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12080298 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21089 WI LITE FIR CT CON'T'RACTOR:FOUR SEASONS ROOFING PERMIT NO: 12080298 OWNER'S NAME: TOM VIVIAN PO BOX 1668 DATE ISSUED:08292012 OWNER'S PIIONF,: 4089963945 SAN JOSE,CA 95109 PHONE NO:(408)278-0330 '[y LICENSED CONTRACTOR'S DECLARATION BUILDING PERDIIT INFO: BLDG I✓ ELECT❑ PLUMB r License Class C^-g Lic.H —1U72(o8 f� r r r: r1 IMIECH RESIDENTIAL COMMERCIALContractor f S FI Iri c• Date 9 -.-,1^ (2 1 hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:TEAR OFF WOOD SHARE 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. I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to sclGinsure 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:54500 permit is issued. APPLICANI-CERTIFIC\TION APN Number:35905074.00 OccupancyType: I certify that I have read this application and slate 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 PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT'ISSUANCE OR granting of permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. ��' 1— Issued by: �.��/✓ fj%G>� Dale:eap Signature i• a — Date ❑ OWNER-BUILDER DECLARATION RF-ROOFS: hereby affirm that I am exempt from the Contractor's License Law for one Of All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: installed without first obtaining an inspection,1 agree to remove all new materials for I,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Signature of Applicant, Dateg-2�^ 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&.Professions Code). ALL ROOF COVERINGS TO 13E CLASS"A"OR BETTER hereby affirm under penalty of perjury one of the following three declarations: I have and will maintain a Certificate of Consent to sclGinsure for Worker's HAZARDOUS MATERIALS DISCLOSURE Compensation,as provided for by Section 3700 of the Labor Code,for the 1 have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Ilcalth&Safely Code,Sections 25505,25533,and 25534. I will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Ilealth& Section 3700 of the Labor Code,for the performance of the work fur which this Safety Code,Section 25532(8)should 1 store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminunts as defined by the Ila)Area Air Quality Management District I will I certify that in the performance of We work for which this permit is issued.I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&Safety Code.Sections 25505.25533,and 25534. Compensation laws of California. If,alter making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must Ow r td agent: C forthwith comply with such provisions or this permit shall be deemed revoked Date: APPLICANT CERTIF'ICAT'ION CONSI'RUCHON LENDING AGENCY I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's correct. I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon die above mentioned property for inspection purposes,(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address 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 WI non-point source regulations per the Cupertino Municipal Code,Section 9.18, I understand my plans shall be used as public records. Signature Date Licensed Professional IJ iao g o REROOF PERMIT APPLICATION COMMUNITY,DEVELOPMENT DEPARTMENT'BUILDING DIVISION 10300 TORRE AVENUE -CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228- FAX(408)777-3333 'buildingAcupertino.oro PROJECT ADDRESS Z 1 0pb APSv OWNER NAME PHONE E-NAIL 0 STREET ADDRESS �1o8q G `4 I STATE.LIP (�-�� i FAX J�+ CONTACTNAMEPHONE IO E-NI.AIL STREET ADDRESS ./ CITY.STATE.ZIP FAX"Ortima 54% n ❑OUNFR ❑ OWNER-RUILDER ❑ DUNE )R ❑CO]TRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NA.NIE LICENSE NL'.AIBER LICENSE 'PE BUS.LIC.v COMPANY SAME C-NLAIL - FAX SAME STREET.ADDRESS CITY.STATE.ZIP PHONE Sot a o e C -O ARCHIrECLEVGINEER NAME 5 111 LICENSE NUMBER BUS.LIC,< COMPANY NAME E-NIAIL FAX - STREET ADDRESS CIT',STATE LIP PHONE CSE of ❑ SFD Or Duplex JIr Multi-Family ROOF AREA: �' VALCATION: 0 STRUCTURE: ❑ Commercial ��- S` S"O EXISTING ROOF TYPE: ❑BUILT-VPROOF ❑ASPIIALTSH6GLES 9WVooDSHAKES ❑WOOD SHINGLES ❑01 HER(SPECIFY) REMOVE!REPLACE JeYESI IF NO. PLY\TOOp ❑ PLVN'D ❑OSB PITCH: ROOF PROPOSED ROOF TYPE: ❑BCILT-UPROpF X1SPHkLT SHINGLES ❑WCODSIIAKES ❑HOOD SHINGLES 13 OTHER ICC-ES REPORT: DESCRIPTION OF WORK: y� I COX 0. 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 cons tion. I a ori zc reprcs< tiv of Cupertino to enter the above-identified properp•for inspection purposes. Signature of Applicant/Agent: Date: g O 12 SUPPLEMENTAL IN'FORMATION' REQUIRED OFFICE USE ONLY _If building is associated With a Home OW ner's Association,provide letterPLAN CHECI(�TYPE ROUTING SLIP of approval from HOA. OVEtJ R.THE.CODNTER Cfi90¢'f JNc PUN REVIEW Provide Planning approval to verify if there any restrictions. ❑ EXPRESS ❑ PLAN'NING PLAN REVIEW Provide copy of Manufacturer's Installation Specifications. Cl STANDARD ❑ FIRE DEPT Provide signed copy of Cupertino's Tear-Off Policy. ❑ OTHER: Reroofdpp 2011.doc revised 03116/11 CiTY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION A�DDRESADDRESS:,,�Iz White fir ct. DATE: 08/27/2012 REVIEWED BY: bob s, APN: BP#: 'VALUATION: $4,500 *PERMIT T1'PE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex PENTAMATION 1SFDWLROOF USE: PERMIT TYPE: WORK tear off wood shake and install comp shingles. SCOPE P.i'. i ..:.1.. .a'i _._._i ✓'. _d`dv ,w - r "`sir Xlech. Plan Check Phonh. Plan Cheek Dec. Plan Check ,Meeh. Parruir Feer Plumb. Permit Fee: Elec. Permit Fee: Oiber,Mech. Insp. Other Plumb Insp. Other Elec.Insp. ,Meeh.hup.Fee: Plumb. br;p. Fee: Elec.Insp.Fee: NOTE: This ewinmte does not include fees due to other Departments(i.e. Planning, Public 11'orks, Fire,Sanitary Saver District,School District, etc). These fees are based an the prelinzinan information available and are onh,an estimate. Contact the Det for addn't info. FEE ITEMS (Fee Resolttnan 11-053 El) 7/1/111 FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 1,300 s.f. Re-roof Suppl. PC Fee: (j) Reg. 0 OT 0.0 hrs $0.00 $195.00 IREROOFRES PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee@ Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Concmicuon Tac: Administrative Fee: Q Work Without Permit? Yes (j) No $0.00 Advanced Planning Fee: $0.00 Select Non-Residential Travel Docaanenlalion Fees: Building or Structure Q A Strong Motion Fee: IBSEISAfICR $0.50 Select an Administrative item Bide Stds Commission Fee: IBCBSC $1.00 :SUBTQTALS:' $1.50 $195.00LTOTAL FEE— $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(DDcupertino.org PROJECT ADDRESS Z / C APNa 6 OWNERNAMEv� PHONE E-MAIL STREETADDRESS CITY, STA ZIP FAX Z O .. U w C 1?I CONTRACTOR NAME LICENSENUMBER LICENS�P BUS.LIC.a COMPANY NAME ^ E-MAIL FAX � Seaalons ooT/;, STREET ADDRESS CITI'.STA P PHONE CA /'A aB-278-033 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 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 Y" 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. 1 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: ReroofPolicv_201 Lrloc reviserl02/16/11