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13040190 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10331 ORANGE AVE CONTRACTOR:SHAO HUI NANCY HSU PERMIT NO: 13040190 OWNER'S NAME: SHAO HUI NANCY HSU 45560 CHEROKEE LN DATE ISSUED:04/29/2013 OWNER'S PHONE: 5105796580 FREMONT,CA 94539 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIALE] License Class Lic.# TEAR OFF(E)COMP,KEEP(E)PLYWOOD&INSTALL(N) CLASS A COMP 2-400 sc� ;4.Contractor Date 1 hereby affirm that I am licensed under 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:35715061.00 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 WITIBN 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 ST CALLED INSPECTION. indemnify and keep harmless the City of against liabilities,judgments, c costs,and expenses which may accrue against said City in consequence of the Date: -[ 29 7,9 granting of this permit. Additionally,the applicant understands and will comply d by: 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 agree to remove all new materials for inspection. OWNER-BUILDER DECLARATION Signature of Applicant: Date: 20/ 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 Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sectio 5501,25533,and 25534. /�/ Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date: 4 2 v 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 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 upon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,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. t el Signature Date ~j+' \� REROOF PERMIT APPLICATION � COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION lI� .10.300 TORRE AVENUE•CUPERTINO,CA 95014-3255 M� (408)777-3228•FAX(408)777-3333•building ftupertino.org CCJi�ER`TINC '. \ PROJECT ADDRESSI O. O APN#� 061 61 1 F 1 E-MAIL OWNERNAME PHONE 51 1q� Jf A 0 fA st e P2 C , STREET ADDRESS �) CITY, STATE,ZIP FAX 14 X56 6 �CWGROC W CONTACT.NAME PHONE r[o E MAIL STREET ADDRESS 1 6V b� CITY,STATE,,ZIP C? O r V� FAX ❑ OWNEROWNER-BUII.DER ❑ OWNERAGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC.# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE ARCHITECT/ENGINEERNAME LICENSENUMEER BUS.LIC.# COMPANY NAME E-MAIL FAN .STREET ADDRESS: CITY,STATE,ZIP PHONE USE OF t OS.F-D or Dup(eX❑ Multi-Family _ ROOF AREA: VALUATION: �Q7 qfCry $ fi, Ooaa m . STRUCTURE: . ❑ Comercial C, EXISTING ROOF TYPE: In BUILT-UP ROOF ®ASPHALT SHINGLES 13WOOD SHAKES ❑WOOD SHINGLES 11OTHER(SPECIFY) REMOVE/REPLACE,IgYES IF NO, PLYWOOD 13%- ❑ �PLYWD ❑OSB PTTCH RT,_OOF❑NO #LAYERS: THICKNESS: ® 5/8" ❑CDX �L- 2 CLASS: A ICC-ES REPORT# PROPOSED ROOF TYPE: ❑BUILT-UP ROOF " ®ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER DESCRIPTION OF WORKfir I 1 r r ems'-.g�� �i . ,C ,.: I r►. � cn 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 e t. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relat g buildi c1;7 i n. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes... Signature of Applicant/Agent: I' d iii Date: 'l SUPPLEMENTAL INFORMATION REQUIRED Ar= If building is associated with a Home Owners Association,provide letter of approval from HOA. Provide Planning approval to verify if there any restrictions. RsI' 'i Provide copy of Manufacturer's Installation Specifications. a XRD vEr i, Provide signed copy of Cupertino's Tear-Off Policy. w a ReroofApp 2011.doc revised 03/16/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 10331 ORANGE AVE DATE: 04/29/2013 REVIEWED BY: MELISSA APN: 357 15 D61 BP4. "VALUATION: $8,000 xPERMIT TYPE: Building Permi# PLAN CHECK TYPE: Alteration/ Repair PRIMARY I PENTAMATION 1 SFDWLROOF USE: SFD or Duplex PERMIT TYPE: WORK TEAR OFF E COMP KEEP E PLYWOOD & INSTALL N CLASS A COMP SCOPE .nt n. , �fecb. Plan Check Plumb,Plan Check Elect.Plan Check llech. Permit Pee: Plumb.Permit 1, Flec. Permit 1,ee: Other:Ytech.Insp. Other Plumh Insp. Lj Other Elec.Insp. Gt ech. Insp.Fere: Plumb. lnsl�.Fee: Klee.Insp,Fee.- NOTE: ee:NOTE:This estimate does not includefeev due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc.). These fees are based on therelinuna information available and are onl an estimate. Contact the Dept for addn'1 info. FEE ITEMS (Fee Resolution 11-053 L . 7ff 11/12) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 r2,40-01 s.f. Re-roof Suppl.PC Fee: (j) Reg. ® OT 010 hrs $0.00 $360.00 IREROOFRES PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp.Fee-0 Reg. .0 OT0�.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 t onstrztction Tax. ,4drninistrative.Fee: Work Without Permit? ®Yes (E) No $0.00 (F) Advanced Planning Fee: $0.00 Select a Non-Residential (E) Building or Structure Travel Doclanentalion Fees: Strong Motion Fee: II SEISMICR $0.80 Select an Administrative Item Bldg Stds Commission Fee IBCBSC $1.00 $1.80 $360.00 $361.80 f� .:x ray� w Revised: 04/01/2013 REROOF EAR-OFF POLICY COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O.,BUILDING OFFICIAL 10300 TORRE A NUE•CUPERTINO,CA 95014-3255 CUPERTINQ (408)_777-3228• AX(408)777-3333•buildingecuoertino.org PROJECT ADDRESS I.t1� Q�F`N A-q�� APN# _ f t^ OWNERNAhfE �' C INJ PHONE EMAIL STREET ADDRESS /,L 9L 0 /� � CITY, STATE,ZIP ,M CA CP(� FAX CONTRACTOR NAME`f 7. 1, l' LICENSE NUMBER LICENSE TYPE Bug\ Bu COMPANY NAME E MAII FAX. STREET ADDRESS CITY,STATE,ZIP ONE 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 r request inspection uest can be s' heduled up to one business day before the requested inspection date. Please call (408) 777-3228 fro 7:30-3:30pm(Mon-Thurs) or 7:30-2:30pm(Friday)to schedule inspection. For Tear-Off and Nailing Inspections,you must also call on the day of the inspection only. after that phase of the work><s completed. The building inspector will be available within one hour. Final Inspections will be giver a two hour window. 3. Tear-Off Ins ection is re ui ed. Any and all dry-rotted wood shall be replaced prior to this inspection. Unless new plywood roof she thing is proposed throughout, all the nails/fasteners shall be either completely knocked-down o removed prior to this inspection. 4. If plywood is installed, a plywood Nailing Inspection is required. 5:: Roofing.shall not be applied thout first obtaining all prior 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 items will be verified: a. Flat roofs shall have 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 ori-site to r 'iew at the time of the inspection. c. Proper spark arrestor installation,vents painted, gutter/downspouts installed, debris removed. .7. 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. he 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 ResidenCo Signature of Applicant/Agent:I r Date: ReroofPolicy_2012.doc revised 10/7/12 OWNER-BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION 10300 TORRE AVENUE-CUPERTINO, CA 95014-3255 CUPERTINO (408)777-$228-FAX(408)777-3333-buildina(aDcupertino.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 l J i t� fn v APN 3 5� )- - Q/[, ' BP#13O q o 1 9a OWNER NAM% l l C OWNER ADDRESS DESCRIPTION OF.WORK:. CA SkQ419d8K 1PAr'T 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.) A(•L .1. I 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. 1, 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 homeowners 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. iLi. A '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. -3. 1 understand as an"Owner-Builder" I am the responsible party of record on the permit. I understand thatfmay 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. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. /J t�'5. I.understand if 1 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 considered.an"employer"under state and federal law. 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 me to serious financial risk. IV,L7. 1 understand under California 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 is performed under contract with a licensed general building Contractor. N 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 owner(s)that result from any latent construction defects in the workmanship or materials. OwnerBuilderForm 2010.doc revised 04/14/10 A-4 9. 1 understand I may obtain more information regarding my obligations as an"employer"from the Internal Revenue Service,the United States Small Business Administration,the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand 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. X10. 1 am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the parry legally and financially responsible for proposed construction activity at the site address listed above. )U_O 11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide byallapplicable laws and requirements that govern Owner-Builders as well as employers. til I.12, I,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 contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license,the 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 on 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.) I 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 Address: 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 drivel'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: (3 - - (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 which I understand is my personal responsibility, I hereby_ authorize the following person(s).to act as my agent(s)to apply 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 owner for the address listed above and I personally filled out the above information and certify its accuracy. Note:A copy of the property owners drivers 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: OwnerBuilderForm 2010.doc revised 04/14/10 Building Department City Of Cupertino La I10300 Torre Avenue Cupertino, CA 95014-3255 "'"Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOX'UST JOB ADDRESS: p3�j PERMIT,# y � 36q.O t 9 D OWNER'S NAME: PHONE# GENERAL CONTRACTOR: BUSINESS LICENSE# ;` ADDRESS: CITY/ZIPCODE. 'f� -Ib a 4-�3 *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRA TORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. // / I am not using any subcontractors: T( Z 1124(3 Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring/Carpeting Linoleum/Wood Glass/Glazing Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date