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11030093 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7682 ORANGE BLOSSOM DR CONTRACTOR:YOON LEE PERMIT NO: 11030093 OWNER'S NAME: YOON LEE 7682 ORANGE BLOSSOM DR DATE ISSUED:03/21/2011 OWNER'S PHONE: 4082523224 CUPERTINO CA, 95014-5251 PHONE NO: LICENSED CONTRACTOR'S DECLARATION f— f— r— BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# F_ I— r— MECH RESIDENTIAL COMMERCIAL Contractor Date JOB DESCRIPTION: RE-ROOF 16 SQUARES,TEAR OFF WOOD SHAKES AND I hereby affirm that I am licensed under the provisions of Chapter 9 RE-ROOF W/COMP 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:$4500 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:36611092.00 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 FROM 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 2 granting of this permit. Additionally,the applicant understands and will comply Issued by: %`'� Date: 1,` with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature Date All roofs shall be inspected prior to any roofing material being installed.If a roof is installed without first obtaining an inspection,I e to remove all new materials for inspection. OWNER-BUILDER DECLARATION Signature of Applican Date: I hereby affirm that 1 am exempt from the Contractor's License Law for one of the following two reasons: OOF 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,Sections 25505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this /— p Owner or authorized agent: �� Su ti �-�"-tom Dater 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 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 indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION fists,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. anting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations pe trCupertino Municipal Code,Section Licensed Professional 9.18. Si Date �/ CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 36611092 . 00 DATE ISSUED. . . . . . . : 03/21/2011 RECEIPT # . . . . . . . . . : BS000012946 REFERENCE ID # . . . : 11030093 SITE ADDRESS . . . . . : 7682 ORANGE BLOSSOM DR SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . . YOON LEE ADDRESS . . . . . . . . . . : 7682 ORANGE BLOSSOM DR CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5251 RECEIVED FROM . . . . : YOON SUN LEE CONTRACTOR . . . . . . . : LIC # *OWNER* COMPANY . . . . . . . . . . : YOON LEE ADDRESS . . . . . . . . . . : 7682 ORANGE BLOSSOM DR CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5251 TELEPHONE . . . . . . . . FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 4, 500 . 00 1 . 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 4 , 500 . 00 0 . 50 0 . 00 0 . 50 0 . 00 1REROOFRES SQ FEET 16 . 00 208 . 00 0 . 00 208 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 209 . 50 0 . 00 209 .50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 209 .50 --------------- TOTAL RECEIPT 209 . 50 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 ADDRESS: 7682 orange blossom dr. DATE: 03/21/2011 REVIEWED BY: bobs. APN: BP#: "VALUATION: 1$4,500 Y PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof PRIMARY SFD or Duplex PENTAMATION 1SFDWLR00F USE: I I PERMIT TYPE: WORK tear off wood shakes and install comp shingle roof class A. SCOPE FEE ID ROOF AREA s.f. 1 REROOFFRES 1,600 T-T I T I T F , F : NOTE: Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addn'l info, FEE ITEMS(Fee Resolution 09-051 fff, 7;7.'10) FEE QTY/FEE MISC ITEMS Permit Fee: $208.00 Work Without Permit? 0 Yes 0 No $0.00 i Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $209.50 $0.00 TOTAL FEE.T $209.50 Revised: 01/15/2011 REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 CUPERTIINO (408)777-3228• FAX(408)777-3333•building(cDcupertino.orq 11�3��q 3 PROJECT ADDRESS ter, �•.,� /' r�- r Z rn��'C ..p� 'J�,. APN# OWNER NAME PHONE E-MAIL r � 'lee .�.-t. r�� G.c� C •('��_C,-i.1:� `'�"_ s/7r�t%�.� "L STREET ADDRESS/ 6I/TY, STATE,ZIP/ . FAX Ly _. -'�-/ .l (�' - y,_�� i.�'.{•74 fir//� APPLICANT NAME PHONE E-MAIL STREET ADDRESS CTS Y,STATE,ZIP J f FAX f OWNER fig-OWNER-BUILDER� W ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME t,. LICENSE NUMBER LICENSE TYPE BUS.LIC.# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC.# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF `0 STD or Duplex ❑ Multi-Family ROOF AREA. VALUATION: (� STRUCTURE: ❑ Commercial EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES OD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY) REMOVE/REPLACE , YES IF NO, 3�� PLYWOOD V/." ❑ PLYWD llfi OSB PITCH: ROOF ❑ NO #LAYERS: THICKNESS: 1:15/8" TYPE: ❑ CDX :12 CLASS: A ("0,i/ ICC-ES REPORT# PROPOSED ROOF TYPE: C3 ? BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES WOOD SHINGLES OTHER ! DESCRIPTION OF WORK: , By my signature below,I certify to each of the f (lowing: 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 ascription of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction. I authorizo,4presentatives of C upertienter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: SUP TAL INFORMATION REQUIRED ozcE USE ONLY _If building is associated with a Home Owner's Association,provide letter rPLAN CHECIC'YPE "°ROUTING SL, IP � of approval from HOA. a 0VEx TIE-COUNTER ❑ BUILDING PLAN REVIEW Provide Planning approval to verify if there any restrictions. ❑-EXPRE'SS' ❑ PUNNING PLAN REVIEW Provide copy of Manufacturer's Installation Specifications. ❑ sxANDARn ❑, FIRE'DEPh Provide signed copy of Cupertino's Tear-Off Policy. ❑`,OTHER: ReroofApp_201 1.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•buildingi�cupertino.org PROJECT ADDRESS APN# OWNER NAME PHONE _ E-MAIL 1,' , .4 •7 STREET ADDRE S CITY, STATE,ZIP FAX CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC.# COMPANY NAME E-MAIL FAX 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: l ReroofPolicy_2011.doc revised 02/16/11 OWNER-BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION 10300 TORRE AVENUE-CUPERTINO, CA 95014-3255 CUPERTlNO (408)777-3228- FAX(408)777-3333- buildinoQcuDertino.org 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 APN BP# OWNER NAME / OWNER ADDRESS c G ! DESCRIPTION OF WORK: 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.) V 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. V` 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. 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. r �_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 rmn�ldered an "employer"under state and federal law. y ' 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 \mej to serious financial risk. ' y 7. 1 understand under Califomia 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 erformed 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 owners)that result from any latent construction defects in the workmanship or materials. OwnerBuilderForn: 2010.doc remised 04114110