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B-2017-1736 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1736 10383 NOEL AVE CUPERTINO,CA 95014-1229(326 47 066) OWNER/BUILDER OWNER'S NAME: TUAN HSING T AND VICTORIA R TRUSTEE DATE ISSUED: 10/10/2017 OWNER'S PHONE:408-318-9477 PHONE NO: LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: • License Class Lic.# Contractor OWNER/BUILDER Date X BLDG _ELECT _PLUMB MECH X RESIDENTIAL_COMMERCIAL 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. JOB DESCRIPTION: RE-ROOF;TEAR-OFF;INSTALL OSB;COMP SHINGLES(22 SQ) I hereby affirm under penalty of perjury one of the following two declarations: 1. 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. Sq.Ft Floor Area: Valuation:$11000.00 ',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 APN Number: Occupancy Type: and state laws relating to building construction,and hereby authorize 326 47 066 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 PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally,the applicant understands and will comply,with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. • Signature Date 10-10-2017 Issued by:Kim Dunbar . Date: 10/10/2017 , OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS: folio,' two reasons:: All roofs shall be inspected prior to any roofing material being installed.If a roof is '^n'U I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for 1 uta. compensation,will do the work,and the structure is not intended or offered for inspection. sale(Sec.7044,Business&Professions Code) 2. I,as owner of the property,am exclusively contracting with licensed Signature ofApplica contractors to construct the project(Sec.7044,Business&Professions Code). Date: 10-10-2017 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 1. 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. HAZARDOUS MATERIALS DISCLOSURE 2. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. I will permit is issued.` maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the 3. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store or handle hazardous shall not employ any person in any manner so as to become subject to the material. Additionally,should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25505,25533,and 25534. Labor Code,I,must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: APPLICANT CERTIFICATION Date:10-10-2017 I certify that I have read this application and state that the above information is CONST,TION JCTION LENDING AGENCY correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C.) to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, • judgments,costs,and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal ARCHITE T'S DECLARATION Code,Section 9.18. I understand my plans shall be used as public records. • Licensed Signatu Date 10-10-2017 Professional • CONSTRUCTION PERMIT APPLICATION 0''„,„ COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION r_ 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 , �:„s,r ( -/ 7 3 .F� (408) 777-3228 • building@}cupertin.o.org PEMIT#B- CUPERTINO REV E DEF E ❑ NEW CONSTRUCTION ❑ADDITION ❑ALTERATION/� � El T.1. ❑MEP gRE-ROOF El SWIMMING POOL/SPA PROTECT ADDRESS /'7 a ✓ /r jL46 all /SO/yC APN# ^ ' _ r ! ^ 0 /_ OWNER NAME PHONE, E-MAIL lig; 7,- 7;(,,e,.., .) C c rsa R 2 - 8 -3(St - 9�77 STREE1 DDRESS CITY, STATE,ZIP ' ❑CONTRACTOR NAME tj2<VNER-BUILDER COMPANY NAME LICENSE NUMBER LICENSE TYPE ISTREET ADDRESS CITY,STATE, ZIP E-MAIL PHONE BUS.LIC I ❑ARCHITECT ❑OWNER•❑OWNER AGENT ❑.CONTRACTOR AGENT ID ENGINEER 0 DEVELOPER 0 TENANT ' CONTACT NAME' E-MAIL STREET ADDRESS CITY,STATE,ZIP PHONE ' DECRIPTONjeaofOt/. .e,, )J f A S /i,,,,-10 I,f,- tea'/' a S g U'c''ea 7144 ' . / rr X e.(A) Con �f'i p� U �v (e _ ( :1 tpS/I"NGLE-FAMILY/DUPLEX 0 MULTI-FAMILY ❑INDUSTRIAL ❑COMMERCIAL EXISTING',USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES I TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION($) I, I. REMODEL REMODEL KITCHEN REMODELOTHR GARAGE ❑ATTACHED ,1 ' BATHROOM SF' SF SF SF ❑DETACHED ii EXISTNG j !❑YES ,EICHLER YES SECOND STORY ADDITION ❑Y FIRE SPRINKLERS,❑ NO DI: NO. 0 NO , DWELLING SECOND DWELLING ❑YES ❑ATTACHED DETACHED OTHER UNITSII UNITADDITON: 0 N SF POOLS[ ❑FIBERGLASS ❑VINYL-LINED ❑GUNITE ❑PREFABRICATED • POOL-SF SPA-SF 1 SPA ATTACHED OYES 0 NO i TOTAL-SF . • RECppp777���'''V B.