10110068 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 11883 SHASTA SPRING CT CONTRACTOR:THD AT-HOME SERVICES, PERMIT NO: 10110068
INC.
r"'NER'S NAME: CATHERINE LIU&MICHAEL YAO 2690 CUMBERLAND PKWY STE 300 DATE ISSUED: 11/10/2010
c,-NER'S PHONE: 5108774550 ATLANTA,GA 30339-3913 PHONE NO:(510)731-1004
C� LI?CENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG F ELECT r— PLUMB
License Class� J Lic.# �—
`s MECH RESIDENTIAL r COMMERCIAL
Contractor 7 H i�) & I'1 o er 5rr2�4yate l I l I v !
JOB DESCRIPTION:RE-ROOF 23 SQ TEAR OFF EXISTING WOOD SHINGLES
I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000)of Division 3 of the Business&Professions NO
RE-SHEET INSTALL GRAND CANYON MISSION BROWN COMP
Code and that my license is in full force and effect. SHINGLE 50 YR COMP CLASS A
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:$14520
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is APN Number:36655026.00 Occupancy Type:
correct.I agree to comply with all city and county ordinances and state laws relating
to building constriction,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 may 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 sourc tions per the Cupertino Municipal Code,Section 180 D YS FROM ST CALLED INSPECTION.
9.18.
S`^nature Date < <U //b Issued by: Date:
❑ 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 any roofing material being installed.If a roof is
I,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an ins ion,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) Date:
I,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant:
constrict 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
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
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
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&Safety Code,Sections 25505,25533,and 25534.
become subject to the Worker's Compensation provisions of the Labor Code,I must Owner ut rized agent:
forthwith comply with such provisions or this permit shall be deemed revoked. ate:
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 constriction 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.)
-r the above mentioned property for inspection purposes.(We)agree to save Lender's Name
unify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the Lender's Address
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION
9.18.
I understand my plans shall be used as public records.
Signature Date
Licensed Professional
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36655026 .00
DATE ISSUED. . . . . . . : 11/10/2010
RECEIPT #. . . . . . . . . : BS000011970
REFERENCE ID # . . . : 10110068
SITE ADDRESS . . . . . : 11883 SHASTA SPRING CT
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : CATHERINE LIU & MICHAEL YAO
ADDRESS . . . . . . . . . . : 11883 SHASTA SPRING CT
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : JEFF RAINEY
CONTRACTOR . . . . . . . : FRANCES BLAKE LIC # 29818
COMPANY . . . . . . . . . . : THD AT-HOME SERVICES, INC.
ADDRESS . . . . . . . . . . : 2690 CUMBERLAND PKWY STE 300
CITY/STATE/ZIP . . . : ATLANTA, GA 30339-3913
TELEPHONE . . . . . . . . : (510) 731-1004
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 14, 520 . 00 1. 00 0. 00 1. 00 0 .00
1BSEISMICR VALUATION 14, 520 . 00 1.45 0. 00 1.45 0 .00
1REROOFRES SQ FEET 23 . 00 299. 00 0. 00 299. 00 0 .00
---------- ---------- ---------- ----------
TOTAL PERMIT 301 .45 0 . 00 301.45 0 .00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 301 .45 VISA
---------------
TOTAL RECEIPT 301.45
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
CITY OF CUPERTINO
FEE ESTIMAT R-BUILDING DIVISION
ADDRESS: �1 E: REVIEWED BY:
Its I APN: BP#: *VALUATION: 1$14,520
*PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD or Duplex ;0 i,, 4 PENTAMATION 1SFDWLR00F
USE: 1,704)"'1", rlf : PERMIT TYPE:
WORK
SCOPE
FEE ID ROOF AREA
s.L
1REROOFFRES 2,300
.
1"C'iI J lwi Cho A, —FT
F-1
'I'A",» " 1 1;1<c.Inv, 1,c;),
NOTE: Theseees are based on the preliminary in ormation available and are only an estimate. Contact the Dept-for addn'1 info.
