09090130 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 1173 CRESTLINE DR CONTRACTOR:T D ROOFING PERMIT NO:09090130
OWNER'S NAME: SU-ER SYANG 675 TULLY RD DATE ISSUED:09/17/2009
ER'S PHONE: 4088732649 SAN JOSE,CA 95111 PHONE NO:(408)892-8872
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG F ELECT� PLUMB
License Class Lic.#
MECH r- RESIDENTIAL COMMERCIAL
Contractor Date
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:RE-ROOF TEAR OFF 1 COMP LAYERS OF
(commencing with Section 7000)of Division 3 of the Business&Professions EXISTING ROOF
Code and that my license is in full force and effect. COVERINGS,FELT UNDERLAYMENT AND INSTALL 15 LBS
SINGLE LAYER FLASHING PIPE VENTS HOOD ASSEMBLY
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:$10000
permit is issued.
APPLICANT CERTIFICATION APN Number:36229041.00 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 accrete 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 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
Signature Date Issued � �-- Date
L'J 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 ro frng material being installed.If a roof is
the following two reasons: installed without first obtaini an inspect n,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 V V
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:
I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE
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. 1 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.
permit is issued. Additionally,should I use equipment or devices which emit hazardous air
I certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District I will
maintain compli An with the,C ertino 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 ode,Sections 505,25533,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 au rized agent: b
forthwith comply with such provisions or this permit shall be deemed revoked. Date:
L-7/rC�i(QN
APPLICANT CERTIFICATION CONSTR LENDING AGENCY
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
i nify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
C and exp e ses which may ad&rue against said City in consequence of the
granting of thi rmit.Addition 1 ,the applicant understands and will comply
with all non-p(i source regula s per the Cupertino Municipal ode,Sec ion ARCHITECT'S DECLARATION
9.18. I understand my plans shall be used as public records.
Signature —✓ Date / b
g 2 Licensed Professional
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36229041 . 00
DATE ISSUED. . . . . . . : 09/17/2009
RECEIPT #. . . . . . . . . BS000008703
REFERENCE ID # . . . : 09090130
SITE ADDRESS . . . . . : 1173 CRESTLINE DR
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER SU-ER SYANG
ADDRESS 1173 CRESTLINE DR
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5034
RECEIVED FROM . . . . : JINWUN SYANG
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 10, 000 . 00 1 . 00 0 . 00 1. 00 0 . 00
1BSEISMICR VALUATION 10, 000 . 00 1 . 00 0. 00 1. 00 0 .00
1REROOFRES SQ FEET 19. 00 247 . 00 0 . 00 247 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 249 . 00 0 . 00 249. 00 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 249.00 #289
---------------
TOTAL RECEIPT 249 . 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36229041. 00
DATE ISSUED. . . . . . . : 09/17/2009
RECEIPT #. . . . . . . . . : BS000008700
REFERENCE ID # . . . : 09090126
i
a
SITE ADDRESS . . . . . : 1173 CRESTLINE DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . . f
OWNER . . . . . . . . . . . . . SU-ER SYANG
ADDRESS . . . . . . . . . . : 1173 CRESTLINE DR
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014- 34
RECEIVED FROM . . . . : JINWUN SYANG
CONTRACTOR . . . . . . . : LESLIE HOANG LIC # 3155
COMPANY . . . . . . . . . . : T D ROOFING
ADDRESS . . . . . . . . . . : 675 TULLY RD
CITY/STATE/ZIP . . . : SAN JOSE, CA 95 11
TELEPHONE . . . . . . . . : (408) 892-8872
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- -------- - ---------- ---------- ----------
1BCBSC VALUATION 10, 000 . 00 . 00 0. 00 1. 00 0 . 00
1BSEISMICR VALUATION 10, 000. 00 . 00 0. 00 1 . 00 0 . 00
1REROOFRES SQ FEET 19. 00 47 . 00 0 .00 247. 00 0 .00
---------- ---------- ---------- ----------
TOTAL PERMIT 249. 00 0. 00 249. 00 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 249. 00 #289
---------------
TOTAL RECEIPT 249 . 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
601 ROOF TEAR OFF 602 ,ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF ,l
V
C�1
- ,, CITY OF CUPERTINO
REROOF
CUPEkTINO PERMIT APPLICATION
APN # 0 �{ Date: / > o
& � I
Building Address: (�
3
Owner's Name: �� Phone #:
�_ �✓ 41h )
HOA: Yes No I a rovide letter from HOA ('�bv
❑
Contractor: Phone #:
T-D ; h f�kj
��► " Fax #:
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Cupertino Business License #. Contractor Lice e #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
pb Asphalt Shingles m-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 ❑ Prpvid Mfgr. Installation Specs.
