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11090027 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1191 ELMSFORD DR CONTRACTOR:PRINCIPLE ROOFING,INC PERMIT NO: 11090027 OWNER'S NAME: HO CHIH-YUAN AND LIU HAO-CHIEH 10160 STERN AVE DATE ISSUED:09/06/2011 OWNER'S PHONE: 4088893257 CUPERTINO,CA 95014 PHONE NO:(408)898-7298 LICENSED CONTRACTOR'S DECLARATIONr BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class 1 3 Lic.# �, 6 16!04,/ - MECH F RESIDENTIAL[_ COMMERCIAL r Contractor Date l;:1 I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:RE-ROOF REMOVE SHAKES,INSTALL OSB SHEATHING (commencing with Section 7000)of Division 3 of the Business&Professions 1/2 Code and that my license is in full force and effect. INCH,30YEAR COMPOSITION CLASS A 26SQS 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:$10400 permit is issued. APPLICANT CERTIFICATION APN Number:36208032.00 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 D YS FROM L ST CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. N�J / z� /`''�/ Signature �j-'�� Date � G� Issued by: Date: 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 1,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 1 hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE 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 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 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 California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must Owner or uthorized agent: Date: forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION 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 in consequence of the ng of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION 0-il all non-point source regulations per the Cupertino Municipal Code,Section 9.18. 1 understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 36208032 . 00 DATE ISSUED. . . . . . . : 09/06/2011 RECEIPT #. . . . . . . . . BS000014673 REFERENCE ID # . . . : 11090027 SITE ADDRESS 1191 ELMSFORD DR SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER HO CHIH-YUAN AND LIU HAO-CHIEH ADDRESS 1191 ELMSFORD DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-4960 RECEIVED FROM . . . . : DERECK X LOI CONTRACTOR DERECK LOI LIC # 27564 COMPANY PRINCIPLE ROOFING, INC ADDRESS . . . . . . . . . . : 10160 STERN AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 TELEPHONE . . . . . . . . : (408) 898-7298 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 10,400 . 00 1. 00 0 . 00 1 .00 0 . 00 1BSEISMICR VALUATION 10,400 . 00 1. 04 0. 00 1. 04 0. 00 1REROOFRES SQ FEET 26 .00 364. 00 0. 00 364 . 00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 366. 04 0. 00 366 . 04 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 366. 04 DISCVR --------------- TOTAL RECEIPT 366 . 04 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 CITY OF CUPERTINO FEE ESTIMATOR— BUILDING DIVISION tAPN£;�F,? DDRESS: 1191 elmsford dr DATE: 09/06/2011 REVIEWED BY: larry s L %`�� BP##: "VALUATION: 1$10,400 ,r PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof PRIMARY SFD or Duplex PENTAMATION 1SFDWLR00F USE: PERMIT TYPE: WORK remove shakes install osb 1/2 in. 30 year composition SCOPE FEE ID ROOF AREA s.f. 1REROOFFRES 2,600 Li I I NOTE. Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addh 7 info. FEE ITEMS (1,�e Resolution 11-053 f?f 7/7.%11FEE QTY/FEE MISC ITEMS Permit Fee: $364.00 Work Without Permit? Yes G) No $0.00 Strom Motion Fee: 1BSEISMICR $1.04 Select an Administrative Item 1314,Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $366.04 $0.00 TOTAL FEE: $366.04 Revised: 07/04/2011 I � C-9 REROOF PERMIT APPLICATION - COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 CUPERTIN4 (408)777-3228• FAX(408)777-3333 • building(a cupertino.org PRO=ADDRESSf 19 1 V-L Ms Poz-u P r?_ APN# OWNER NAME �'YI 1 �-� y v/-�t +J U PE f �✓�' E MIAIL HO , �? 7 STREET ADDRESS FZ j') CITY, STA . FAX APPLICANT NAME PHONE E-MAIL STREET ADDRESS CrrY,STATE,ZIP FAX ❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME r LICENSE NUMBER LICENSE TYPE BUS.LIC.# COMPANY NAME E-MAIL FAX STREET ADDS CITY,STATE,ZIPPHONE ;U j7G ft klj A,/ b�-v S ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC.# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF SFD or Duplex ❑ Multi-Family ROOF AREA: VALUATION: STRUCTURE: ❑ Commercial 26 EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY) REMOVE/REPLACE YES IF NO, PLYWOOD h" ❑ PLYWD OSB PrfCH ROOF ❑ NO #LAYERS: ' CKNESS: ❑ 5/8" TYPE: ❑ CDX :12 CLASS: A PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ASPHALT SHINGLES 11WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT# DESCRIPTION OF WORK t By my signature below,I certify to each of the 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 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 buildin ction. I authorize.representatives of Cupertino tc enter the above-identified properr;for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED a � W —If building is associated with a Home Owner's Association,provide letter 's _cuJ1l sI�P of approval from HOA. 4mx -�` —Provide Planning approval to verify if there any restrictions. 2. Provide copy of Manufacturer's Installation Specifications. —Provide signed copy of Cupertino sTear-Off Policy. E. ReroofApp_2011.doc revised 03/02/11 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-building(d-)cupertino.org PROJECT ADDRESS ( '^L1 4 S T r r,j) APN# OWNER NAME C I i I� L4 A � (-I PHO�E ��C J Z� E-MAIL STREET ADDII I f �� /✓ v ,^ CITY, ST�TE,ZIP�1�, � � Lj 1 FAX CONTRACTOR NAME/_ /`-1 - -/�� LICENSE NUMBER LICENSE TYPE BUS.LIC.# i4_ a7z L �L COMPANY NAME E-MAIL FAX STREET DRESS/ j V✓Y �� CIT`STATE,ZIP. ,� , PHONEct }C 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, 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: Reroolpolicv 2011.doc revised 02/16/11