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11050222
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21741 SANTA BELLA PL CONTRACTOR:THE HOME PERMIT NO: 11050222 IMPROVEMENT SOURCE INC OWNER'S NAME: HUNGLIN HSU 1400 COLEMAN AVE STE C12 DATE ISSUED:05/26/2011 'NER'S PHONE: SANTA CLARA, CA 95050 PHONE NO:(408)567-9710 ❑ LICENSED CONTRACTOR'S DECLARATION F_BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class C 3`t Lic.# Cl a tl C14 L� MECH RESIDENTIAL COMMERCIAL Contractor'1-Kt,i+gxNt ]wtAn.,aNi�� } IJai a40-1L JOB DESCRIPTION: RE-ROOF 29 SQ TEAR OFF EXISTING SHAKE,RE-INSTALL I hereby affirm that I am licensed under the provisions of Chapter 9 7/16'OSB RADIANT BARRIERS CLASS A (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. Sq.Ft Floor Area: Valuation:$15500 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 APN Number:35622023.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS ROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the C �ilil Date: �� granting of this permit. Additionally,the applicant understands and will comply Issued by: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. _ a&, RE-ROOFS: Signature a L/ All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection,I agree to remove all new materials for inspection. uJ OWNER-BUILDER DECLARATION . Signature of Applican Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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 HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). 1 have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Se�-0551 25534. Section 3700 of the Labor Code,for the performance of the work for which thisOwner or authorized ageDate: permit is issued. 1 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 CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 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 ARCHITECT'S DECLARATION 'emnify and keep harmless the City of Cupertino against liabilities,judgments, sts,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN 35622023 . 00 DATE ISSUED. . . . . . . : 05/26/2011 RECEIPT # . . . . . . . . . : BS000013584 REFERENCE ID # . . . : 11050222 SITE ADDRESS . . . . . : 21741 SANTA BELLA PL SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : HUNGLIN HSU ADDRESS . . . . . . . . . . : 21741 SANTA BELLA PL CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : DONALD SPINGOLA CONTRACTOR . . . . . . . : DONALD SPINGOLA LIC # 30509 COMPANY THE HOME IMPROVEMENT SOURCE IN ADDRESS . . . . . . . . . . : 1400 COLEMAN AVE STE C12 CITY/STATE/ZIP . . . : SANTA CLARA, CA 95050 TELEPHONE . . . . . . . . : (408) 567-9710 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 15, 500 . 00 1 . 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 15, 500 . 00 1 . 55 0 . 00 1 . 55 0 . 00 1REROOFRES SQ FEET 29 . 00 377 . 00 0 . 00 377 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 379 . 55 0 . 00 379 . 55 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 379 . 55 VISA --------------- TOTAL RECEIPT 379 . 55 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 REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408)777-3228• FAX(408)777-3333• buildingacupertino.org CUPERTINO PROJECT ADDRESS ` APN# OWNER NAME PHONE3' �' E-MAIL STREET ADDRESS CITY, STATE,ZIP FAX Ll k/ A C s"061!:4 1 APPLICANT NAME PHONE E-MAIL STREET ADDRESS CITY,STATE,ZIP FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME v LICENSE NUMBER (`g LICE E BUS.LIC.# ✓ S gemT CO rfANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,Z PHONE a✓t , Ste. 149 S v-> -9�/a ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC.# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF XIFD or Duplex ❑ Multi-Family ROOF AREA: VALUATION: VALUATION: STRUCTURE: ❑ Commercial 009th 6 �_ <©-0 EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLESCOyD.,S/ S ❑WOOD SHINGLES El OTHER(SPECIFY) REMOVE/REPLACE S IF NO. PLYWOOD 1:1w, LR (. PLYWD SB PITCH: ROOF ❑ NO #LAYERS: THICKNESS: 1:15/8" TYPE: ❑ CDX 12 CLASS: A PROPOSED ROOF TYPE: ❑BUILT-UP ROOF N�SPHLT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT# DESCRIPTION OF WORK: ti h 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 buildi . I authonMrepresentatives of Cupertino to enter the above-identified prope ;for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL REQUIREDMUSE,gNi w� _If building is associated with a Home Owner's Association,provide letter pN Tr IioilTlNQ SLIP of approval from HOA. ❑ ,OVER THS COUNTER ❑ BUILDING PLAN REVIEW �z- Provide Planning approval to verify if there any restrictions. ❑ EXPREss ❑ 'PLANNIATGPLAN.REVIEW. p Provide copy of Manufacturer's Installation Specifications. ❑ STAN DEPT ❑ FIRE DEPT Provide signed copy of Cupertino's Tear-Off Policy. ❑ .OTHER ., 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 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333• building(,�cupertino.org PROJECT ADDRESS !,N1 S � APN# OWNER NAME i4VN La ,i J PHO NE ` 3e 3 ^,.n f E-MAIL ADDRESS CITY, STATE,ZIP FAX u • J CONTRACTOR NAME . LICENSE NUMBER LICENSE TYPE BUS.LIC.# �+ o/� COMPANY NAME AX `/'{ E-MAIL O J 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 shall be scheduled 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. On the day of the inspection, a building inspector will be available within one hour for either a Tear-Off Inspection or Nailing Inspection if you call again on that day between the hours specified. 3. The following inspections are required: a. 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. b. If plywood is installed, a plywood Nailing Inspection is required. c. Progress Inspection is required when approximately 50% of roof covering is installed. 4. New roof coverings shall not be applied without first obtaining all 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. 5. 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 I/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. 6. 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: ReroofPolicy_2011.doc revised 02/16/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 21741 Santa Bella Place DATE: 05/26/2011 REVIEWED BY: RDW APN: BP#: `°VALUATION: 1$15,500 r°PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof PRIMARY SFD or Du lex PENTAMATION 1 SFDWLROOF USE: P PERMIT TYPE: WORK Remove existing shake roof, install 7/16" radiant OSB and timberland lifetime comp shingles. SCOPE FEE ID ROOF AREA s.f. 1 REROOFFRES 2,900 T-T T 77" F71 NOTE. Theseees are based on the preliminary information available and are only an estimate. Contact the De t or addh7 info. FEE ITEMS (fee Resolution 09-051 Eff. 7;'1.;10) FEE QTYIFEE MISC ITEMS Permit Fee: $377.00 Work Without Permit? 0 Yes E) No $0.00 Strom Motion Fee: 1BSEISMICR $1.55 Select an Administrative Item Bld€, Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: 1 $379.55 $0.00 TOTAL FEE: $379.55 Revised: 04/29/2011