12120078CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 1122 SCOTLAND DR
OWNER'S NAME: MAN STEVEN SIU AND FEI YU
OWNER'S PHONE: 4083936863
❑ LICENSED CONTRACTOR'S DECLARATION
License Class Lic. #
Contractor Date
1 hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business & Professions
Code and that my license is in full force and effect.
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
permit is issued.
APPLICANT CERTIFICATION
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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and 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
9.18.
Signature Date
❑ OWNER- BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
1, as owner of the property, or my employees with wages as their sole compensation,
will do the work, and the structure is not intended or offered for sale (Sec.7044,
Business & Professions Code)
1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
I 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
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
permit is issued.
I certify that in the performance of the work for which this permit is issued, I shall
not employ any person in any manner so as to become subject to the Worker's
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
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION
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 prope for inspection purposes. (We) agree to save
indemnify and keep harmless th ity of Cupertino against liabilities, judgments,
costs, and expenses which mgyaccrue against said City in consequence of the
granting of this pe ,pnif. Add' 6211y, the applicant understands and will comply
with all non -po t source gulations per the C}pertino Municipal Code, Section
9.18. r
CONTRACTOR: MAN STEVEN SIU AND FEI PERMIT NO: 12120078
YU
1122 SCOTLAND DR DATE ISSUED: 12/14/2012
CUPERTINO, CA 95014 PHONE NO:
BUILDING PERMIT INFO: BLDG f— ELECT J_ PLUMB I-
MECH RESIDENTIAL f— COMMERCIAL f—
JOB DESCRIPTION: REMOVE AND REPLACE COMPOSITION ROOFING (1190
SQFT)
Sq. Ft Floor Area: I Valuation: $7000
APN Number: 36228019.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: � /1% �/GCl Date: /P ' l 4/ 1
R - ROOFS:
All roofs shall be inspected prior m9fing material be' g installed. If a roof is
installed without first obtainin an i pection, I agree to ove all new materials for
inspection.
Signature of Applicant: /� ` Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should I us , quipment or devices which emit hazardous air
contaminants as define y the Bay Area Air Quality Management District 1 will
maintain com h a Cupertino Municipal Code, Chapter 9.12 and the
Health & ety C e, Sec ' ns 25511x, 25533, and 25534.
Owner 11* auth i�zad, n
I �` - Date:_
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
> 2 2_ I Licensed Professional
Date / /�f
CUPERTINO
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
(408) 777 -3228 • FAX (408) 777 -3333 • building(ftupertino.org
J _
ReroofApp_2011.doc revised 03116111
W%
PROJECT ADDRESS
T—APN#
, ��
OWNER NAME
PHONE ..�
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STREET ADDRESS
CITY, STATE, ZIP
FAX
CONTACT NAME ,. + i
PHONE e
Y
E -MAIL
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STREET ADDRESS
CITY, STATE, ZIP
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FAX /
❑ OWNER LW OWNER - BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
LICENSE NUMBER
LICENSE TYPE
BUS. LIC. #
COMPANY NAME
E -MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
ARCHITECT/ENGINEERNAME
LICENSE NUMBER
BUS. LIC. #
COMPANY NAME
E -MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ SFD or Duplex ❑ Multi- Family
ROOF AREA:
VALUATI N:
STRUCTURE: El Commercial
G ,G?
Z /
� ` 1C/
EXISTING ROOF TYPE: ❑ BUILT -UP ROOF YkASPHALT SHINGLES ❑ WOOD SHAKES
❑ WOOD SHINGLES ❑ OTHER (SPECIFY)
REMOVE /REPLACE BYES
IF NO.
PLYWOOD ❑ /." ❑
PLYWD ❑ OSB
PITCH:
ROOF
❑ NO
# LAYERS:
THICKNESS: 11 5/8"
TYPE: 13 CDX
1
12
CLASS:
PROPOSED ROOF TYPE: ❑ BUILT -UP ROOF #ASPHALT SHINGLES 11 WOOD SHAKES
// ``
❑ WOOD SHINGLES ❑ OTHER
ICC -ES REPORT #
DESCRIPTION OF WORK:
By my signature below, I certify to each of the fo jhe property wner or authorized agent to act on the property owner's behalf. I have read this
application and the information I have provide s co ct. I have read the scription of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building on cti n. I authori r esentatives of Cupertino to enter the above - identified property for inspectl� purposes.
L, I
2,1
Date: L - /
Signature of Applicant/Agent:
SUPPLEMENTAL INFORMATION REQUIRED
OFFICE USE
_ If building is associated with a Home Owner's Association, provide letter
P� �C'TYPE
ROUTING
of approval from HOA.
ov> x;TlnE COUNTER "
BUILDING PLAN REVIEW
Provide Planning approval to verify if there any restrictions.
