of Division 3 of the Business S Professions NEW
Code and that no.license is in full force and effect. 15/32 OSB SHEATHING,ONE LAYER 30LB FELTAND
INSTALL NEW ASPHALT ROOFING 15SQFTCLASS A
I hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a Certificate of consent 10 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 Ore work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$7000
,\rrl.Ic\�r cISRTTFIcn•rlcm
I certify that I have read this application and state that the above information is ANN Number:35919024.00 Occupancy T)pe:
correct.I agree to comply with all city and county ordinances and state Imus relating
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned propeny for inspection purposes. (We)agree to save
indemnify and keep harndess the City of Cupertino against liabilities.judgments, PERMIT EXPIRES IF WORK IS NOT STARTED
costs,and expenses which may accrue against said City in consequence Of the
gramingoflhispennil. Additionally,the applicant understathdsand will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR
with all non-point source regulalims perthe Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION.
9.18.
Signature Date Issued by: /FAN 6�7TL1� Date:
.❑ � O\\'NIiR-ISllll.l)F;R DIiCI.,\RATION
I hereby affirm that I ant eyenhpt from the Contractor's License Law for one of R4:ROOFS:
the following two reasons: All roofs shall be inspected prior to any roofing material berg installed.If a roof is
1,as owner of the property,or my employees with wages as their sole compensation, installed without first Obtaining mit inspection,I agree to remove all new materials for
will do the work,and die structure is not intended or offered for sale(Sec.7044, inspection.
Business R Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to Signmure of Applicant: Date:
construct the project(Sec.7044,Business&Professions Code),
hereby affirm under penally of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS%iATERIALS DISCLOSURE
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the stork for which this permit is issued 1 have read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain Worker's Compensation Insurance,as provided for by California Ilealth S Safety Code,Sections 25505,25533,and 25534. .1 will maintain
Section 3700 of the Labor Code,for theerformance of the work for which this compliance with the Cupertino Nlmhici pal Code,Chapter 9.12 and the I Iealth S
p Safely Code,Section 25532(x)should I store or handle hazardous material.
permit is issued Additionally,should I use equipment or devices which emit hazardous air
I certify that in the performance of the work for which this pemrit is issued,I shall contaminants as defined by the Ray Area Air Qualil) Management District I will
not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Nlunicipal Code.Chapter 9.12 and the
Compensation lases ofCalifomin. If.after making this certificate of exemption,I Health S Safety Code.Sections 25505,25533,and 25534.
become subject to the Worker's Compensation provisions of the Labor Code,1 must
forilnvith comply with such provisions or this permit shall be deemed revoked ,or horized agent: .7
/ Date- Y
i
,U'PLICAN'I'CIiR'I'I PIC.\'PION CONSTRUCTION LENDING AGENCY
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 mid state laws relating I hereby afmrm that there is a construction lending agency for the performance of work's
to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.)
upon the above mentioned properly for inspection purposes.(We)agree t0 save Lender's Name
indemnify and keep harmless the City of Cupertino against liabilities,judgments•
costs,and expenses which may accrue against said City in consequence of the Lender's Address
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section ARCH ITECf'S DFCLA RAT'I ON
9.18.
i - I understand my plans shall be used as public records.
Signature Date 3 y
Licensed Professional
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
CUPERTINO (408)777-3228• FAX(408)777-3333•buildinafil�cuoertino.org
PROJECTADDRFSS 629 Lonna bne I
APN 03�
OWNER NAME Tun G/41Qh Lf�c PHONE E-MAIL
E!-MAIL
STREET ADDRESS / nnq One CITY $T TE,ZI , J�`j t-UI� FAX
CONTRACTORNAME LO (' LICENSE NUMMBBEERR lILICENSE TYPE TTT BUS.LIC.q
�Lvi✓F,� ✓i =
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY.STATE,ZIP PHONE
1 UNDERSTAND AND AGREE TO THE FOLLOWING:
I. 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 Y" 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, I 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. I also understand that
smoke detectors and carbon monoxide detectors are required to be installed in accordance with Sections R314 and R315 of
the 2010 California Residential Code. t 1 -/
Signature of Applicant/Agent: Date: 13 Z
ReroofPo1icv_201 Ldoc revised 02/16111
OWNER-BUILDER DISCLOSURE FORM
COMMUNITY DEVELOPMENT DEPARTMENT- BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO, CA 95014-3255
CUPERTINO (408)777-3228• FAX (408)777-3333• buildina8cuoerino.ora
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:
SUMS S SAPN BP#
Lonna tno L
OWN NAME - O NE DD ESS rn 0
u ickLonna Ln
DESCRIPTION OF WORK:
i
Q
Weare 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.)
01. 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-
Builder"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.
O2. 1 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.
(_?5�3. 1 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.
_(P4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license
numbers on permits and contracts.
I understand if I employ or otherwise engage any persons,-other than California licensed Contractors, and the
to al value of my construction is at least five hundred dollars (5500), including labor and materials, I may be
considered an"employer" under state and federal law.
(D-6. I 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.
jV7. 1 understand under California Contractors'Stale 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.
64'1 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.
AvnerBuilderFa-nr 2010.doc revised 04/14110
. 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 vnvw.cslb.ca.gov for more information about licensed
contractors.
00. 1 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.
