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10100170 CITY OF CUPERTINO F UILDING PERMIT BUILDING ADDRESS: 11883 SHASTA SPRING CT CON'TRACTOR:XIANGYANG YAO PERMIT NO: 10100170 OWNER'S NAME: XIANGYANG YAO 1188' SHASTA SPRING CT DATE ISSUED: 10/22/2010 NER'S PHONE: 4085051058 CUP]'sRTINO,CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION BUI],DING PERMIT INFO: BLDG r ELECT F PLUMB r License Class Lic.# MECH r RESIDENTIAL r COMMERCIAL Contractor Date JOB DESCRIPTION:RE-ROOF REPLACE CURRENT ROOF WITH THE GAF I hereby affirm that I am licensed under the provisions of Chapter 9 LAM[HATED FIBERGLASS ASPHALT-STYLE GRAND CANYON (commencing with Section 7000)of Division 3 of the Business&Professions COLOR MISSION BROWN CLASS A l OSQFT 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 Sq.1 rt Floor Area: Valuation:$12000 permit is issued. APPLICANT CERTIFICATION APr Number:36655026.00 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, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the 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. Issued by;,,- Date: Signature Date -r_/ 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: instilled without first obtain' g 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, insl ection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Sig nature of Applicant: JV I,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 I hereby affirm under penalty of perjury one of the following three — declarations: HAZARDOUS MATERIALS DISCLOSURE I have and will maintain a Certificate of Consent to self-insure for Worker's I Compensation,as provided for by Section 3700 of the Labor Code,for the h rve 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 con npliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& have and will maintain Worker's Compensation Insurance,as provided for by Sa ety Code,Section 25532(a)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this 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 mf intain 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 Hf alth&Safety Code,Sections 25505,25533,and 25534. Compensation laws of California. If,after making this certificate of exemption,1 Or vne or authorized agent: become subject to the Worker's Compensation provisions of the Labor Code,I must Date:— forthwith � '� � �Z�' U 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 1 ereby 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 fo which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter L4 rider's Name upon the above mentioned property for inspection purposes.(We)agree to save i- ' -unify and keep harmless the City of Cupertino against liabilities,judgments, Lcnder's Address and expenses which may accrue 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 ource regulations per the Cupertino Municipal Code,Section I r mderstand my plans shall be used as public records. 9.18. Signature Date I v ? ;I'— 2 DI L censed Professional CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT F.ECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 3665E026 . 00 DATE ISSUED: . . . . . . : 10/2; /2010 RECEIPT #. . . . . . . . . : BS00(011826 REFERENCE ID # . . . : 1010(170 SITE ADDRESS . . . . . : 1188_ SHASTA SPRING CT SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPEPTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : XIANGYANG YAO ADDRESS . . . . . . . . . . : 1188:. SHASTA SPRING CT CITY/STATE/ZIP . . . : CUPELTINO, CA 95014 RECEIVED FROM . . . . : MICH)!,EL YAO CONTRACTOR . . . . . . . . L::C # *OWNER* COMPANY . . . . . . . . . . : XIANGYANG YAO ADDRESS . . . . . . . . . . : 1188;' SHASTA SPRING CT CITY/STATE/ZIP . . . : CUPEPTINO, CA 95014 TELEPHONE . . . . . . . . FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ----------- ---------- ---------- ---------- 1BCBSC VALUATION 12, 000 . 00 1 . 00 0 .00 1. 00 0 .00 1BSEISMICR VALUATION 12, 000 . 00 1 .20 0 . 00 1 .20 0 . 00 1REROOFRES SQ FEET 10 . 00 130 . 00 0 . 00 130 . 00 0 . 00 ----------- ---------- ---------- ---------- TOTAL PERMIT 132 .20 0 . 00 132 .20 0 .00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- --------------------- CREDIT CARD 132 .20 �NEX --------------- TOTAL RECEIPT 132 .20 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: D kTE: REVIEWED BY: APN: BP#: "VALUATION: $12,000 R*PERMITTYPE: Minor Building Permit PLAN CH ECK TYPE: Re-roof PRIMARY 7�)T 111 _____TPENTAMATION 1 SFDWLROOF USE: SFD or Duplex l L,001�,.