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10040108 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21139 GARDENA DR CONTRACTOR:T D ROOFING PERMIT NO: 10040108 OWNER'S NAME: YUK YU 675 TULLY RD DATE ISSUED:04/16/2010 NNER'S PHONE: 6508680909 SAN JOSE,CA 95111 1 PHONE NO:(408)892-8872 II ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIA COMMERCIAL License Class C 3 L .# N S �1 I RE-ROOF REMOVE WOOD SHAKE INSTALL 15#FELT AND 30 Contractor Date K 1 �o 10 YR COMP CLASS A 20 SQUARES I hereby affirm that I am licens u er 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. Sq.Ft Floor Area: Valuation:$8000 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:32608060.00 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 Issued by: l�'`��-Date: -7— 16—LU granting of this permit. Additionally,the applicant understands and will comply with all non-point sou regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: �ij+aureL! Date , All roofs shall be inspected for to any roofing material being installed.If a roof is installed without first obtai g i spection,I agree to remove all new materials for inspection. l ❑ OWNER-BUILDER DECLARATION / (o Signature of Applicant: 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 I,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) I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I 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 upert'no Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sectio 25 ,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Date: Owner or authorized agent: permit is issued. L 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 CONSTRUCTION LENDING AGENCY 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 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 noon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION Lmnify and keep harmless the City of Cupertino against liabilities,judgments, s,and expensesich may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this perm#Ad itionally,the applicant understands and will comply with all non-point s r e egulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date 4-11 b]( 0 Date CITY OF CITY OF CUPERTINO IsREROOF CUPERTINO PERMIT APPLICATION APN # Date: t I 2 Building Address: X11 3 C�,� dam► Phone #: Owner's Name: ChG r (4 69 o HOA: Yes164K [ ` No If es, provide letter from HOA Phone #: Contractor: Pvo � r (} 1rC J Fax#: Cupertino Business License #: Contractor License #:gy S ) C 1 Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles ❑ Asphalt Shingles j Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other (Specify) .63 Other (Specify) Number of existing coverings ❑ Provide I.C.C.E.S. Report To be Removed ❑ Provide Mfgr. Installation Specs. Job Description: Re=Buillding: Green 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 inIan_set the sheet index. Valuation: $' an I Have Read, Undeps d and Will Comply with Cupertino's Tear-Off Policy: I Signature Revised 02/05/09 CITY OF CUPERTINO REROOF CUPERTINO FEE SCHEDULE Number of Fee ID Fee Description Fee Permit Type Squares :Group 1REROOFCOM Re-roof Commercial B 1COMMLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICO Seismic Commercial B �O 1RER00FRES Re-roof Residential B 1SFDWLR00F 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES 1 Commission Fee 1BSEISMICRE Seismic Residential B 1RER00FMRES Re-roof Multi-Family B 1MFDWLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICRE Seismic Residential B 1BUSLIC Business License B lip M.Indoor Air Quality and Finishes 1.Use LowRdo-V©C Paint 1 IAO/Health pts y=yes 0 2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes 0 3.Use Low/too ViOC Adhesives 3 IAO/Health pts y=yes 0 4.Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes D 5.Use Engineered Sheet Goods with no added Urea Formaldehyde 61AQ/Health pts y=yes 0 S.Use Exterior Grade Plywood for Interior Uses 1 IACVHealth pts y=yes 0 7.Seal laMsad Fkairfiolebrd or hGDF 4 IAQ/Health pts yEyes 0 B.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes D 9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y=yes D 10.Install lltrhole House Vacuum System 3 IACVHealth pis y=yes 0 1 1 1 N.Flooring 1.Select FSC Certified lldood Flooring 8 Resource pts y=yes 0 2.Use fBapidly Renewable Flooring Materials 4 Resource pts y=yes 0 3.Use Recycled Content Ceramic Tiles 4 Resource pts y=yes 0 4.Install Natural Linoleum in Place of Vinyl 5 IAQ/Hean pts y=yes 0 5.Use Exposed Concrete as Finished Floor 4 Resource pts y=yes 0 6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes 1 0 1 1 1 Total Points Available: 1401 130 57 Total Points Project Received: 01 0 0 f G:datalprogsJgreenbuildingguidelines/ramodelers/greenpointsfinal2.12.64proteried.rls CITY OF CUPERTINO 3 ITEMS OF 6 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 32608060 . 00 DATE ISSUED. . . . . . . : 04/16/2010 RECEIPT #. . . . . . . . . BS000010207 REFERENCE ID # . . . : 10040108 SITE ADDRESS 21139 GARDENA DR SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER YUK YU ADDRESS 21139 GARDENA DR CITY/STATE/ZIP CUPERTINO, CA 95014 RECEIVED FROM LESLIE HOANG CONTRACTOR LESLIE HOANG LIC # 23155 COMPANY T D ROOFING ADDRESS . . . . . . . . . . : 675 TULLY RD CITY/STATE/ZIP SAN JOSE, CA 95111 TELEPHONE (408) 892-8872 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- 1BCBSC VALUATION 8, 000 . 00 1. 00 0 .00 1 . 00 0 . 00 1BSEISMICR VALUATION 8, 000 .00 0 . 80 0 .00 0 . 80 0 . 00 1REROOFRES SQ FEET 20 . 00 260 . 00 0 . 00 260 . 00 - ---- - ---------- ---------- ---------- TOTAL PERMIT 261 . 80 0 .00 261 . 80 0 . 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -- -------------- - 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 604 ROOF IN-PROGRESS 605 FINAL REROOF 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 C U P E RT I N O (408)777-3228 • FAX(408)777-3333-building(5-cugertino.org PROJECT A„RESS � � q P� _ � APN# OWNERNAME0 � 1 r �C,1�t� E-MAIL `l J �O STREET ADD�tESS 1 CITY,,§TATE,ZIP (�� FAX All "�� cif A 21� lea. )e� T' 11 J CONTRACTOR NAME LICENSE NUMBER I CI 1 LICENSE TYPE BUS.LIC.# F —0 a r 1 01 ,39 COMPANY NAME E-MAIL FAX STREET DRES `la( " CITY,STATE,ZIP - -- PHON p {r Q y 7 C_ d S �SoS� rim 1� 1 �(OS� G� I UNDERSTAND AND AGREE TO THE FOLLOWING: 1. The re-roof project shall comply with all applicable provisions of the 2007 California Building Code. 2. An inspection request shall be scheduled the day before the inspection date. Please call (408)777- 3228 between 7:30 - 3:30pm (Mon-Fri) to schedule the next day inspection. 3. After the roof is torn off and the nails/fasteners have been removed and all the dry-rotted wood has been replaced, you must call for a roof inspection. A building inspector will be available with one hour. There are special hours for the 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. 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. 6. 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 item will be verified: a. Flat roofs shall have a minimum of/" per foot of slope and demonstrate there is no ponding. b. A listing from an approved testing agency shall be available on-site to review at the time of the inspection. c. Proper spark arrestor installation. 7. NOTE: If you call for a plywood nailing inspection and the job is not ready, you will be charged to a re- inspection fee of$126.00. The re-inspection fee shall be paid before another inspection can be scheduled. `y my signature below, I certify t9 ea of the following: I am the property owner or authorized agent to act on Lhe property owner's behalf. I un#e and an gree to comply with the re-roof policy stated above. Signature of Applicant/Agent: Date: _ Reroof Policy_2010.doc revised 04/14/10