FEE ITEMS (Fee Resolutiofi 09-05I Ef 7%Ii70) FEE QTY/FEE MISC ITEMS
P/on Chc'c;k Fe c:
E'ttfrr2lf.:"llc'c1r.ilelec~
Mail C'hc"A"
Permit Fee: $299.00
Safhhh Iftssh 1=(v
f'lffrrrh._1kc�1t.;T'Ic<. C%nir f'��c':
/'lffttth.%"1lcrth.%t:l�'t' /'e�tfrtrt CTc°c'
t`ufz.N'11(1101z Tiff
Jc:0101tc01 1i'c,viell
Work Without Permit? 0 Yes (F) No $0.00
Tari cl 0octrttt"Watioll C cc',:
Strong Motion Fee: IBSEISMICR $1.45 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00
SUBTOTALS: $301.45 $0.00 TOTAL FEE: $301.45
Revised: 11/08/2010
INPUT Resources Energy e
. n oor rrua ity an mis es
1.Use Low/No-VOC Paint 1 IAQ/Health pts y=yes 0
2.Use Low VOC,Water-Based Wood Finishes 2 IAQIHealth pts y=yes 0
3.Use Low/No VOC Adhesives 3 IAQIHealth 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 Particleboard 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 I 1 0
1 I 1
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=yes0
6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes 0
I 1 I
Total Points Available: 1 1401 1301 57
Total Points Project Received: 01
01 0
G:data/propstgreenbuildingguidelineslremodelerslgreenpointsfinal2.12.04protected.xls
Building Department
City Of Cupertino
ELI] 10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
C U P E RT I N O Fax: 408-777-3333
CONTRACTOR / SUBCONTRACTOR LIST
JOB ADDRESS: r j 4. z G PERMIT# 1100 U U
OWNER'S NAME: G ,J E `I v PHONE# C) ZS Z c7 2
GENERAL CONTRACTOR: j-or4 C 5t2t)iC.t S BUSINESS LICENSE#
ADDRESS: 2.456t) G CITY/ZIPCODE: S,+,J t-t?}t/ 452 7
*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 SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
Date
Please check applicable subcontractors and c plete 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/Con r Signature Date
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
ALBERT SALVADOR, P.E.,C.B.O.,BUILDING OFFICIAL
CUPERTINO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•building(akupertino.ong
PROJECT ADDRESS ,ry j `V I ,1,(.4_ G APN#
OWNER NAME C6 7 �5 PHONE /y �fC� E-MAIL
G M i a)
-(A �Gj L L I �✓ j- I C I"LII , �D f�V 3 L rj 2 /Z
STREET AD SSCITY, STATE,ZIP I FAX
Q > 5 N ir5��t 5 ►�r G� , G v,�t;z ,J�. e A
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC.#
836021 C39
COMPANY NAME E-MAIL FAX
THD AT HOME SERVICES 510-357-3750
STREET ADDRESS CITY,STATE,ZIP PHONE
2456 VERNA CT. SAN LEANDRO, CA 94577 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.
8. 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 rstan and agree to comply with the re- of policy stated above.
Signature of Applicant/Agent: Date: It /el
ReroofPolicy_201 0.doc revised 05/17/10
CITY Of
CITY OF CUPERTINO
III REROOF
CUP RT'INO PERMIT APPLICATION
0 11 Ob to sr-'
APN# Date:
(; �t� Jp-0� 11 rc�� o
Building Address:
I 1 '0
Owner's Name: GAT N ` l- J t4 le-L-M / YA O Phone#:
HOA: Yes ❑ No If yes, provide letter from HOAR
Contractor: THD @ HOME SERVICES Phone#: 510-877-4550
Fax#: 510-357-3750
Cupertino Business License#: Contractor License #:
836021
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
Wood Shingles ❑ Wood Shingles
❑ Other(Specify) )iL Other(Specify) 6,c-,0P
Number of existing coverings ❑ Provide I.C.C.E.S. Report#
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description: ���,� - 7t iAZ �rt� 5'71,,Jj iJ-t�7 50
��•,� �r 5 . �J v
rc✓�J �� �, 5;1�,✓� lr
Residential 0 Commercial ❑
Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if
Green Building Checklist& attach it to the application or if there are any restrictions: ❑
applicable, include in plan set & the sheet index.
Valuation: . / r I' 5 2-
I
I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
Signature
Revised 02/05/09