10080098 CITY OF CUPERTINO BUILDING PERMIT
CONTRACTOR:EVERSPRING PERMIT NO: 10080098
[LDING ADDRESS: 7818 LUNAR CT CONSTRUC CION INC
`ER'S NAME: TONY WANG
1173 S DE ANZA BLVD STE D DATE ISSUED:08/16/2010
r 1+IER'S PHONE: 4086559688
SAN JOSE,CA 95129 PHONE NO:(408)446-8398
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB
erase Class Lic.# MECH r RESIDENTIAL r COMMERCIAL
ntractor Date
JOB DESCRIPTION:RE-ROOF REMV EXISTING COVERINGS&RE-ROOF 40YR
ereby affirm that I am licensed under the provisions of Chapter 9 COMPOSITI;ROOF CLAS A 20SQ
mmencing with Section 7000)of Division 3 of the Business&Professions
,de and that my license is in full force and effect.
iereby affirm under penalty of perjury one of the following two declarations:
ave and will maintain a certificate of consent to self-insure for Worker's
mpensation,as provided for by Section 3700 of the Labor Code,for the
rformance of the work for which this permit is issued. Valuation:$6500
gave and will maintain Worker's Compensation Insurance,as provided for by Sq,Ft Floo Area:
ction 3700 of the Labor Code,for the performance of the work for which this
rmit is issued. APN Numl-er:36220023.00 Occupancy Type:
APPLICANT CERTIFICATION
:ertify that I have read this application and state that the above information is
orrect.I agree to comply with all city and county ordinances and state laws relating
building construction,and hereby authorize representatives of this city to enter PERMIT EXPIRES IF WORK IS NOT STARTED
)on the above mentioned property for inspection purposes. (We)agree to save
demnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE O
)sts,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION.
ranting of this permit. Additionally,the applicant understands and will comply
ith all non-point source regulations per the Cupertino Municipal Code,Section Date: F
.18. Issued by:
-,tture Date
RE-ROOFS:
OWNER-BUILDER DECLARATION
All roofs s call be inspected prior to any roofing material being installed.If a roof is
hereby affirm that I am exempt from the Contractor's License Law for one of installed A ithout first obtaining an inspection,I agree to remove all new materials for
he following two reasons: inspection
,as owner of the property,or my employees with wages as their sole compensation, Date:
vill do the work,and the structure is not intended or offered for sale(Sec.7044, Signature if Applicant:
3usiness&Professions Code)
as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERI S TO BE C SS"A"OR BETTER
;onstruct the project(Sec.7044,Business&Professions Code). �fJ
[hereby affirm under penalty of perjury one of the following throe HAZARDOUS MATERIALS DISCLOSURE
declarations:
[have and will maintain a Certificate of Consent to self-insure for Worker's I have re;td the hazardous materials requirements under Chapter 6.95 oft e
Compensation,as provided for by Section 3700 of the Labor Code,for the Californi i Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material.
Addition illy,should I use equipment or devices which emit hazardous air
Section 3700 of the Labor Code,for the performance of the work for which this containh ants as defined by the Bay Area Air Quality Management District I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
I certify that in the performance of the work for which this permit is issued,I shall Health 8 Safety Code,Sections 25505,25533,and 25534.
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 Owner or an dJagent:become subject to the Worker's Compensation provisions of the Labor Code,I must
Date:forthwith comply with such provisions or this permit shall be deemed revoked. TION LENDING AGENCY
APPLICANT CERTIFICATION I hereby iffirm that thction lending agency for the performance of work's
I certify that I have read this application and state that the above information is for whic]i this permit is issued(Sec.3097,Civ C.)
correct.I agree to comply with all city and county ordinances and state laws relating Lender';Name
to building construction,and hereby authorize representatives of this city to enter
the above mentioned property for inspection purposes.(We)agree to save Lender';Address
nify and keep harmless the City of Cupertino against liabilities,judgments,
Lgrantingof
ses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION
ermit.Additionally,the applicant understandsand will complynt source regulations per the Cupertino Municipal Code,Section I unders and my plans shall beused as public records.
License i Professional
Date
CITY OF
CITY OF CUPERTINO92
REROOF
CUPERTINO PERMIT APPLICATION
APN#
Date:
Buildin Address.
