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12090035 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21103 WHITE FIR CT CONTRACTOR:FOUR SEASONS ROOFING PERAIIT'NO: 12090035 OWNER'S NAME: KIM GONG SIK AND EUN JOO PO BOX 1668 DATE ISSUED:09/062012 OWNER'S PI PONE: 4088651846 SAN JOSE,CA 95109 PRONE NO:(408)27M330 ❑ LICENSED CONTRACT'OR'S DECLARATION C: Ci C �/O r BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Cf--T Lic.H r r r F' AIECH RESIDENTIAL COMMERCIALContractor r 5 2 Date 9 5 Z hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION: REROOF 13 SQ TEAR OFF WOOD SHAKE AND INSTALL (commencing with Section 7000)of Division 3 of the Business&Professions CLASS Code and that my license is in full force and effect. A COhIP SHINGLES 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 die work for which this Sq,FI Floor Area: Valuntion:54500 permit is issued. API'LICANI'CER'1'IFICA'1'I0N APN Number:35905081.00 Oceupaney Type: I certify that T 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,mid hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes, agree to save PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep hmmless the City of Cupertino against I iabilities,judgments, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this 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. Issued by: Date: / L� Signature Date ��/1/ �TG� ❑ OWNER-BUILDER DECLARATION RE:ROOFS: 1 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 beiig installed.If a roof is the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for I,as owner of the property,or ay employees with wages as their sole compensation, inspection. ,r , will do the work,and tie structure is not intended or offered for sale(Sec.7ec.7044, JJJ(-/,'/ Business&Professions Code Signature of Applicant: Date: ZI I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALI-ROOF COVERINGS TO BE 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 self-insure for Worker's BA'LARDOUS MATERIALS DISCLOSURE Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued California Health&Safety Code.Sections 25505,25533,and 25534. 1 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 Ilcalth& Section 3700 of the Labor Code,for the performance of die work for which this Safety Code.Section 25532(a)should I store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Ray Area Air Quality•Management District I will 1 certify that in the performance of the 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 Ilcalth&Safety Code,Sections 25505,25533,and 25534. Compensation laws of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must Owner or authorized agent: forthwith comply with such provisions or this permit shall be deemed revoked. Date: APPLICANTCERTIFICATION CONST'RUCT'ION 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(See.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupenino 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 ARCI IIT'ECf'S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. 1 understand my plans shall be used as public records. Signature Date I Licensed Professional I-znc� o0 �S REROOF PERMIT APPLICATION COMMUNITY(DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333•buildingIScupertino.oro (((�� - PROJECT ADDRESS 211 o G .APNa .�//— O �O$ Ow:NERNANIE 'NO APHONE � �l E-MAIL Q S [JCp O p STREEI'ADDRESS 1103 I ^ G CIT' STATE.ZIP l FAX CONTACT NAME. PHONE I E-?IAIL STREET ADDRESS Sot NS CITY.STATE, ZIP FA.N ❑OUNFR ❑ OWRER BUILDER ❑ OM'NER AGENT JrCo%TRACTUR ❑CONTRACrOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER Cl TENANT CONTRACTOR NAME LICENSE NCSIBER LICENSE TYPE BUS.LIC.. COMPANY NAME C-NI.AR FAX STREET ADDRESS CITY.STATE.ZIP PHONE SOZ A O 2. C B'O ARCHITECT'ENGINEER?AME LICENSE NL:NIBER BUS:LIC. COMPAN'YNAME I E-MAIL FAX STREET ADDRESS CITY.STATE.ZIP PHONE USE OF ❑ SFDorDuplex j. Multi-Family ROOF AREA: VALUATION: STRUCTURE: ❑ Commercial �Ry/ S SQ If EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALTSHINGLES rWOODSHAKES ❑WOODSHINGLES ❑01'HER(SPECIFY) RENIOVF.:REPLACE YES IF NO. PLY\1'OOD ❑ PLY\\'D ❑OSB PITCH: l2 ROOF ❑ R . AYER � KN SS' ❑ 1 P Y PROPOSEDROOFTYPE, ❑BUILT-UPROOF 36SPHALT SHINGLES ❑wODD SI I AKES ❑WOOD SHINGLES 13 OTHER ICC-ES REPORT DESCRIPTIONCIF WORK! I/ZEI cbxe ae a 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. 1 have read this application and the information I have provided is correct. I have read the Description of work and veriR'it is accurate. I agree to comply with all applicable local ordinances and state laws relaline to building cons tion. 1 aDrize represe tiv of Cupertino to enter the above-identified property for inspection purpose. Signature of ApplicanUAgmt: lite: O SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY _If building is associated\Yith a Home Owner's Association.provide letter PLAN CHECK TYPE ROUTING SLIP ofapproval 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 ❑ FTRE DEPT Provide signed copy of Cupertino's Tear-Of Policy. ❑ OTHER: - ReroojApp_2011.doc revised 03/16/11 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 21103 WHITE FIR CT DATE: 09/05/2012 REVIEWED BY: MENDEZ APN: BP#: 'VALUATION: $4,500 *PERMITTYPE: Minor Building Permit PLANCIIECKTI'PE: Re-roof PRIMARY SFD Or Duplex PENTAMATION 1SFDWLROOF USE: PERMIT TYPE: WORK RE-ROOF 13 SO TEAR OFF WOOD SHAKE AND INSTALL CLASS A COMP SHINGLES SCOPE t FEE ID ROOFAREA s.f. 1REROOFFRES 1,300 Mech. Plan Check ; Plumb.Plop Chrak Flee.Plan Check Mech. Permit Fee: Plumb.Permit Fee: F:lec.Permit Fee: Other Mech. /n.sp. Other Plumb Insp. Ej Ober Elce.Insp. Sdech.Insp. Fee: Plumb. hasp. Fre: Elec.bap.Fee: NOTE: This awintate does not includejees due to other Departments(i.e. Planning. Public (Forks, Fire,Sanitary Sewer District,School District,etc. . These fees are based on the preliminan information available and are oniv an estimate Contact the Dept for addn'I in a. FEE ITEMS (Fee Resolution 11-053 E/T 7///1 U FEE QTY/FEE MISC ITEMS Plan Check Fee Supp/. PC Fee Phmib./Alech./Elec Permit Fee: $195.00 Supp/. Insp Fee Phtnb./Alevh.1Elec Plutnh./Alech.Xlec Permit Fee: Consnvetion Tits: Administrative Pee: Work Without Permit? O Yes 0 No $0.00 Advanced Planning Fees: Travel Documentation Fees: Strong Motion Pee: IBSEISMICR $0.50 Select an Administrative Item 131da Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $196.501 $0.001 TOTAL FEE: 7$196.501 Revised: 07/01/2012 REROOF TEAR-OFF POLICY COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL CUPERTINO 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 (408)777-3228• FAX(408)777-3333•buildinonD.cuoertino.oro PROJECT ADDRESS APN# Z o3 OWNER NAMEPHONE E-MAIL Ao s) ,r-ri'6 - STREETADDRESS 3 ^ CIN.STATE ZI FAX 2-11 O CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC.# 41A(08 1 CI-31 COMPANY NAME p p E-MAIL FAX P 6 SC'B$oINS In STREETADDRESS (-SbZ W. n - CITY.STATEZI!5 Ye � �I(� PHONE .0330 , J c7 Jw- 1 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%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. 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 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: Rerog1policr_201 l.doc revised 02/16111