12090038 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21097 WIIITE FIR Cf CONTRACTOR:FOUR SEASONS PERMITNO: 12090038
ROOFING
OWNER'S NAME: QU GONG YUAN AND BAD RITA PO BOX 1668 DATE ISSUED:09/102012
OWNER'S Pl1ONE: 4084379236 SAN JOSE,CA 95109 PHONE NO:(408)278-0330
LICENSED CO\FRAC'TOR'S DECLARATION JOR DESCRIPTION: RESIDF.N7IAL 11 COMMERCIAL
License Class C_ 3R Lie.N 4 );L1 Ok RE-ROOF 13 SQ TEAR OFF WOOD SHAKE AND INSTALL
Contractor
V_.to C"-' Date9n1d CLASS A COMP SHINGLES
1 herehy affirm that 1 am licensed under the provisions of Chapter 9
(commencing with Section 7000)of Division 3 of the Business& Professions
Code and that my license is in full force and effect.
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:54500
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of date work for which this
.U'N Number:35905078.00 Occupancy Type:
permit is issued.
APPI.IC.4N'I'CF.R'1'IFIGVI'ION
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 VV[TIIIN 180 DAYS OF PERMIT 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 DAYS FRObLAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments, J1
costs,and expenses which may aceme against said City in consequence of the -1 b - / t
granting of this permit. Additionally,the applicant understands and will comply Issued by: Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS;
Signature Date l0-- �- All roofs shall be inspected prior to any roofing material being installed. If a roof is
insmlled without first obtaining an inspection,I agree to remove all new materials for
inspection.
❑ OWNIER14ILDER DECLARATION
Signature of ApplicanC Batt.'—9-/O -/a
1 hereby affirm that I am exempt from the Contractor's License Law formic of
the following two reasons: ALL ROOFCOVE! IN .S I.
BE CLASS"A"OR BETTER
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,
Business&Professions Code) '
I,as owner of the property,am exclusively contracting with licensed contractors to 11A-LARDOIIS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business d Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California llenith&Safety Code,Sections 25505,25533•and 25534. [will
1 hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Ilealth&Safety Code,Section 25532(x)should I store or handle hazardous
I have mid will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should 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: / ate: C,-`O.
permit is issued
1 certify that in the performance of the work for which this permit is issued,1 shall
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California. If,ager making this cenificate of exemption,I CONSTRUC1 N LF LADING 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
,%PPLICAN'1'CF.R'I'IFIC,\TION Lender's Address
I cer ify that 1 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, ARCIIITF C1"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
CUPERTINO (408)777-3228• FAX(408)777-3333•building(cDcuoertino.ora
PROJECT ADDRESS APN• '_3
7_ 10,11
OWNER NAME �+ PHONE E-MAIL
l.-�on uwn � M3
STREET"ADDRESS �'0 C CI STATE.LIP M 7.38-03301 I FAX
CONTACT NAME PHO\E J�+E-NIA L
STREET ADDRESSS CITY.STATE. 21P FAY '"
❑OM'NFR ❑ MNER BUILDER ❑ OUNERAGERT A CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR.NAME LICF.NSENU.IBER _17.1 LICF.NSET'PE BUS,LIC.•
COMPANY NANIC E-MAIL FAX .
STREET.ADDRESS CIT\'.STATE.ZIP PHONE
Sot w ose C MIR-z"79-02&
ARCHI rECT,EeGINEER NAME LICENSE NUMBER BUS.LIC..
