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15060179 (3) CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10176 ENGLISH OAK WAY CONTRACTOR:ATHK CONSTRUCTION PERMIT NO: 15060179 OWNER'S NAME: NGUYEN TAM AND CJUYEN HUONG 18950 AFTON AVE DATE ISSUED:06262015 OWNER'S PHONE: 4088880337 SARATOGA,CA 95070 PHONE NO:(408)849-2251 AiT LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL TEAR OFF(E)WOOD SHAKE,INSTALL(N)OSB, 15# License Class C, 3 9 Lic.itTC{ FELT,50 YR CLASS A COMP ROOF SYSTEM(30 SQ'S) r Contractor Date I hereby affirm that I m licensed under the provisions f Chapt r 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 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. Sq.Ft Floor Area: Valuation:$10000 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. APN Number:34212077.00 Occupancy Type: APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITIIIN 180 IT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 FR ED 74Z indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of thegranting of this permit. Additionally,the applicant understands and will com Is Date: z-5-- with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature 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 new materials for inspection. ❑ OWNER-BUILDER DECLARATION b 1 hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: the following two reasons: ALL ROOF COVERINGS TO CLASS"A"OR BETTER 1,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) 1,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(x)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this ) Owner or authorized agent: G Date: permit is issued. r 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 CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 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, ARCHITECT'S DECLARATION costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 (408)777-3228• FAX(408)777-3333• building a(�cupertino.orq CUPERT(NO I o/ _7 � PROJECT 01 -7 („ N 4 L I j FI A K � OWNER NAME t APN# Z r / Z O c r PHONE J E-MAIL i r/ N G--� N 0 �� 0337 STREET ADDRESS CITY, STATE,ZIP FAX S PA c� ✓C C. t1 i'-G IZ- 7 r. CONTACT NAME PHONEE-MAIL -A j t{ �� c.o vJ L. fl 8 _� J^ STREET ADDRESS CITY,STATE, ZIP ` _ FAX 1 ,d flr 7v � L) s -�v TUL— � Cft J`10'7O ❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHrrECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC.# U COMPANY I,�AME E-MAIL FAX H I 1-i K coo N C� 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: ❑ Commercial -30 S vj 1 0 Q EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY) REMOVE/REPLACE ❑YES IF NO. PLYWOOD ❑ 'w, ❑ PLYWD ❑ OSB PITCH: ROOF ❑ NO I #LAYERS: THICKNESS: El 5/8- TYPE: ❑ CDX 12 CLASS: A PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT# DESCRIPTION OF WORK: -�-rt-t-,- c O u o .A) 7A J s AA P 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 behalf. 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 constru tion. I authorize representatives of Cupertino to enter the above-identified roperty for inspection puposes. Signature of Applicant/Agent: Date: ,/ SUPPLEMENTAL INFORMATI REQUIRED OFFICE USE ONLI _If building is associated with a Home Owner's Association,provide letter PLAN CHECK TITE ROUTING SLIP of approval from HOA. ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW Provide Planning approval to verify if there any restrictions. ❑ EXPRESS ❑ PLANNING PLAN REVIEW _Provide copy of Manufacturer's Installation Specifications. ❑ STANDARD ❑ FIRE DEPT Provide signed copy of Cupertino's Tear-Off Policy. ❑ OTHER: ReroofApp_2011.doc revised 03/16/11 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 a(�,cupertino.org PROJECT ADDRESS j r -7 (O -EN G- L c S�'I 0 ot k L't APrI y 3 2 I 2 r v OWNER NAME' O J N J „ PHONE j / J 3 _ E-MAIL STREET ADDRESS S _� v� CITY, STATE,ZIP FAX CONTRACTORR(NAMEN / LICE N NUMBER LICENSE TYPE BUS.LIC.# l �% T Y COMPANY NAE L(f� E-MAIL FAX STREET ADDRF, � rSS CITY,S ATE,ZIP PHONE 1 g ° A-F ,D rJ v� sT c� �- v-t &_/ J 0-7 I UNDERSTAND AND AGREE TO THE FOLLOWING: 1. The re-roof project shall comply with all applicable provisions of the 2013 California Codes. 2. An inspection request can be scheduled up to one business day before the requested inspection date. Please schedule inspections online or call (408) 777-3228 from 7:30-3:30pm (Mon-Thurs) or 7:30- 2:30pm (Friday) to schedule inspection. For Tear-Off and Nailing Inspections, you must also call on the day of the inspection only after that phase of the work is completed. The building inspector will be available within one hour. The hours for this service are: 7:30-10:30am and 12:30-3:30 (Mon-Thurs) and 7:30-10:30am and 12:30-2:30 (Friday). Final Inspections will be given a two hour window. 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/fasteners shall be either completely knocked-down or removed prior to this inspection. 4. If plywood is installed, a plywood Nailing Inspection is required. 5. Roofing shall not be applied without first obtaining all prior 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. 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/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, 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 2013 California Residential Code. Signature of Applicant/Agent: Date: ReroojTo1icy_2014.d6c revised 01/15/14 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 10176 ENGLISH OAK WAY DATE: 06/26/2015 REVIEWED BY: MELISSA APN: 342 12 007 BP#: 'VALUATION: j$10,000 xPERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof PRIMARY SFD or Duplex PENTAMATION 1 SFDWLROOF USE: I PERMIT TYPE: WORK TEAR OFF E WOOD SHAKE INSTALL N OSB 15# FELT 50 YR CLASS A COMP ROOF SCOPE SYSTEM (30 SQ'S) FEE ID ROOF AREA s.f. 1 REROOFFRES 3,000 Mech. Plan Cheek Phinib. Plan Check E lec..Plan Check a1rI! i Plunih I Permh I %rer A/erh. Insp Other Plumb Insp. (Mier Elec.Insp. L_j 'rch. Insp. Fee: Plumb. hish. Fee: Llec.Insp.Fee: NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works, Fire,Sanitary Sewer District,School District,etc). Thesefees are based on the prelimina information available and are only an estimate Contact the De t or addn'l info. FEE ITEMS (&e Resolution 11-053 a. TT,13) FEE QTY/FEE MISC ITEMS l�tn Check Fee: �1rI�I�I. rC Fie l iimb.,/.11ech.%Elet Permit Fee: $ .00 7r Cpl. Insp Fee �'-71mb.%"Aleck.:-"F_lec 'lumb.111ech./Elec Permit Fee: o7qrlwfio;, Tor: Work Without Permit? Yes Q No $0.00 hwnce d Planning Fees: Cut7el Documentation Fees. Strony,Motion Fee: 1BSEISMICR $1.30 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $512.30 $0.00 TOTAL FEE: $512.30 Revised: 05/07/2015