-: TOTAL VALUATION: Commercial or Mul)i-Fainilu Buildings with Public Swimming Pools requires Department of Environmental Heath approval / 7 )I • �I 42,q RE-ROOF,EXISTING ROOF TYPE: ❑BUILT-UP ROOF❑ASPHALT SHINGLES[ NOOD SHAKES❑WOOD SHINGLES❑TILE OTHER(SPECIFY)-� //� &tO— REMOVE%REPLACE❑NO IF NO PLYWOODgr;" 0 318" PLYW OD TYPE: PITCH: ROOF CLASS I OYES II OF LAYERS THICKNESS❑5/8" OTHER OSB ❑CDX OTHER 7- •12 ;A PROPOSED ROOF TYPE:❑BUILT-UP ROOFSPHALT SHINGLES 0 WOOD SHAKES❑WOOD SHINGLES 0 OTHER ' *Provide a signed copy of the Cupertino's Tear-Off Policy SF22C0 :tot SQUARES Q 2 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'belialf. I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. I acknowledge and authorize all information contained on this application form to be made available for public record. /. to ‘ �(7, 'I 1 ' Signature of Applicant/Agent: ..�` Date: , - SUPPLEMENTAL INFORMATION REQUIRED ,I ii *New SFD/Second Dwelling Units/Multifamily Dwellings:A Demolition permit is required prior to issuance of a building permit for all new construction. *Commercial Buildings: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project. *Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. *HOA-Provide a letter of approval from the Home Owner's Association , I1 1, 1 BldgApp_2017.doc revised 108/01/17 REROOF TEAR-OFF POLICY (IrkCOMMUNITY 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(o�cupertino.orq 3 Z(, ( 1 PROJECT ADD S�g--7 Aloe/ /ule APN# 2 2/, �, •-• t D to Co OWNER NAME 7st ? PHOI j-s -zIt- ? '77 EMAIL STREET ADDRESS CITY, STATE,ZIP FAX CONTRACTOR NAME LICENSE UMBER y LICENSE TYPE BUS.LIC.# COMPANY NAME E-MAIL FAX ur 1/d7 � /.4e7- -7 STREET ADDRESS / CITY,STATE,ZIP PHO 4f3 3 ,QAn/J ii te(;o( e,�a 2 gun//��q A v =E' e l I UNDERSTAND AND AGREE TO THE FOLLOWING: 1. The re-roof project shall comply with all applicable provisions of the 2016 California Codes. 2. An inspection request can be scheduled up to one business day before the;requested inspection date. To schedule inspections call (408) 777-3228 from 7:30-3:30pm (Mon-Thurs):or 7:;30-2:3Opm (Friday) to schedule inspection. For Tear-Off and Nailing Inspections, you must also call'on the dray oflthe inspection only after that phase of the work is completed. The building inspector will!be'fout to the job site within one hour. The hours for this service are: 7:30-10:30am and;12:30-3.30 (1VIo'n-Thurs) and 7:30-10:30am and 12:30-2:30 (Friday). Final Inspections will be given a two hour window. k;' 3. Tear-Off Inspection is required. Any and all dry-rotted wood shall be replaced prior,to this inspection. Unless new plywood roof sheathing is proposed throughout, all the nails/fastener's;shall be either completely knocked-down or removed prior to this inspection. t 4. If plywood is installed, a plywood Nailing Inspection is required. 5. Roofing shall not be appliedwithout first obtaining all prior inspection and written,app'roval;s 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 live 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 a minimum of I/"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 on-site to review 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. 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 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 2016 California Residential Code. Signature of Applicant/Agent: Date: ReroofPolicy_2014.doc revised 06/01/7 \\401,...1/4/ OWNER-BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION J.., CUPERTINO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 J CUPERTINO (408)777-3228•FAX(408)777-3333•buildinncS cupertino.orq 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 ovo•P c--er `�°l-f/A B , APN 3 2- -0 cD '7 ( ` 7 ‘o OWNER NAME y / OWNER ADDRESS DESCRIPTION OF WORK: ./Out_ ic--14 5 S(Cdze. l�jrtp�� 'Yz s-teo ( ©.S'6 Sea-z l G!i /7-e-(,) ��d Uh!/�O 611/)3 4 sh srvie 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.) tn. 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. I, as an Owner-Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person andilhis or her employees while working on my property. My homeowner's 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. er 2. I 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. X7'3. I understand as an"Owner-Builder" I am the responsible party of record on the permit. I understand that I may 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. *1 4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. 17 5. I understand if I 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. ft 76. I 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. g17. I understand under' California Contractors' State License Law, an Owner-Builder who builds single-family residential structures carin'ot 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. 