�RI;.l PERMIT TYPE: WORK SCOPE FEE ID ROOF ARIA s.f. 1REROOFFRES 1,000 L= NOTE: These fees are based on the preliminary information avail able and are only an estimate. Contact the De t or addn'1 info, FS (Fee Resolr�tion 09-051 Ef1 7i1!lO) FEE QTY/FEE MISC ITEMS Szpp . c> , Ptrrmfa.%:��f�<<lr.�IIcc: f'lratl C/wz:k., Permit Fee: f_130.0C upjdl 111s1>1_`(V f'Ir�,rzh.i.lt��j1.,Zl�e ('reit f ��c°: Pharrttz.%alz�t°.tr.il:lc't Permit Fcc; (`�t7ctr-rrt`�irt� Tz�.t Work Without Permit? 0 Yes E) No $0.00 f'Irrtrrttfr,=� f'G��>: A Strong Motion Fee: IBSEISMICR $1.2) Select an Administrative Item Bldg�Stds Commission Fee: 1BCBSC $1.00 FSUBTOTALS: $132.20 $0.00 TOTAL FEE $132.20 Revised: 10/17/2010 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 Qcupertino.org PROJECT ADDRESS I 2 ) rg� yin p 7AP -566 OWNER NAME AGK \ GLS PHONE j_L �` /� E-MAIL�w l C4a Q c6a� a It C . LT777 STREET ADDRESS I f Z C ! / CITY, STATE,i IP n %I FAX CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC.# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,Z P PHONE I UNDERSTAND AND AGR�_EE TO THE FOLLOWING: 1. The re-roof project shall comply with all applicable )rovisions of the 2007 California Building Code. 2. You must schedule all needed inspections a minimum of one day before the requested inspection date. Please schedule inspections online or call (408)777-.3228 between 7:30-3:30 (Mon-Fri). 3. Tear-off roof inspection is required. Please call fr.r tear-off inspection after the roof is torn off and all the nails/fasteners have been removed. Any and all dry-rotted wood shall be replaced prior to this inspection. A building inspector will be available within one hour. There are special hours for this service: 7:30 — 10 30am and 1:00—3:30pm (Mon—Thurs); 7:30 — 10 30am and 1:00—2:30pm (Friday). 4. If plywood is installed, a plywood nailing inspection is required. 5. In-Progress roof inspection is required. Call for zn in-progress roof inspection to verify building is weather tight after installation of approximately 250/) of the roofing material. 6. New roof coverings shall not be applied without firs obtaining all inspections 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. 7. A final inspection and approval shall be obtained fr(m the building inspector when the re-roofing is complete. To receive a final sign-off, the following items will be verified: a. Flat roofs shall have a minimum of 1/4"per foot of slope and must 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. 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-ir spection fee shall be paid before another inspection can be scheduled. By my signing below, I certify each of the following is tru,;: I am the property owner or authorized agent to act on the property owner's behal I understand and agree to comply with the re-roof policy stated above. Signature of Applicant/Agent: Date: l0 RerooJPolicy_2010.doc revised 05/17/10 OWNER-BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMEN r•BUILDING DIVISION 10300 TORRE AVENUE-CUPERTINO,CA 9 5014-3255 (408)777-3228• FAX(408)777-3333• buildir 2;1L u_ rtino.orq CUPERTINO Dear Property Owner(s): ourself as the builder of the property An application for a building permit has been submitted in your name listing y improvements specified at: SITE ADDRESS ) (-� y! APN 3 `/ v BP# OWNER NAME Y,1 C` ac OWNER ADDRE!4S DESCRIPTION OF WORK: 12 r We are providing you with an Owner-Builder Acknowledgmentbth s pend �mitassuedtion en your Verification Form as the Owner-Builder. We your responsibilities and possible risk you may incur y 9 of each will not issue a building permit until you have read, d catedinitia!en agent oyour f ownergannot execute this noticenunles s returned this form to us at our official addroe�ss al of the permi'ting authority. you,the property owner, obtain the prior app OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF 14FORMATION (DIRECTIONS:Please read and initial each statement below to signify you understand or verify this information.) X�= 1. 