12090070 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21110 WIIITE FIR CT CONTRACTOR:FOUR SEASONS PERMITNO: 12090070
ROOFING
OWNER'S NAM F: SON VU PO BON 1668 DATE ISSUED:09/132012
OWNER'S PI IONE: 4082916705 SAN JOSE,CA 95109 PIIONE NO:(408)278-0330
LICENSED CONI'RACI'(1R'S DECLARATION .1011 DESCRIPTION: RISIDEN'r1AL COMMERCIAL
License Class C' 3 ( Lic.# �7910k TEAR OFF EXISTING WOOKSHAKE AND INSTALL 1/2"
COX
Contractor ESR-; 100- Date PLYWOOD THEN 30# FELT UNDERLAYMENT, INSTALL
1 hereby affirm that I am licensed under the provisions of Chapter!) CERTAINTEED PRESIDENTIAL COMP SHINGLES
(commencing with Section 7000)of Division 3 of the Business& Professions
Code and that my license is in full force and effect.
hereby affrm under penalty of perjury one of the following tw'a declarations:
1 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.PI Floor Area: Valuation:54500
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for die performance of the work for which this
\I'N Numhrr.35905083.00 Oecupnncy'I'ype:
permit is issued.
nPr1.ICAN'r cER'ru�Ic,rr1DN
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 complywith all city and county ordinances and state laws relating WITHIN 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 FRO LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the y I Z
granting of this permit. Additionally,the applicant understands mid will comply Issued b)•: Dale:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RF-ROOFS:
Signature Date 2 All roofs shall be inspected prior to my roofing material lac hg installed.If a roof is
installed without first obtaining an inspection,1 agree to remove all new materials for
inspection.
❑ ON', .R-BUILDER DF,CLARATION p
.Signature of Appli Date:
I hereby affirm that I am exemptfrom the Contractor's LicenseLaw for one of
the following Iwo reasons: AL1,ROOF COV' NGS T'O BE CLASS"A"OR IIE'I'FER
1.as owner of the property,ormy employees with wages as their sole comrEnsation,
will do the work,rid die structure is not intended or offered for sale(Sec.7044,
Business R Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to 11AZ\RDOIIS 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 Ilealth S Safety Code,Sections 25505,25533,and 25534. 1 will
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 S Safety Code,Section 25532(a)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 Section3700 of the Labor Code,for the air contaminants as defined by the Bay,Area Air Quality Management District I
performance of the work for whichthis permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,m provided for by the Health S Safety Code.Sections 25505,25533,and 25534.
Section 3700 of the Labor Code,for die performance of the work for which this
Owner or authorized agent:
permit is issued. Mate:
I cenify that in the performance of die work for which this permit is issued.I shall
not employ any person inany manner so as to become subject to the Worker's
Compensation laws of California. If,after making this certificate of exemption,I CONS'IR II )N LENDING AGFNCY
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 pemhit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICA\1'CFRTIFICATION Lender's Address
1 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 mid state laws relating
to building construction,and hereby authorize representatives of this city to enter
upon die above mentioned property for inspection purposes.(We)agree to save ARCIII'1'F.CI"S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilitics,judgments,
costs,and expenses which may accrue against said City in consequence of die I understood my plans shall be used as public records.
granting of this permit.Additionally,the applicant understands mid will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
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(dcugertino.org
PROJECT ADDRESS `^ / 4(14j/-e,
` _ APN0
OWNER NAME � ,3 PHONE E-MAIL
/uS C
STREET ADDRESS CITY.ST 7.IP FAX
S A
CONTRACTOR NAME LICENSE NUMBER LICENS PE BUS.LIC.k
LI-79 Ing
COMPANY NAME E-MAIL FAX
So
STREETADDRESS CITY.STA P /� PHONE a
nT A D C O
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 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, 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:
Rer-oofPo1icv_2011.doc revised 02/16111
REROOF PERMIT APPLICATION
COMMUNIV DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO.CA 95014.3255
CUPERTINO (408)777-3228• FAX(408)777-3333 • buildino(okupertino.oro
4�09 00 70
PROJECTADDRESS Z111O G F1,r C4 Ap\• DL �2
OWNERNa.S1E �o .a 6CE
s lV867_381 4
V
E-A1AIL
STREEfADORESS CI ' STATE.ZIv 1 FAS
2 t r so 14
CONTACT NAME PHONE E-?JAIL
-0 30
STREET ADDRESS Sc214,ormnq S CITY.STATE.LIP ecn Tose. CA . qn FAS
❑OWNER ❑ OANER-RUILDER ❑ OWNER AGENT JICONTMCTOR ❑CONTRACTOR AGENT, ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TEFnnT
CONTRACTORNAME LICE SENL'NIBER LICENSE 'PE BUS.LIC•
9 a 13_Q-a
COMPANY N'AMC E-MAIL FAN
STREET ADDRESS• CITY.SLATE.ZIP PHONE
SoZ o -lase . C 8-0
,ARCHI TECTrENGINCER NAME LICENSE NUMBER BUS.LIC.