,? Lunar C4. Cu ►� o �S�vr
Owner's Name: .T0 0 tAjaV\j Phone #:
HOA: Yes ❑ No ® If yes, provide letter fro in HOA 'o 6 c�O FT
Contractor: Phone #:
Fax#:
Cupertino Business License #: Contractor License #:
El X66 3�
Type of Roof Covering:
Existing: Prc posed:
❑ Built-Up Roof :i Built-Up roof
❑ Asphalt Shingles X Asphalt Shingles
9r, Wood Shakes :i Wood Shakes
❑ Wood Shingles :j Wood Shingles
❑ Other (Specify) (3 Other (Specify)
Number of existing coverings ij Provide I.C.C.E.S. Report #
To be Removed u Provide Mfgr. Installation Specs.
Job Description:
�C�5�i� C�U'�
i+ 21)
-
Residential - 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 31an set & the sheet index.
Valuation:
I Have Read, Understand a d Will Comply with Cupertino's Tear-Off Policy:
SijM e
Revised 02/05/09
CITY OF
CITY OF CUPI4RTINO
[0 REROOF
CUPERTINO FEE SCHEIIULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1REROOFCOM Re-roof Commercial B 1COMMLROOF
1BCBSC Cal Bldg Standaris B ALL PERMIT TYPES
Commission Fee
1BSEISMIC0 Seismic CommerHal B
20 1RER00FRES Re-roof Residential B 1SFDWLR00F
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
1 1BSEISMICRE Seismic Residential B
1RER00FMRES Re-roof Multi-Family B 1MFDWLROOF
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
1BSEISMICRE Seismic Residential B
1BUSLIC Business License B
M.Indoor Air Quality and Finishes
1.Use i wao-v6C Paint 1 IAW Iealth pts y--yes D
2.Use Low VOC,Water-Based Wood Finishes 2 IAQhlealth pts yeses 0
3.Use Looft VOC Adl fives 3 IAM lealth pts y=yes 0
4.Use Salvaged Materials for Interior Finishes 3 Resc irce pts y=yes D
5.Use Engineered Sheet Goods with no added Urea
Formaldehyde 6 IAQ/f lealth pts y=yes D
S.Use Exterior Grade PlNaood for Interior Uses 1 IAQ/i lealth pts y=yes D
7.Seal410*0+0e4100 1 's;!r-M _ -_ . _ 4IAQ/Ilealth. s - es
B.Use FSC Certified Materials for Interior Finish 4 Rescurce pts y=yes 0
9.Use Finger-Jointed or Recycled-Content Trim 1 Resc urce pts y=yes 0
10.Install Whole House Vacuum System 3 IAadaalth pts y=yes 0
1 1 D
N.Flooring
1.Select FSC Certified Wood Flooring B ReSol roe pts y=yes D
2.Use l3apdylianeDiat]Ie,flmdpg'alateria�s 4 Resol rce pts y--yes 0
3.Use Recycled Content Ceramic Tiles 4 Resoi.rce pts y=yes D
4.Install Natural Linoleum in Place of Vinyl 5 IAQ/F salth pts yeses 0
5.Use Exposed Concrete as Finished Floor 4 Resot rce pts y--yes 0
6.Install Recycled Content Carpet with Low VOCs 4 Resor roe pts y--yes 0
1 1 1
Total Points Available: 1 1401 1301 57
Total Points Pro'ect Received: 0 0 0
MdaWproWgreenbuild'ing;Nidelinestremodelerslgreenp6intsfinat212Mpn twledxls
OWNER-BUILDER DISCLOSURE FORM
is COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 950'4-3255
CUPERTINO (408)777-3228- FAX(408)777-3333- building a 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 ADD E APN BP UO�
Z_u + C ��ri a
OWNER NAML _ OWNT ADDR SS
Y1 aVl 92,Er
DESCRIPTION OF WO K:
U
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 2gent 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.)
–7 t-4. 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 prope-ty owner is providing his or her own labor and material
personally. I, as an Owner-Builder, may be held liable and sub ect to serious financial risk for any injuries sustained by
an unlicensed person and his 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.
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 as:;ume this responsibility.
*T ,3. 1 understand as an"Owner-Builder" I am the responsib a party of record on the permit. I understand that I may
protect myself from potential financial risk by hiring a licensed :,ontractor and having the permit filed in his or her
name instead of my own.
771—.,4. I understand Contractors are required by law to be lice ised and bonded in California and to list their license
numbers on permits and contracts.