COMPANY NAME I E-MAIL FAX
STREET ADDRESS CITY.STATE LIP PHONE -
USE OF ❑ SFD or Duplex JL Multi-Family ROOF.AREA: A1( VALUATION:
STRUCTURE. ❑ Commercial ��// 5 s$—Q
EXISTING ROOF TN PE' ❑BUILT-UP ROOF ❑.ASPILALTSHINOLES PCOODSHAKES ❑U'OODSHINGLES ❑OTHER(SPECIFY)
RC\IOVF:REPLACE YE
S IFNO. PLYWOOD ilet., ❑ PLYUD SB ROOF
E'-LAYERSAS ❑ X
'I' CLASS
PROPOSED ROOF TYPE: ❑BCILT-UPROOF JRASPHALTSHINOLES ❑U'OODSIIAAES ❑"ODD SHINGLES ❑OTHER ICC.ES REPORT•
DESCRIPTION OF\\'ORI::
yZ 11
P
as a
Br my signature below.I ecnify to each of the following: I am the propem owner or authorized agent to act on the property owner's behalL have read this
application and the information I have provided is correct. I have read the Description of Work and verifyit is accurate. I agree to comply with all applicable local
ordinances and state laws rdalinR to building cans tion. I a orize represe tiv of Cupertino to enter the above-identified propery for inspection purposes.
Signature of ApplicandAgem: Date: O 12
SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY
_ If building is associated With a Home 0\ener's Association.provide letter PLAN CHECT:TYPE ROUTING SLIP
of approval from HOA. ❑ OVER-THE-COUNTER ❑ OUILOIN'C PLAN REVIEW
Provide Planning approval to verify if there any restrictions. ❑ EXPRESS ❑ PLAN:NIN'C PLAN'REVIEW
Provide copy of lNIanufaaurer's Installation Specification. ❑ STANDARD ❑ FIRE DEPT
Provide signed copy of Cupenino's Tear-OTT Policy. ❑ OTHER:
ReroojApp_2011.doc revised 03/16/11
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 21097 WHITE FIR CT DATE: 09/05/2012 REVIEWED BY: MENDEZ
12s APN: BP#: 'VALUATION: $4,500
*PERMITTI'PE: -Minor Building Permit PLANCIIECKTYPE: Re-roof
PRINIARY SFD or Duplex PENTAMATION 1SFDWLR00F
USE: PER11111T TYPE:
WORK RE-ROOF 13 SQ TEAR OFF WOOD SHAKE AND INSTALL CLASS A COMP SHINGLES
SCOPE
FEEID ROOFAREA
s.f.
1REROOFFRES 1,300
Meeh.flan Check Plumb. Plan Check Eke. Plan Check
Flech. Permit Fee: Plumb. Permit Fee: Flec.Permit Fee:
Other l,fech.Insp. Ocher Plumb Insp. Other Elee.Insp.
Mcch.Insp. Fee: Plumb. brsp.Fee: Elce.Insp.Fee:
!TOTE: This estimate does not include jecs clue to other Departments(i.e. Planning, Public{Narks, Fire,Sanitary Server District,School
District,etc. . These feev are hased on the preliminai3 information available and are adv an estimate. Contact the De t or adeln'I in o.
FEE ITEMS (Fee Resolution 11-053 F_!X 7/1/11) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Suppl. PC Fee
P1umb./A1e ch./Elec
Permit Fee: $195.00
SuppL Insp Fee
Phtmb./A1ech./Elec
Plumb./A1ech./Flee Permit Fee: 177
Construction Tac:
Adminisnotive Fee:
Work Without Permit? 0 Yes Q No $0.00
Advanced Planning Fees:
Travel Documentation Fees:
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $196.50 $0.00 TOTAL 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- buildingCoDcupertino.OL9
PROJECT ADDRESS APN a
� G
OW NER NAME. PRONE E-MAIL
b - - a36
STREET ADDRESS CITY.STAT IP Lf FAX
W U Pl
CONTRACTORNAMELICENSE NUMBER LICE�ETYPE BUS,LIC.p
COMPANY NAME E-MAIL FAX
e S /+
STREET ADDRESS CITY.ST IP fiOSC CB a P O E^ � 5-03
SO2 5 J DD
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 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: 9
ReroofPolicY 20ll.docrevised02/1611