12080301 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21093 WHITE FIR C'I' CONTRACI'OR:FOUR SEASONS ROOFING PERMITNO: 12080301
OWNER'S NAME: REICH HOWARD 1 PO BOX 1668 DATE ISSUED:08292012
OWNER'S PIIONE: 4088659190 SAN JOSE„CA 95109 PHONE NO:(408)278-0330
9- LICENSED CONURACfOR'S DECLARA'T'ION BUILDING PERMIT INFO: BLDG C ELECT r1 PLUMB
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License Class x'-39 Lic.# 41210$ r r
$ _Xq_ l� DIECH RESIDENTIAL COh111fERCtAL
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Contractor �t 2 1 N C. Date I
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1 hereby atTirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:TEAR OFF WOOD SHAKE AND INSTALL 13 SQFT CLASS A
(commencing with Section 7000)of Division 3 of the Business&Professions COMP SHINGLES
Code and that my license is in full force and effect.
1 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,a provided for by Section 3700 of 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 Sq.Ft Floor Area: Valuation:54500
Section 3700 of the Labor Code,for the perfomtance of the work for which this
permit is issued.
APN Number:35905076.00 Occupancy Type:
APPLICANTCERT'IFICAT'ION
I certify that l 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 PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes. (We)agree to save
indemnify and keep harmless the City ofCupertino against liabilities,judgments, WITHIN ISO DAYS OF PERMIT ISSUANCE OR
costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION.
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. Issued by: Date: ff /,;;L
Signature__ Date
❑ OWNER-BUILDER DECLARATION RE-ROOFS;
All roofs shall be inspected prior to any roofing material being installed.If a roof is
1 hereby affirm that I am exempt from the Contractor's License Law Formic of installed without first obtaining an inspection,I agree to remove all new materials for
the following two reasons: inspection.
I,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, Signature of Applicam' Date:
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVER , .S T'O BE CLASS"A"OR BETTER
hereby affirm under penalty of perjunone of the following three
declarations: HAZARDOUS MATERIALS DISCLOSURE
I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the
Compensation,as provided for by Section 3700 of the Labor Code,for the California Ilcalth&Safety Code,Sections 25505.25533,and 25534. 1 will maintain
performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Ilcalth&
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.
Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should 1 use equipment or devices which emit hazardous air
contaminants as defined by the Ilay Area Air Quality Management District 1 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 Bcalth&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 eu zcd i
become subject to the Worker's Compensation provisions of the Labor Code,I must ate: '?
forthwith comply with such provisions or this permit shall be deemed revoked.
CONS'1'RI1CfION LENDING AGENCY
APPLICANT CERTI FICATION I hereby affirm that there is a construction lending agency for the performance of work's
I certify that 1 have read this application mid state that the above information is for which this permit is issued(Sec.3097,Civ C.)
correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records.
9.18.
Licensed Professional
Signature Date
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: a,lp " White fir ct. DATE: 08/27/2012 REVIEWED BY: bob s,
APN: BPO: -VALUATION: IS4,500
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration I Repair
PRIMARY PENTAh1ATION
USE: SFD or Duplex PER 1SFDWLROOF
i
WORK tear off wood shake and install comp shingles.
[SCOPE
S_
Mech. Plan Check Plumb.Plan Cheek Flee. Plan Check
Mech. Pernut Fee: Plumb, Pennit Fee.' F;lec•. Permit Fee:
Other Mech. Insp. Other Plumb Insp. Other Flee.lup.
kle.ch.Insp.Fee: Plumb. beep. Fee.: Elce.Insp.Fee:
NOTE: This estimate does not include fees due to other Departments(i.e. Planning, Public Works, Fire,Sanitaq,Server District,School
District,etc). Thesefees are hosed on the preliminan information mmilable and are onh,an estimate Contact the De t or addn'l in o.