Job Description:
TQ C� [ G {'r .S b.�
f� y
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Residential commercial
cis ,'., �► �P„�S
vo S S S.,Q ti,
Green Building: Please complete relevant portion of the Co armed it Lanni Dept. if
Green Building Checklist & attach it to the applicationr ' there are ny restrictions: Ela licable include in plan set & the sheet index. ins
Valuation: 01 �`' w ''�' QrP i o ,v IV P
I Have Read, Un rstand and Will Trnply with Cupertino's Tear-Off Policy:
Signature
Revised 02/05/09
ao-,
CITY OF CUPERTINO
REROOF
CITY OF
CUPEkTINO 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
1 BSEISMICO Seismic Commercial B
1REROOFRES Re-roof Residential B 1SFDWLROOF
/ 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
/ 1BSEISMICRE Seismic Residential B
1 REROOFMRES Re-roof Multi-Family B 1MFDWLROOF
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
1BSEISMICRE Seismic Residential B
1 BUSLIC Business License B
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
Fax: (408)777-3333
Building Department
Subject: Re-roofing policy for the City of Cupertino
1. Prior to permit issuance,you must agree to comply with 2007 IBC Standards
and manufacturers specifications on re-roofing.All roofs are Class "A"per Cupertino
municipal code 16.04.080.
2. New roof coverings shall not be applied without first obtaining all inspection
and written approval from the building inspector. A final inspection and
approval shall be obtained from the building inspector when the re-roofing
is completed.
3. All roofs shall be inspected prior to any roofing installation.
4. To receive a final sign off from the City,the following steps are
required:
1) Pre-inspection and/or tear off approval.
2) In-progress inspection approval.
3) Final inspection approval.
a) Spark arrester installation.
5. If plywood is installed,a plywood nail inspection is required.
6. Any roofing which is applied without first obtaining an inspection,
will require the removal of all new material down to the sheathing,
so a proper City inspection can be performed.
7. NOTE: If you call for a plywood nail inspection and the job is not ready,
you will be charged a re-inspection fee of$176.18. The re-inspection fee must
be paid before another inspection can be scheduled.
IMPORTANT:
1. Flat roofs must have a minimum of 1/4 "per foot slope and demonstrate
that there is no ponding.
2. An I.C.B.O.report is required to be on the job site at the time on inspection.
I understand and will comply with the above stated policy on re-roofing.
Homeowner's Name: lU - e✓ q n '
J (,1, d; 4 �p
Job Site Address:
Roofing Company Name: ( Pq
Applicant's Signature: JDate:J NI
( /
/ 6
Greg Casteel
Building Official
Revised 07/30/08
INPUT RLsources Energy IAQ�Heafth
M.In oor Air Qua rty an rnrshes
1.Use LowMo-VOC Paint 1 IAQ/Health pts y=yes 0
2.Use Low VOID,Water-Based Wood Finishes 2 IAQ/Health pts y=yes. 0
3.Use LowMo VOC Adhesives 3 IAQ/Health pts y=yes 0
4.Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes 0
5.Use Engineered Sheet Goods with no added Urea
Formaldehyde 61AQ/Health pts y=yes 0
6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 0
7.Seal all Exposed Particieboard or MDF 4 IAQ/Health pts y=yes 0
8.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes 0
9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y=yes 0
10.Install Whole House Vacuum System 3 IAQ/Health pts y=yes 0
1 1 f
N.Flooring
1.Select FSC Certified Wood Flooring 8 Resource pts y=yes 0
2.Use Rapidly 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/Health 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 0
i
Total Points Available: 1 1401 130 57
Total Points Project Received: 0 0 �:: ]
0
6
G:data/progs/greenbuildingguidelines/remodele green intsfina12.12.04protected:xls
Community Development
w` + 10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
,CITY OF Fax(408)777-3333
v V I ER'NO
Buil= ONE #
artment O� 0� 01 c>
JOB ADDRES�• / RMIT #
OWNER S NAME: H 3 /
GENERAL CONTRACTOR: I FAX #
TP
I am not using any subcontracto s:
jitu4re Date
Please check applicable subcontractors and co,m Tete the followin information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
XT, � o
Owner on actor Si e Date