COMPANY NAME I E-MAIL- FAN
STREET ADDRESS CITY.STATE ZIP PHONE
LSE OF ❑ SFD or Duplex i Multi-Family ROOF AREA: VALUATION,
STRUCTURE: ❑ Commercial SQ. SQ
EXISTING Roor TYPE: ❑BUH.T-UPROOF ❑ASPIIALTSHINGLES Pil!WOODSHAKES ❑WOODSHINGLES 1101 HER
RCNIOVF.:REPLACE YES IF NO. PLY\\'ppD .' ❑ PLYWD ❑ OSB PITCH: ROOF
❑ N . AYE0. ICKy ❑ /d" Ty :I2 A A.
PROPOSED ROOF T1'PE: ❑BLALRUPROOF IMES RDPORT•
� ASPHALT SHINGLES ❑\\'(x1D SHAKES ❑\\GOD SHINGLES CI
DESCRIPTION OF U'ORKa _ %/Z Coy
e[11
Cer
ff d
By my signature below.I certify to each of the followine: I am the property miner or authorized agent to act on the propem'owner's behalf. I have read this
application and the information I have provided is con ect. 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 orize represe civ so"C upertino to enter the above-identilicd property for inspection purposes.
Signature of ApplicanVAgent: Date: O
SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY
_If building is associated with a Home OAeners Association,provide letter PLAN CHECK TYPE ROUTING SLIP
of approval from HOA. ❑ OA`ER-THECOUNTER ❑ BUILDINGPLANREVIEW
_Provide Planning approval to verify if there any restrictions. 1:3 ❑ PLANNING PLAN REVIEW
Provide copy of Manufacturer's Installation Specifications. ❑ STANDARD ❑ FIRE DEP-r
Provide signed copy of Cupenino's Tear-OfT Policy. ❑ OTHER:
ReroojApp_201I.doc revised 03/16111
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 21110 White Fir Ct DATE: 09/11/2012 REVIEWED BY: Beth
APN: 35905083 131'#: 12090070 VALUATION: $4,500
•PERMIT'TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD or Duplex i'ENNIIT TYPE:
1SFDWLR00F
USE: PERMIT Tl't'E:
WORK sin le family residential re-roof
SCOPE
FEEID ROOFAREA
s.f.)
1REROOFFRES 1,300
Moth.Plan Chcvk Plumb. Plan Check Elae.Plan Check'
Flesh. Permit Fee: Man&Permit Fee: Gee. Permit Pcc:
Other Atech. imp. Other•Plumb lisp. - Other Elea imp. Ll I
:Vech.hasp.Fee: Plumb. hup. Fee: Oct..hrsp. Fee:
NOTE: This estitnare sloes not include fees(lite to other Departments(i.e. Planning, Pablic Works, Fire,Sanitary Sewer District,School
District, etc. . These fees are based on the prelitninarl information available and are only an estimate. Contact the Dela for athin'I in o.
FEE ITEMS (Fee Resolulion 1/-053 Elf 7/1/11) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Suppl.PC Fee
PlumGrAfr:ch.:Elec•
Permit Fee: $195.00
Suppl. lnsp Fee
PlumbAllech.:Elec•Permit Fee:
t:onsnvciion Tax
Adminisirative Fes'•
Work Without Permit? O Yes (j) No $0.00
Aelvanced Planning Fees:
Travel Documentation F¢es:
Strong Motion Fee: 1BSEISd11CR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00
SUBTOTALS: $196.50 $0.001 TOTAL FEE: 1 $196.50
Revised: 07/01/2012