011. 1 agree that,as the party legally and financially responsible for this proposed construction activity, I will abide
by�ll applicable laws and requirements that govern Owner-Builders as well as employers.
l/�J�12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the
information 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 verification acceptable to the city may be required to be presented when the permit is issued
to verify the roeowner's si nature.
Property Owner's Signature: Date:
---- ----- --- --- ---------- --- ------- ------------------i-- - u----- -arty----------- ------------------ --- ----
(NOTE: The following Authorization Form is required to be completed by the pperty 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:
Omne)'Buildel'Foiwi 2010.doc rerised 04114/10
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 829 Lonna Lane DATE: 07/25/2012 REVIEWED BY: Sean
APN: BP#: 'VALUATION: $7,000
*PERMITTYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD Or Duplex PENTAMATION
USE: pPERMIT TYPE: 1SFDWLR00
WORK Tear off existing asphalt roofing and install new 15/32 OSB sheathing, one layer 301b felt and install
SCOPE new asphalt roofing.
FEE ID ROOFAREA
(s.L)
1REROOFFRES 1,500
blech. Plan Check Plumb.Plan Check Elec.Plan Check
blech.Permit Fce: Plumb.Permit Fee: Flee.. Permit Fee:
Other.Afech. lisp. Other Plumb Insp. Ll I Other Flec.Insp.
Mech.hup.Fec: Phonb. hhap.Fee: Clec.Insp.Fee:
A'OTF: This estimate doer trot fndrbejeer due to other Departments(i.e. Planning, Public (Forks, Fire,Snnitury Sewer District,School
District,etc.). There fees are bared on the prelintinarl•information available and are onh•air eviitruae. Contact the De t or rabbi'I info.
FEE ITEMS (Fee Resolution I1-053 Elf 7/1/11) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
SuppL PC Fee
Plumb.11lech.1Elec
Permit Fee: $225.00
Supp/. Insp Fee
PlumbJhlech./Elec
P/umh./Mech./Elec Permit Fee.'
Cons'Dvction Tux:
Adininirtrntive Fee:
Work Without Permit? O Yes Q No $0.00
AtIvanced PlunnigG Fees:
Travel Doc nnenlutiun Fees:
Suon¢ Motion Fee: IBSEISMICR $0.70 Select an Administrative Item
Blda Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $226.70 $0.001 TOTAL FEE: F$226,701
Revised: 07/01/2012
Zo-7 0 l cc 1
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTINO /(408)777-3228 • FAX(408)777-3333 •buildingP—cuoertino.org
PROJECT ADDRESS)(]3Q / _nnq Ln. 7N� APN#
OtVT 9 H 66 I// LLL---•••a+ L PHON
IU
ce-
STREETADDRESS CITY ATE,ZI �V FAX
8 onn� Ln . i►� Gf} �j
CONTACT NA Ji- L E/ A /L. lJ I I 1 PHON _Z ('e' E-MAIL
�'
STREET ADDRESS LOhn b ' Cm'.S TE, ZIP �wD FAX
0\VNER ❑ OWNER-BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑CONIRACORAGENT ❑ ARCHriwr ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME LICENSENUMSER LICENSE TYPE BUS.LIC.a
COMPANY NAME E-MAIL FAX
F
STREET ADDRESS CITY,STATE,ZIP PHONE
ARCHITECDENGINEER NAME - / LICENSE NUR®ER BUS.LIC.a
COMPANY NAME /V E-MAIL FAX
STREET ADDRESS CITY.STATE,ZIP PHONE
USE OF- � SFD or Duplex ❑ Nfuld-Family ROOF AREA: VALUATION:
/�o �DDO
_STRULTURE:' ❑ Corarrlercial
EXISTING ROOF-TYPE: ❑BUILT-UPROOF KISPHALTSHINGLES ,,gg❑WOOD SHAKES ❑WOODSHTNGLES ❑OTHER(SPECTY)
.REMOVE tREPLACE XYPS IF NO. PLYWOOD Oa16- 1 f Z, PLYWD OSB
PITCH ' ROOF
❑ LAYERSa1'K. ❑ b6' TYPE. ❑CO �'(� CLAM A
PROPOSED ROOF TYPE^ ❑BUILT-UP ROOF WASPH.ALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER [CC-ES REPORT
DESCRIPTION OF\VpRK:r
b
in SAA aae C_"'nsz�&
o l6. 45 ( an
i Gin
7o n $
By my sigruaturc below,1 cern n•m each of[he following: I am the prope owner or aud\orized agent to act on the property oW 's halt: 1 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 relating to building co m-'on. I au o .ze mtives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent:' I Daze:
SUPPLEMENTAL INFORMATION REQUIRED OFFICEUSEONLY
_ If building is associated with it Home OWmees Association,provide letter PLAN CHECK TYPE ROUTING SLIP-
of approval from HOA. `//��`/1''jj,, OVER-THE-COUNTER BUILDING PLAN REVIEW'
Provide Planning approval to verify if there any restrictions.
LJ`EXPRESS ❑ PLANNING PLAN REVIEW
Provide copy of Malmfacmrer's Installation Specifications. ❑ STANDARD ❑ FIRE DEPT
Provide signed copy of Cupetvno's Tear-Off Policy. -❑' UTHER;
RerwfApp_2011.doc revised 03/16/11