11040129 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7565 DE FOE DR CONTRACTOR:AMK ROOFING PERMIT NO: 11040129
OWNER'S NAME: DR.TOM HSU 184 TALMADGE AVE DATE ISSUED:04/19/2011
O'-'NER'S PHONE: 4086660661 SAN JOSE,CA 95127 PHONE NO:(408)937-6972
L✓ LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class C� ��Lic.# :3a
19
� MECH F RESIDENTIAL f— COMMERCIAL
Contractor r %Date Y" !9— I I
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:RE-ROOF TEAR OFF EXISTING TILE REPLACE WITH
(commencing with Section 7000)of Division 3 of the Business&Professions LIGHT
Code and that my license is in full force and effect. WEIGHT TILE.EXISTING ROOF SHEATHING TO REMAIN.
CLASS A 45SQ
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
permit is issued. Sq.Ft Floor Area: Valuation:$21000
APPLICANT CERTIFICATION
1 certify that I have read this application and state that the above information is APN Number:35925017.00 Occupancy Type:
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, PERMIT EXPIRES IF WORK IS NOT STARTED
costs,and expenses which lnay accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR
with all non-point sour a regulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION.
9.18.
Signature Date At Issued by: Date:
Vr
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS:
the following two reasons: All roofs shall be inspected prior to 99y roofing material being installed.If a roof is
1,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining aq pection,I agree to remove all new materials for
will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection.
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: Date:
construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
declarations:
1 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
performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
Section 3700 of the Labor Code,for the performance of the work for which this compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
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
not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Compensation laws of California. If,after making this certificate of exemption,I Health&Sofety Code,Sections 25505,25533,and 25534.
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. Ow�jj thorized agent:
Date: `1 #�
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
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 I hereby affirm that there is a construction lending agency for the performance of work's
to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.)
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
c- and expenses which may accrue against said City in consequence of the Lender's Address
ag of this permit.Additionally,the applicant understands and will comply
www all non-point source regulations per the Cupertino Municipal Code,Section
9.18. ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Signature Date
Licensed Professional
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 7565 de foe DATE: 04/19/2011 REVIEWED BY: bobs.
APN: BP#: "VALUATION: $21,000
'PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD or Duplex PENTAMATION 1SFDWLR00F
USE: PERMIT TYPE:
WORK tear off existing tile replace with light weight tile. Exisiting roof sheathing to remain.
SCOPE
FEE ID ROOF AREA
s.f.
1REROOFFRES 4,500
NOTE. Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addn 7 info,
FEE ITEMS ( e Resolution 09-051 Eff'. 7/f,"10) FEE QTY/FEE MISC ITEMS
Permit Fee: $585.00
Work Without Permit? 0 Yes (F) No $0.00
Strong Motion Fee: IBSEISMICR $2.10 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $588.10 $0.00 TOTAL FEE: $588.10
Revised: 01/15/2011
CITY OF CUPERTINO
3 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35925017.00
DATE ISSUED. . . . . . . : 04/19/2011
RECEIPT #. . . . . . . . . : BS000013223
REFERENCE ID # . . . : 11040129
SITE ADDRESS . . . . . : 7565 DE FOE DR
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . . DR. TOM HSU
ADDRESS . . . . . . . . . . : 7565 DE FOE DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 92514
RECEIVED FROM . . . . : JOSE J JIMENEZ
CONTRACTOR . . . . . . . : JOSE J JIMENEZ LIC # 30602
COMPANY . . . . . . . . . . : AMK ROOFING
ADDRESS . . . . . . . . . . : 184 TALMADGE AVE
CITY/STATE/ZIP . . . : ,SAN JOSE, CA 95127
TELEPHONE . . . . . . . . : (408) 937-6972
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 21, 000 .00 1. 00 0.00 1.00 0. 00
1BSEISMICR VALUATION 21, 000.00 2. 10 0.00 2 .10 0. 00
1REROOFRES SQ FEET 45.00 585. 00 0. 00 585.00 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 588. 10 0.00 588.10 0. 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
309 EXTERIOR LATH 311 SCRATCH COAT
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
CUPERTINO
(408)777-3228- FAX(408)777-3333 - building�Dcupertino.org
PROJECT ADDRESS TAPN
#
1
OWNER NAME PHONE E-MAIL
STREET ADDRESS CITY, STATE,ZIP FAX
-�- d t C I C L 61
CONTRACTOR NAME /� .��1r+�--�/`"'Z� LICENSE NUMBER LICENSE TYPE. BUS.LIC.#
A
O=P"4 1
COMPANY NAME f E-MAIL-MAFAX
T
STREET ADDRESSSTATE,ZIP / PHONE Q
ZLI
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 inspection request shall be scheduled the day before the inspection date. Please call (408)777-
3228 from 7:30 - 3:30pm (Mon-Thurs) or 7:30 - 2:30pm (Friday) to schedule the next day inspection.
