15090042CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 1192 ELMSFORD DR CONTRACTOR: THD AT-HOME PERMIT NO: 15090042
SERVICES, INC.
OWNER'S NAME: NAMKUNG JOHN AND TIFFANY 2690 CUMBERLAND PKWY STE 300 DATE ISSUED: 09/08/2015
OWNS 'S PHONE: 4088135578 ATLANTA, GA 30339-3913 PHONE NO: (510) 731-1004
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
/ JTEAR OFF (E) WOOD SHINGLE (NO PLY) & INSTALL (I)
License Class
Lic. # 3`6o 2 CLASS A COMP ROOF SYSTEM (30 SQ'S)
Contractor -
I
��Ntt`�/� Date /
I 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. 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
/p ance of the work for which this permit is issued.
J] a and will maintain Worker's Compensation Insurance, as provided for by
e tion 3700 of the Labor Code, for the performance of the work for which this
p
,ren
issued.
APPLICANT CERTIFICATION
I cert6 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 ' gmen
costs, and expenses which may accrue against said City in conse nce of the
granting of this permit. Additionally, the applicant unders con
and will comply with
all non -point source regulations per the Cupertino Mu ' pal Cod , Section 9.18.
Signature Date q
❑ OWNER -EMI DECLARATION
I hereby affirm that I a mpt from the Contractor's License Law for one of
the following two reas s:
1. 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)
2. 1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations:
i. 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.
2. 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
permit is issued.
3. 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
become subject to the Worker's Compensation provisions of the Labor Code, I
must forthwith comply with such provisions or this permit shall be deemed
revoked.
APPLICANT CERTIFICATION
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,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply with
all non -point source regulations per the Cupertino Municipal Code, Section 9.18.
Signature Date
Sq. Ft Floor Area: I Valuation: $20172
APN Number: 36209004.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 PAYS FROM LAST CALLED INSPECT ON.
Issued b Date: ��
RE -ROOFS:
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 n rials for
inspection. -7
Signature of Applicant:, / Date: 1/0 S
ALL ROOF
"A" OR BETTER
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
maintain compliance with the Cupertino Municipal Co hapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, 9"5534.
Owner ora e '2,
en
B , Date: f S
STRUCTION LENDING AGENCY
I hereby ►rm there is a construction lending agency for the performance of work's
for w ' s permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
CUPERTINO (408) 777-3228 • FAX (408) 777-3333 • buildina(&cupertino.orct /�v O a Y2
PROJECT ADDRESS I A L EI L
O
T; OWNER NAME O ���
PHO E �'3- 557('
E-MAIL
STREFT DDRESS Lr� I
CITY, STATE, ZIP I O/ F.\
CONTACT NAME Eileen Baughman PHONE 707-527-7727
E-MAIL
__F
STREET ADDRESS 2456 VERNA COURT
cITY, STATE, ZIP
SAN LEANDRO, CA 94577
F'" 510-357-3750
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑
CONTRACTOR NAME
LICENSE NUMBER 836021
LICENSETYPE C39
BUS. LIC.#
COMPANY NAME THD AT HOME SERVICES
E-MAIL
FAX 510-357-3750
STREET ADDRESS 2456 VERNA COURT
CITY, STATE, ZIP SAN LEANDRO,CA 94577
PHONE 5510-877-4550
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC. #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF fd '217D or Duplex ❑ Multi -Family
STRUCTURE: ❑ Commercial
ROOF AREA:
�/y�..��.��
VALUATION
�
EXISTING ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES ❑ WOOD SHAKES XWOOD SHINGLES ❑ OTHER (SPECIFY)
REMOVE /REPLACE 7kYES
❑ 1,
IF NO.
# LAYERS:
PLYWOOD ❑ h"❑
THICKNESS: 135/8"
PLYWD ❑ OSB
TYPE: ❑ CDX
PITCH:
' 12
ROOF
CLASS: A
PROPOSED ROOF TYPE: ❑ BUILT-UP ROOF &SPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER
ICC -ES REPORT #
DESCRIPTION OF WORK:
�-/7T_
re-ASQ.- I� 1 1 IAJ5 t /I
rr ; mrGr
By my signature below, I certify to each ofthe following: I am the property owner or authorized aunt to act on the property owner's behalf. I have read this
application and the information I have provided is correct. 1 have read the Description of *ild verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building constructio ze represe of Cupertino to enter the above -identified for inspection purposes.