8. I 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. OwnerBuilde7Forrn 2010:doc revised 04/14/10 H 9. I 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. ne�10. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the party legally and financially responsible for proposed construction activity at the site address listed above. lir'11. I agree that,as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner-Builders as well as employers. ff,712. 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 lawsdesigned 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 i 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 obtaina permitas Owner-Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractorsare properly licensed and the status of their workers'compensation insurance coverage. CONSTRUCTION LENDING AGENCY (DIRECTIONS:Please domplete 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 driver's license, form notarization, or other verification acceptable to the city maybe required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: (NOTE: The followingAuthorization Form is required to be completed bythe property owner onlywhen designating an ; ; q P p p Y 9 9' 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. k'ef04-16 Scope of Construction Project(or Description of Work): Project Location or Address: /03 k /1)o Cat-e,74 a 28-6 l Name of Authorized Agent: (jlfe-/e L"lY('I� Tel No � �2" 7 Address of Authorized Agent: 6' `?2 / It 7e�r �-e / �/'e* c /, 0 946-c I ' g 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 owner's driver's license, form notarization, or other verification acceptable to th'e city may be required to be presented when the permit is issued to verify the property owner's signature. . ' sol 7 Property Owner's Signature: Date: �� OwneBuilderFor,n 2010.doc revised 04/14/10 SMOKE / CARBON MONOXIDE ALARMS1„ 47. OWNER CERTIFICATE OF COMPLIANCE - xa COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION U , tNO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228•FAX(408)777-3333•buildinq(a�cupertino.orq PERMIT CANNOT.BE FINALED UNTIL THIS LERTIFICATE.TAS.BEEN COMPLETED,SIGNED„.AND RETURNED TO THE BUILDING DIVISION PURPOSE This affidavit is a self-certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with 2016 CRC Section R314,R315,2016 CBC Sections 420.6 and 907.2.11.2 where no interior access for inspections are required. GENERAL INFORMATION Existing single-family and multi-family dwellings shall be provided with Smoke Alarms and Carbon Monoxide alarms. When the valuation of additions, alterations,or repairs to existing dwelling units exceeds $1000 00, CRC Section R314,R315, and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or Carbon Monoxide Alarms be installed in the following locations. AREA SMOKE ALARM CO ALARM Outside of each separate sleeping area in the immediate vicinity of the X X bedroom(s)—(Smoke alarms shall not be located within 3 feet of bathroom door) On every level of a dwelling unit including basements and habitable attics X X Within each sleeping room X Carbon Monoxide alarms are not required in dwellings which do not contain fuel-burning appliances and that do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal. Power Supply In dwelling units with no commercial power supply, alarm(s)may be solely battery operated. In existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do not result in the removal of wall and ceiling finishes or there is no access by means of attic,basement or crawl space.Refer to CRC Section R314 and CBC Sections 907.2.11 4 and 420 6.2.An electrical permit is required for alarms which must be connected to the building wiring. As owner of the above-referenced property,I hereby certify that the alarm(s)referenced above has/have been installed in accordance with the manufacturer's instructions and m compliance with the California Building and California Residential Codes. The alarms specified below have been tested and are operational,as of the date signed below Address 10 ? 8 6e/ /l1.4e ,240 , Permit No.12 6 f'7 Specify Number of Alarms #Smoke Alarms Mill #Carbon Monoxide Detectors I I have read and agree to comply with the terms and conditions of this statement Owner jor Owner Agent's))NName: 44 Signature Date: .lif!//e.. Contractor Name: /� 4. Y/ "r'/ Si nature Lic.# Date7/ J7. Smoke and COform.doc revised 01/10/2017