0 FJM"'kESS
PLANNING PLAri REVIEW
Provide copy of Manufacturer's Installation Specifications.
1D. sTaNnARn '
D ,FIREDEPT
Provide signed copy of Cupertino's Tear -Off Policy.
OTA
ReroofApp_2011.doc revised 03116111
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CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
FEE ID ROOF AREA
s.f.
1 REROOFFRES 1,190
ADDRESS: 1122 Scotland Dr
DATE: 12/14/2012
REVIEWED BY: Sean
Ff,,J!, 11"on 1 F'Y'
APN:
BP #:
"VALUATION: 1$7,000
*PERMIT TYPE: Minor Building Permit
PLAN CHECK TYPE: Re -roof
PRIMARY SFD or Duplex
USE:
I
PENTAMATION 1SFDWLR00F
I PERMIT TYPE:
WORK
Remove and replace composition roofing 1190 sq ft).
SCOPE
Sapp/. Insp Fee
FEE ID ROOF AREA
s.f.
1 REROOFFRES 1,190
NOTE. This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
Dictrirt- otr_ )_ Tho.co foee are haced an the nreliminary information available and are onlv an estimate. Contact the Dept for addh7 info.
FEE ITEMS (Fee Resolution 11 -053 Eff 7111122
/Itch. Plan t'Ajf',ck E
1,11(m,h. M(w ( /w( A
1-1/cc Plait f `hcck
Ff,,J!, 11"on 1 F'Y'
Fh,wzh. Pe f .tit 1' °cr:
F7, Permit Vice:
t);lwr kfi. ,A Ins / >.
Otlwr F >brrtsb 10'1, 1p
01,17,,,I' 1,17o, Inap.
f'hlrrrb.ilt ler; /z;'l.lee
NOTE. This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
Dictrirt- otr_ )_ Tho.co foee are haced an the nreliminary information available and are onlv an estimate. Contact the Dept for addh7 info.
FEE ITEMS (Fee Resolution 11 -053 Eff 7111122
FEE
QTY/FEE
T MISC ITEMS
Plan Check Fee:
Suppl. PC.' Tree
f'hlrrrb.ilt ler; /z;'l.lee
Permit Fee:
$180.00
Sapp/. Insp Fee
Plrlrnfl. i:��h clr.;'I;lec:
l'lurrtf7.!:,1leclt. %71<>c Permit FCC.,
Construction Tax:
r,4dlnhfislrYattL'c' Fee'
Work Without Permit? 0 Yes (F) No
$0.00
,idLY1nCG'Cl Pllrrnl7rlg 1'CeS:
�
I ralvl Docilmentation Fees:
Strong Motion Fee: 1BSEISMICR
$0.70
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
$1.00
SUBTOTALS: `
$181.70
$0.001 TOTAL FEE.
$181.70
Revised: 10/01 /2012
CUPERTINO
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
(408) 777 -3228 • FAX (408) 777 -3333 - buildingQcupertino.om
PROJECT ADDRESS
,�1
APN #
/ Z Z D !� R•
OWNER NAME
PHONE d
E-MAIL
%
STREET ADDRESS
CITY, STATE, ZIPO N
JK
FAX
BUS. LIC. #
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE
COMPANY NAME
E -MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
I UNDERSTAND AND AGREE TO THE FOLLOWING:
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.
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 /4" 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 foll
property owner's behalf. I understand a
smoke detectors and carbon monoxid detec
the 2010 California Residential Cod ,
of Applicant/Agent: X
is true: I am the property owner or authorized agent to act on the
;omply with the re -roof policy stated above. I also understand that
required,)o be installed in accordance with Sections R314 and R315 of
Date: ) 12- - 1 �1 —1 2_
re&- 1
CUPERTINO
OWNER- BUILDER DISCLOSURE FORM
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
(408) 777 -3228 • FAX (408) 777 -3333 • building(acupertino.om
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 ; �� z frC p-IANQ �Y l C Pr�iNa 1 p�
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APN ? p = O / -OC)
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BP#
OWNER NAME
eve,► MNIU LX ��Z
OWNER ADDRESS
i�1 SlCfiuL"d r C� r�i�
DESCRIPTION OF WORK: P - Yd Z+ e
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.)
<111 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. 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.
: 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.
n3. 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.
�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.
w� 5. 1 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.
r_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.
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.
�8. 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.
OwneYBuildeYForm 2010.doc revised 04 114110
_9. 1 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.
5�010. 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.
,11. 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. 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 ust be completed and signed by the property owner and
returned to the agency responsible for issu' ermit. Not A copy of the property owner's driver's license,
form notarization, or other verification accep ble the city MP required to be presented when the permit is issued
to verify the property owner's signature.
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:
Address of Authorized Agent:
Tel No
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 04 114110