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 (1500), including labor and materials, I may be
considered an "employer' under state and federal law. ..,,
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' c)mpensation disability insurance, and contribute to
unemployment compensation for each "employee." I also undE!rstand my failure to abide by these laws may subject
me to serious financial risk.
`*,�7. 1 understand under California Contractors' State Licen:;e 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.
7_w-8. 1 understand as an Owner-Builder if I sell the property br which this permit is issued, I may be held liable for
any financial or personal injuries sustained by any subsequen, owner(s)that result from any latent construction
defects in the workmanship or materials.
OwnerBuilderForm 2010.doc revised 04114110
-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.clov for more information about licensed
contractors.
7 -\J 1.0. 1 am aware of and consent to an Owner-Builder building p 3rmit 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.
'' Q 11. 1 agree that, as the party legally and financially responsibly;for this proposed construction activity, I will abide
by all applicable laws and requirements that govern Owner-Builder3 as well as'employers.
77-✓d2. 1 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 -egulated 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 and.rstanci 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 worcers'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 driver's license,
form notarization, or other verification acceptable to the city may be re juired to be presented when the permit is issued
to verify the property owner's si nature.
Property Owner's Signature: Date:
---------------------------------------------------------------------- ----------------------------------------------------------------------
(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 F'ROPERTY'OWNER'S BEHALF
Excluding the Notice to Property Owner, the execution of which I unde rstand 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:
I 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 propery owner's driver'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:
O vnerBuilderForm 1010.doc revised 04114110
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT•B JILDING 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 cDcipertino.org
t APJ#
PROJECT ADDRESS p� I / , p
PHO �q f�� E-MAIL�DN I�WA r�L'Ct�
OWNER NAME �o �y r (O
STREET ADDRESS
N CITY, STATE,ZIP FAX
�!, Q-.� LICENSE NUMBERQ$'�-�,�5 LICENSE TYPE ? BUS.LIC.#
CONTRACTOR NAME V � ) 1�
_ E-MAIL FAX
COMPANY NAME!� ,2��C`
F-V CITY,STATE,ZIP �,✓�c1'G /�1 Z PHONE
STREET ADDRESS f
7 I UNDERSTAND AND AGREE TO THE FOLLOWING:
1. The re-roof project shall comply with all applicable prow sions 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 tez r-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 — 10:30ain and 1:00— 3:30pm (Mon—Thurs);
7:30 — 10:30an 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[he roofing material.
6. New roof coverings shall not be applied without first obi aining all inspections and written approvals
from the building inspector. Any roofing which is appli;d 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 t ie building inspector when the re-roofing is
complete. To receive a final sign-off, the following itenis will be verified:
a. Flat roofs shall have a minimum of 1/4"per foot of s lope 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: am the property owner or authorized agent to act
on the property owner's behalf. I derstand a d agree to con ply with the re-roof policy stated above.
Date:
Signature of Applicant/Agent:
ReroojTo1icy_2010.doc revised 05/17/10
CITY OF CUPER"INO
3 ITEMS OF 3 PERMIT RECE:=PT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 36220023 . 00
DATE ISSUED. . . . . . . : 08/16/2010
RECEIPT #. . . . . . . . . : BSOOOO11185
REFERENCE ID # . . . : 10080098
SITE ADDRESS . . . . . : 7818 LUNAR CT
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER TONY WANG
ADDRESS . . . . . . . . . . : 7818 LUNAR CT
CITY/STATE/ZIP . . . : CUPERTINO , CA 95014-4921
RECEIVED FROM . . . . : TONY K WANG
CONTRACTOR . . . . . . . : PATRICK 'rSAO LIC # 29932
COMPANY . . . . . . . . . . : EVERSPRI:\TG CONSTRUCTION INC
ADDRESS . . . . . . . . . . : 1173 S D3 ANZA BLVD STE D
CITY/STATE/ZIP . . . : SAN JOSE, CA 95129
TELEPHONE . . . . . . . . : (408) 445-8398
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 6, 500 . 00 1 .00 0. 00 1 . 00 0.00
1BSEISMICR VALUATION 6, 500 . 00 0 .70 0. 00 0 .70 0 .00
1REROOFRES SQ FEET 20. 00 260 .00 0 .00 260 . 00 0 .00
---------- ---------- ---------- ----------
TOTAL PERMIT 261.70 0. 00 261.70 0 .00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 261.70 MC
---------------
TOTAL RECEIPT 261 .70
VOICE ID DESCRIPTION VDICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF