12090171 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21100 WHITE FIR Cf CONTRACI'OR:FOUR SEASONS ROOFING PERJ11'I'NO: 12090171
OWNER'S NAME: HSU WAN-YEN ETAL PO BOX 1668 DATE ISSUED:09/192012
OWNhR'S PHONE: 4082573356 SAN.IOSE,CA 95109 PHONENO:(408)278-0330
L LICENSED CO\I'RAC`f0R('SDECLARATION BUILDING PERI\II-I'INFO: BLDG (- ELECT'r PLUMB[
License Class C— 3 '
Lic.# � / a I0
np � t NIECII r RESIDEN'T'IAL r__ COMMERCIAL r
Contractor �SF . l f"C• Date l q--I p l '�2•
�— JOB DESCRIPTION:TEAR OFF EXIS'T'ING WOOD SHARE ROOF.INSTALL 13
hereby affirm that I um licensed under the provisions of Chapter 9
(commencing with Section 7000)of Division 3 of the Business& Professions SQRS
Code and that tar license is in full force and effect. 12"CDX PLYWOOD,3'HEN 30#FELT UNDERLAYMENT.
INSTALI.CERTAIN]1717D PRESIDENTIAL COMPOSITION
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,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
permit is issued Sq.Ft Floor Area: Valuation:54500
AI'1'I.ICANI'Cr:R'rD'IGrrION
I certify that I have read this application mid state that the above information is APN Number:35905088.00 Occupancy Type:
correct.I agree to comply with all city and county ordinances and state laws relating
to building construction,and hereby authorize representatives ofthis 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, PERMIT EXPIRES IF WORK IS NOT STARTED
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understandsand will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR
with all non-point source regulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION.
9.18.
Signature q �� • Issued by: Date:
J�aL
❑ OWNER- 1,I)ER IIECUARA'1'R).N
1 hereby affirm that 1 am exempt from the Contractor's License Lawfar one of RE-ROOFS:
the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
1,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I agree to remove all new materials for
will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection.
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicanr Date:
construct the project(Sec.7044,Business'&- Professions Code).
hereby affirm under penalty of perjury one of the following three AL1,ROOF COVERIN S'f0 RE CLASS"A"Olt B1717ER
declarations:
I have and will maintain it Certificate of Consent to self-insure for Worker's 11.\%,\Rl101iS M,\'I'EIt DISCLOSURE
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 read the hazardous materials requirements under Chapter 6.95 of the
1 have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code.Sections 25505.25533,and 25534. I will maintain
Section 3700 of the labor Code,for the performance of the work for which this compliance with the Cupertino Municipal Code,Chapter 9.12 and the I lealth&
Safety Code,Section 2553_(.)should I store or handle hazardous material.
permit is issued. Additionally,should I use equipment or devices which emit hazardous air
I certify that in the performance of the work for which this permit is issued I shall contaminants as defined by the Bay Area Air Quality Management District 1 will
not employ any person In any manner so as to become subject to die Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Compensation laws of California. If,after making this certificate of exemption,I Ilealth&Safety Code.Sections 25505,25533,and 25534.
become subject to the Worker's Compensation provisions of the Labor Code,I must
Iorthwith comply with such provisions or this permit shall be deenned revoked. Own eryrifuthoet agent:
Date: 2__�9—iZ
UTI IC\N'I'CFR"I'IPIC\'PION CONSTRUCf1ON LENDING..AGENCY
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 and state laws relating I hereby affirm that there is a construction lending agency for the performance of work's
to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097.Civ C.)
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name
indemnify and keep harmless the Cit'of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the Lender's Address
granting of this permit.Additionally,the applicant understands and wilfcomply
with all non-point source regulations per the Cupertino Municipal Code,Section ARCIIIT'ECI"S DECLARATION
9.18.
1 understand my plans shall be used as public records.
Signature Date
Licensed Professional
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 21100 White Fir Ct DATE: 09/14/2012 REVIEWED BY: Sean
APN: 359 QS_dS 'BPtI: /. 090 ] 'VALUATION: $4,500
"PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY Multi-Family Dwelling Buildina is PENTAMATION 1R2R00F
USE: >3 Stories O Yes 0 No PERMITTYPE:
WORK Tear off existing wood shake roof. Install 1/2" CDX plywood then 30# felt underla ment. Install
SCOPE Certainteed Presidential Composition shingles. Color: Country Gray.
FEE ID ROOFAREA
s.f.
1REROOFMRES 1,300
Mech. Plan Check Phunh.Platt Check rlee. Plan check
M1lech. Permit Fee: Phmrh. Permit Fee: Clec.Permit Fee:
Other Alech. Insp. Other Plumb Insp. Otter Elce.lasp.
Ale.ch. Insp. Fee: Plumb. lisp. Fee: Elec.btsp.Fee:
NOTE: This estimate does not include fees clue to other Deparonents(i.e. Planning, Public I1'orks, Fire,SanitarySewer District,School
District, etc. . Thesefees are based an the prelintinan information available and are only an estimate. Contact lite De t or addn7 info.
FEE ITEMS (Fee Resolution 11-053 F2 711111) FEE QTY/FEE MISC ITEMS
Plan Chuck Fee:
Suppl. PC Fee
Plumb./Ale ch./Clec
Permit Fee: $195.00
Supp/. /mvp Fee
Plumb./Alech./C1ec.
Plumh.Allech./F.lec Permit Fee:
Construction Tar:
Administrative Fee:
Work Without Permit? 0 Yes 0 No $0.00
Advanced Planning Fees:
Travel Documentation fees: A
Strong Motion Fee: PBSEISMiCR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: 1 $196.50 $0.001 TOTAL FEE: $196.50
Revised: 07/01/2012
REROOF PERMIT APPLICATION
COMMUNITY iDEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 -
CUPERTINO (408)777-3228• FAX(408)777-3333•buildinoCdcupertino.org
71
PROJECT ADDRESS //00
DDRESS //o O ZilAto46 AP\• sI ssJ� 5 /l�E
OWNERNNME PHONE ✓' EAIAIL C/
2 S'1-3
STREEI'ADDRESS Q ��� CI STATE.ZIP M ' FAN '
J 0+ i 1
CONTACT NANIF PI IO 30� EAIAIL I
STREET ADDRESSSat CITY.STATE.ZIP FAX
Cl94
OU'NFR ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NNNIE LICENSE NL:%IBER 0 LICENSE PE BUS LIC.
'
213
COMPANY NAME E-.NIAIL FAX
STREET ADDRESS CITY,STATE.ZIP PHONE
SO Z, Q O$Q. C 8'0
ARCHITECT,ENGINEER NAME LICENSE NUMBER BUS,LIC.
COMPANY NAME E-NULL FAX
STREET ADDRESS CITY.STATE.ZI P PHONE
USE OF ❑ SFD Or DupleN JIC MUI[I-Fam11\' ROOF ALUATION: 0 n 3
STRUCTURE: ❑ Commercial �ayr S S(J
EXISTING ROOF TYPE: ❑BUILT-LP ROOF ❑ASPIIALTSHINOLFS JIGOODSHAKES 13 WOOD SHINGLES ❑O`rHER(SPECIFY)
RE}IO\'F.:REPLACE YES IF N'O. PLYWOOD ❑ PLN'\\'D ❑OSB PITCH; •12 ROOF A
❑ N YF.R . THICKNESS ❑ / TVP
PROPOSED ROOF TYPE; ❑BCILT-UP ROOF XISPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT:
DESCRIPTION OF\PORI:: Z"
Cox
e* 0.
By my signature below.I certify touch 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 itis accurate. I agree to comply with all applicable local
ordinances and state laws relating to building cons tion. I a Orin represe tiv of Cupertino to enter the above-identified property for inspection purposes.
Signature of ApplicanJAgent: .Kate:
SUPPLEMEWAL INFORMATION REQUIRED - OFFICE USE ONLY
_ If building is associated with a Home 0%%ner's Association.provide letter PLAN CHECK TYPE ROUTING SLIP
of approval from HOA. OVER-THE-COUNTER BUILDING PLAN REVIEW
Provide Planning approval to verify if there any restrictions. ❑ EXPRESS ❑ PLAN'NINC PLAN REVIEW
Provide copy of Manufacturer's Installation Specification. ❑ STANDARD ❑ FIREDEPT
Provide signed copy of Cupertino's Tear-Off Policy. ❑ OTHER:
ReroofApp_2011.doc revised 03/16111
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(dcuoertino.orci
PROJECT ADDRESS// / �A�PNp�- �J 5;/2 /'
OWNER NAME E-MAIL
_ Vot, //
STREET ADDRESS
CITY STATE ZIP FAX
21106 dl
CONTRACTOR NAME ciicL ST LC/ CE I WMSGBTEARTE,ZIP b L =EBUS.
LIC.a� gj Ol
COMMspasolta DOE-MAIL FAX
STREETADDRa 5// PHO
Z -0.4 o
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, 1 certify each of the following is true: I am the property owner or authorized agent to act on the
property owner's behalf. 1 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 11314 and R315 of
the 2010 California Residential Code.
Signature of Applicant/Agent: Date:
RerogtPolic —2011.doc revised 02116111