Signature of Applicant/Agent: Date: 1 1 5�
SUPPL NTAL INFORMA UIRED
If building is associated with a Home Owners Association, provide letter
of approval from HOA.
Provide Planning approval to verify if there any restrictions.
Provide copy of Manufacturer's Installation Specifications.
Provide signed copy of Cupertino's Tear -Off Policy.
OFFICE USE ONLY
fPLAN CHECK TYPE ROUTING SLIP
-THE-COUNTER ❑ BUMDING PLAN REVIEW
❑ EXPRESS ❑ PLANNING PLAN REVIEW
❑ STANDARD ❑ FIRE D
HE
1 Reroo I.doc revised03/16/11
CITY OF CUPERTINO
I llJ�l
FEE FISTIMATOR - BUILDING DIVISION
WIADDRESS:
1192 ELMSFORD DR
DATE: 09/08/2015
REVIEWED BY: MELISSA
Mech.
APN: 362 09 004
BP#: `_ j Q �
*VALUATION:
1$20,172
*PERMIT TYPE: Minor Building Permit
PLAN CHECK TYPE: Re -roof
PRIMARY SFD or Du lex
USE: P
I'lec Iris!._ Vee.
PENTAMATION 1 SFDWLROOF
PERMIT TYPE.
WORK
TEAR OFF E WOOD SHINGLE & INSTALL N CLASS A COMP ROOF SYSTEM 30 SQ'S
SCOPE
FEE ID ROOF AREA
s. f.
1REROOFFRES 3,000
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, etre, sanitary sewer District, Scnoot
District etc These fees are based on the relim/nar information available and are oniv an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff 711113)
11ech. Plan Check
'lumb. Plan CheckElec.
flan Check
Mech.
[Plumb. Permit Fee
Elec. Permit Fee:
Other Mcch. Insp.E1__L_
t )ther Plurnb .Insp.
Other Elec. Ins/ LJ L
1lech, Irtsp. V,r
Plumb. Insp. Fee:
I'lec Iris!._ Vee.
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, etre, sanitary sewer District, Scnoot
District etc These fees are based on the relim/nar information available and are oniv an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff 711113)
FEE
QTY/FEE
MISC ITEMS
Plan Check Pee:
.S uppl. PC Fee
Plumb.!Meeh./Elec
Permit Fee:
$51
Suppl. Insp I'ee
�6U
Plumb./Rech./Elec
I'l umb. /Mee,,h. /Elec .Perrnit Fee:
C "onstruction Tax:
tclministrative. Fee:
Work Without Permit? 0 Yes No
$0.00
Itivanced .Planning Fees:
i
Travel Documentation Fees:
Strong Motion Fee. IBSEISMICR
$2.62
Select an Administrative Item
, v 5.
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$513.62
$0.00 TOTAL FEE:
$513.62
Revised: 07/02/2015
REROOF TEAR -OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
C U P E RT I N O 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333 - buildinaCcDcupertino.ora
PROJECT ADDRESS /
APN # 36 - O - OO
OWNER NAME ` O IL � � II � � �
PHONE �J - � I � - n
/
(ZIP
E-MAIL
STREET ADDRESS) I I ` i `
7 l
CITY, STATE,
-�r.JO O/
FAX
CONTRACTOR NAME
LICENSE NUMBER
836021
LICENSE TYPE
C39
BUS. LIC. #
COMPANY NAME
THD AT HOME SERVICES
E-MAIL
FAX
510-357-3750
STREET ADDRESS
2456 VERNA CT.
CITY, STATE, ZIP
SAN LEANDRO, CA 94577
PHONE
510-887-4565
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. 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 for 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 an in -progress roof inspection to verify building is
weather tight after installation of approximately 25% of the roofing material.
6. New roof coverings shall not be applied without first 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 from 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.
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 wit - re -roof policy stated above.
Signature of Applicant/Agent: / J / Date:
RerooJPolicy_2010.doc revised 05/17/10