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13010051 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10902 WILKINSON AVE CONTRACTOR:HOMEOWNER PERMIT NO: 13010051 OWNER'S NAME: KOBAYAKAWA REBECCA IN DATE ISSUED:01/08/2013 OWNER'S PHONE: 4087681478 CUPERTINO,CA 95014 PHONENO: ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r 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:REMOVE EXISTING SHAKE AND REPLACE WITH (commencing with Section 7000)of Division 3 of the Business&Professions ASPHALT Code and that my license is in full force and effect. COMP 1 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:$11500 permit is issued. APPLICANT CERTIFICATION APN Number:35613059.00 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: �/ CS OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All 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 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: I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(See.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 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. I will maintain 1 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 California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must Owner ' d agent: 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 costs,and expenses which may acerae against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. 1 understand my plans shall be used as public records. r Signature Date�3 Licensed Professional REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228•FAX(408)777-3333•buildinG(rDcuoertino.om 005 PROIECTADDRESS /o Too 6 IIZ-1 Aso., pfvem rte J OWNERNAME/J�Q//. /��/ �� PHONE�O�/�J/a /((� •l V� � /7 �)O/, �' _( STREET ADDRESS /DQ�.2. G1J'l i#'15o� /Ji.K CrrY ✓�'e ✓/p GST ��DAI Ax CONTACT /oNAqME0� 4�wC. D / EMAIL 7OQ // 7D STREET ADDRESS CFTE. 1p FAX C'4- qJ / u ❑OWNER X OWNER-BUILDER ❑ OWNERAGENT ❑ CONTRACrOR ❑CONTRACrOR AGENT ❑ ARCmiECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME LICENSENUABER LICENSETYPE BUS.LIC.# D /✓� COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,Z@ PHONE ARCmTECDENGINEER NAME LICENSENUMBER BUS.LIC.# COMPANY NAME FAX STREET ADDRESS /T CITY,STATE,ZIP PHONE USE OF XSFD or Duplex ❑ Multi-Family ROOF AREA: y� VALUATION: L STRUCTURE: El Commercial �O D V 1113,00 EXISTING ROOF TYPE: ❑BUILT-UP ROOF ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY) REMOVE/REPLACE RYES IF NO. PLYWOOD SS" ❑ PLYWD ❑ OSB PITCH: © nn ROOF ❑ #I ❑ 5/d" E: X 9�:1G CLASS' A PROPOSEDROOFTYPE: ❑BUILT-U1PROOF XSPHALT SHINGLES ❑WOOD SHAKES El WOOD SHINGLES ❑OTHER ICC-ES REPORT# DESCRA'TION OF WORK: By my signature below,I certify to each ofthe following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information 1 have vided 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 Oil ' onstruaiom I authorize representatives of Cupertino to enter the above-identi property r inspection purposes. Signature of Applicanr/Agent Date: l SUPPLEMENTAL INFO TION REQUIRED _If building is associated with a Home Owner's Association,provide letterourmGS LYPR ur n of approval from HOA. +R PN _ —Provide Planning approval to verify if there any restrictions. ©)5E`'�REEs iv`Y '�;�av�N�f� w,?inrmlNcsLANlsEVIE , v`%��y Provide copy of Manufacturers Installation Specifications. Provide signed wpy of Cupertino s Tear-Off Policy. f ,ltar O$oTTu:Ray rasa"h�; f v: ReroojApp_1011.doc revised 03/16/11 C CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 10902 Wilkinson Ave DATE: 01/08/2013 REVIEWED BY: Sean APN: BP#: -VALUATION: $11,500 *PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof PRIMARY SFD or Duplex PENTAMATION 1SFDWLROOF USE: PERMIT TYPE: WORK Remove and replace composition roofing 4000 sq ft). SCOPE FEE ID ROOF AREA s.f. 1REROOFFRES 4,000 ;bfiecn.Phm Check Plumb.Alan Check F,lec.Plan Ceck 31ech. F<;;mit Feer Numb,., Permit F,6r Rlea. llo mit P"',, olhee,l,fech.i¢v. Otho plumb 01ho F7�a:Insp, ASech. 7nsp. F<e Phewb.hf 5r).Fee: 1;'lec.In<p. NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . These fees are based on the preftmiWna in ormation available and are only an estimate. Contact the De t or addn'I info. FEE ITEMS Lfee Resolution 11-053 E . 711112) FEE QTY/FEE MISC ITEMS Plun Check Fee.: Snlrpl. PC Fee 1'1um6.;4tlech.;Zlec Permit Fee: $600.00 ,SvppL bzsp Fere Plumb.:a/ecfa.;l7ee Plumb.hblech./Elct Permit Fee: Construction Tax: Administraf[ve Fee: Work Without Permit? ® Yes (F) No $0.00 �Idvanced Planning 1 zes: 'D-Ovel Documenfalion.Fees: Strong Motion Fee: IBSEISMICR $1.15 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 x. $602.15 $0.00 TOTAL FEE; $602.15 Revised: 10/01/2012 REROOF TEAR-OFF POLICY COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION ALBERT SALVADOR, P.E.,C.B.O., BUILDING OFFICIAL GUPERTINO 10300 TORRE AVENUE-CUPERTINO, CA 95014-3255 (408)777-3228- FAX(408)77,7,--33]333-buildingacuoertino.oro PROJECTADDRESS Iq O da //ICINSDn /`i�'t/Pi. APNa OWNER NAME ['� J L1„� JZ'E �6 p �[/�/Y) EMAIL STREET 6/ SC/� COY//�/� 07 W crry LJa 1z� �zJ 7 / YSgJ Q/!J' FAX CON ACTORNAME LICENSE NUMEER „ LICENSE TYPE EUS.LIC. COMPANY NAME E-MAM FAX STREETADDRESS 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 one business day before the requested inspection date. Please call (408) 777-3228 from 7:30-3:30pm (Mon-Thurs) or 7:30-2:30pm (Friday) to schedule 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. 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. 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 J/d'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. 7. 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. 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. % Signature of Applicant/Agent: Date: ReroojPo1icy_2012.doc revised 10/7/12 OWNER-BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228•FAX(408)777-3333- buildina(� a cuoertino.or 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/Q A �'//`l �v� APN BP# OWN=M OWNER ADDRESS — i 611 DESCRIPTION OF WORK: S - 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.) 6-1- 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. 1, 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. y— 2. 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. gA�_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. A L4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. AZ5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total 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. X�P 5. 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. PZ/6—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. 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. OwnerBuilderForm 2010.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. f=,�_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. ;b__1 1. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner-Builders as well as employers. 12. I 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 property owner's sin e. Property Owner's Signature: Date: --------------------------------------------------------------------------------------------------------------------------------------------- (NOTE: The following Authorization 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.doc revised 04114110 Building Department City Of Cupertino 10300 Torre Avenue C)�nar4jox wil e& z CUPERTlNO �~...... Fax: 408-777-3333 CONTRACTOR/SUBCONTRACTOR LIST JOB ADDRESS: PERMIT# OWNER'S NAME: PHONE# GENERAL CONTRACTOR: BUSINESS LICENSE# ADDRESS: ' ?�� CITY/ZIPCODE: *Our municipal code Mquires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL'OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors:'- Signature Date Please check applicable subcontractors and complete the following information: t/ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring/Carpeting Linoleum/Wood Glass/Glazing Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile caner I Contractor Signature Date