On the day of the inspection, a building inspector will be available within one hour for either a Tear-Off
Inspection or Nailing Inspection if you call again on that day between the hours specified.
3. The following inspections are required:
a. 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/fasteners
shall be either completely knocked-down or removed prior to this inspection.
b. If plywood is installed, a plywood Nailing Inspection is required.
c. Progress Inspection is required when approximately 50% of roof covering is installed.
4. 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.
5. 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/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 on-site to review at the time of the inspection.
c. Proper spark arrestor installation.
6. 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 an agree to comply with the re-roof policy stated above. I also understand that
smoke detectors and carbon monoxide ectors are required to be installed in accordance with Sections R314 and 8315 of
the 2010 California Residential Code _...__.._.-.-.
Signature of Applicant/Agent: Date:
ReroofPolicy_2011.doc revised 02/16/11
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
.:U P E RT I N O Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: PERMIT# a
OWNER'S NAME: PHONE#
GENERAL CONTRACTOR: BUSINESS LICENSE#
ADDRESS: 1 CITY/ZIPCODE: JTJ
"Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
"� d
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBC .NTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
1 am not using any subcontractors:
l� Y 11I
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
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO, CA 95014-3255
(408)777-3228• FAX(408)777-3333• buildingacupertino.org
CUPER.TINO
PROTECT ADDRESS0-F _ n �
L ft I C ZN h tom" �f
OWNER NAME. PHONE ✓ E-MAIL
STREET ADDRESS n CITY, STATE,ZIP FAX
APPLICANT NAME 1 PHONE E-MAIL
r -(5733
STREET ADDRESS CITY,STATE, ZIP FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT VIKONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME LICENSE NUMB LICENSE TYPE BUS.LIC.#
S75 _T
COMPANY NAME JI X22E-MAIL FAX
3'
STREET ADDRESS CITY,STATE,ZIP PHONE
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC.#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF SFD or Duplex ❑ Multi-Family ROOF AREA: VALUATION:
STRUCTURE: ElCommercial S 0cj S?j- 1 •Q c C
EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ®'OTHER(SPECIFY)
L
REMOVE/REPLACE-ErY—ES IF NO, PLYWOOD�� h" ❑ PLYWD 13O PITCH: :12 ROOF
11 NO #LAYERS: I THICKNESS. El 5/g-, TYPE: ElCDX —L–'12 CLASS: A
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ®OTHER G ICC-ES REPORT#
DESCRIPTION OF WORK:
P
By my signature below,I certify to each of the follcq. ing: 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 provide 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 buil ing struction. I authorize representatives of Cupertino tc enter the
above-
-iidentified prropert-for inspection purposes.
Signature of Applicant/Agent: / Date:7 '! 7 ZZ
z'> 'a
SUPPLEMENTAL INFORMATION REQUIRED k,WrcE �e ' " _ -
u
_If building is associated with a Home Owner's Association,provide letter - RI't e> cxP - ,• .z RauTtN�sLIP -`=
of approval from HOA.
PP OvER xI�CQ>tII!FL�R. t��hN REVIEW �
76 elt mi
Provide Planning approval to verify if there any restrictions. CI ExPREss ❑ PEANNING rLaN REVIEW
r
RN
_Provi�opy of Manufacturer's Installation Specifications. sTetiN... Q SIRE DEPT
rovide signed copy of Cupertino's Tear-Off Policy. Q�oTBx �
ReroofApp_2011.doc revised 03/02/11