1 understand a frequent practice of unlicensed pemons is to have the property owner obtain an 'Owner- Builder" building permit that erroneously implies thatthe prspb'ect t seriouserty owner is financial his for any injr own uries sustainedor and l by personally. I, as an Owner-Builder, may be held Iia � M homeowner's insurance may not an unlicensed person and his or her employees while working on my property. Y provide coverage for those injuries. I am willfully acting aE an Owner-Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. ed to t e signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor :o assume this responsibility. I understand building permits are not requir that I t ' �3. I understand as an"Owner-Builder" I hminherecord having t epermit. perm t filed in sdor her may protect myself from potential financial risk by 9 a lice ised Contractor name instead of my own. required by law to Ce licensed and bonded in California and to list their license �4. I understand Contractors are numbers on permits and contracts. � 5. I understand if I employ or otherwise enga dollars r($500),t including her than Clabo�andrnia lmate ia1sContractors, and the J maybe total value of my construction is at least five hundred considered an"employer' under state and federal law. � 6. I understand if I am considered an "employer' ur der state and federal law, I must register with the state and ty insurance, and contribute to federal government,withhold payroll taxes, provide also understandsation my failtolabide by these laws may subject unemployment compensation for each"employee."ye m�e/to serious financial risk. uilds ly y t 7. 1 understand under California ConteLicense Law,intent to offer them Owner sa eu'udnle shalbwork sI ld performeby residential structures cannot legally build them with the licensed subcontractors and the number of structures dyes not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. �8. I understand as an Owner-Builder if I selnthe sub�a uent ownelr(s)thach this tresulltlfrom any latent s issued, I may bonstrudct onle for any financial or personal injuries sustained by a y q defects in the workmanship or materials. OwnerBuilderForm_2010.doc revised 04/14/10 (L' _9. 1 understand I may obtain more information regardirn] my obligations as an "employer'from the Internal Revenue Service, the United States Small Business Admini Aration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also unc erstand 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. � 10. 1 am aware of and consent to an Owner-Builder bu Iding permit applied for in my name, and understand that am the party legally and financially responsible for proposed construction activity at the site address listed above. ,1 11. 1 agree that, as the party legally and financially resaonsible for this proposed construction activity, I will abide by`311 applicable laws and requirements that govern Owner.Builders as well as employers. )U12. 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 contract)rs are regulated by laws designed to protect the public. If you contract with someone who does not have a license, tP e 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 )n 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.) 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 AJdress: 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 acleptable to the city may be required to be presented when the permit is issued to verify the propeqy owner's si natur Date: - —7 Z — Property Owner's Signature: T - - ------------------------------------------------------------------ -------------------------------------------------------------------- (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 whish I understand is my personal responsibility, I hereby authorize the following person(s)to act as my agent(s)to ap f ly 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: declare under penalty of perjury that I am the property owni;r 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: OwnerBuilderFonn_2010.doe revised 04/14/10 CITY OF 001 -70 CITY OF CU'ERTINO IsREROOF CUPERTINO PERMIT APP]__jICATION APN# Date: Building Address: ��/ 1 �� Owner's Name: �/a.17yya� / Phone #: HOA: Yes No ❑ If yes, provide letter f-om HOA Contractor: Phone #: Fax#: Cupertino Business License #: Contractor License #: Type of Roof lZovering: Existing: Proposed: ❑ Built-Up Roof ❑ uilt-Up roof ❑ Asphalt Shingles Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes Wood Shingles ❑ Wood Shingles ❑ Other (Specify) ❑ Other (Specify) Number of existing coverings ❑ Provide I.C.C.E.S. Report# ❑ To be Removed ❑ Provide Mfgr. Installation Specs. Job Description: Pce Y Can�c7v. cvlcY M;6s;0-,, Prc .Jh /0;a-,s;CTT Residential M Commercial ❑ Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if Green Building Checklist & attach it to the application or if there are any restrictions: ❑ applicable, include in plan set & the sheet index. Valuation: I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy: � i ? f Signature Revised 02/05/09