FEE ITEMS (Fee Resolution 11-053 ElL 711111) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 1,300 s.f. Re-roof
Suppl. PC Fee: Q Reg. O OT 0.0 hrs $0.00 $195.00 /REROOFRES
PME Plan Check: $0.00
Permit Fee: $0.00
Stipp]. Insp. Fee-.0 Reg. Q OT 0.0 1 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
COIISfMction Tac:
Adminislt•mive Fee: O
Work Without Permit? O Yes 0 No $0.00 0
Advanced Planning Fee: $0.00 Select a Non-Residential Q
Travel Documenturiav Fees: Building or Structure 0
A
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
y _:S,UBTOTALS ` $1.50 $195.001!7.,, -" -TO'`LtFEE $196.50
Revised: 07/01/2012
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(okupertino.orcl
PROJECTADDRESS Z(O 9 3 WL� - 2 APN
OWNER NAME PHONE E-MAIL
- 86� 40
STREET ADDRESS Z O C CITY,STATE ZIP FAX
CONTRACTOR NAME LICEVSENUMBER LICENSE TYPE BUS.LIC.p
L4-79 to
COMPANY NAME E-MAIL FAX
STREETADDRESS SO2 (1 CITY.STAT IP CA
PHONE .�g-O.33O
1 UNDERSTAND AND AGREE TO THE FOLLOWING:
I. The re-roof project shall comply with all applicable provisions of the 2010 California Codes.
2. An inspection request can be scheduled up to 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.
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. Progress
and 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. Progress Inspection is required when approximately 50% of roof covering is installed.
7. 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'/0 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.
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, 1 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 2010 California Residential Code.
Signature of Applicant/Agent: Date:
Re,ogJPa1icv_201 I.doc reviser!02/16/11
o :�ol
REROOF PERMIT APPLICATION
COMMUNITY,DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTINO (408)777-3228• FAX(408)777-3333•buildinclocupertino.orG
PROIECT ADDRESS APN• n i0 Z ,O-7
ZI O � C C `Y
OWNER NAME PHONE E-MAIL
w e-1 0 6S—
sTREErADDRESS I0 1 CI ' STATE.ZIP ' FAS
C M
CONTACT NAME PHONE E-MAIL
STREET ADDRESS Sot S CITI'.STATE.J.IP FAS
❑Ou'NER ❑ OWNER-BUILDER ❑ ONNERAGENT J(CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME LICENSE NUMBER LICENSE 'PE BUS.LIC.-
COMPANY\AMC E-MAIL FAX
STREET ADDRESS CITY.STATE.ZIP PHONE
Sat w oSe C 8'6
ARCHITER.ENGINEER SAME LICENSE NUMBER BUS,LIC.
COMPANY NAME I E-PIAIL FAX
STREET ADDRESS I CITY.ST.ATE.ZIP PHONE
USE OF ❑ SFD or Duplex jf Multi-Family ROOFAREA; VALUATION: :
STRUCNRE', ❑ Commercial ^, S�
EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPIIALT SHINGLES PCOODSHAKFS ❑W'OODSHINGLES 1301HERISPECIFYI
RENIOVE:REPLACE YES IF NO. PLY11"7D ii ❑ PLYWD ❑OSB PITCH: 1z ROOF
❑ N LAYERS ICKNE ❑ a:9' T'PE- COX U
PROPOSEDROOFTYPE: ❑BUILT-UPROOF 416SPH.ALT SHINGLES ❑W'OOD SIIAKES ❑WOODSHINGLES C)OTHER ICC-ES REPORT.
DESCRIPTION OF WORK: qtit
*.
By my signature bclou-.I cenify 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 conslion. I a' oriu reprcsc tiv of Cupertino to enter the above-identified property for inspection purposes.
Signature of ApplicanUAgwc Date: O
SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY
_If building is associated With a Home Owvner's Association.provide letter PUN CHECK TYPE ROUTING SLIP
of approval from HOA. R-THE-COUNTER Er BUILDT517 LAN REVIEW
Provide Planning approval to verify if there any restrictions. ❑ EXPRESS ❑ PLANNING PLAN REVIEW
_ Prod 'copy'of Manufacturer's Installation Specifications. 13STANDARD .❑ FFREDEPT
Provide signed copy of Cupertino's Tear-OtT Policy. ❑ OTHER:
ReroofApp_01 Loot:revised 03/16/11