12090206 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21068 WRITE FIR CT CONTRACTOR:FOUR SEASONS ROOFING PERMITNO: 12090206
OWNER'S NAME: KIIAN AYUD AND BEEGUM MOIIAMED S PO BOX 1668 DATE ISSUED:09252012
OWNER'S PIIONE: 6507869670 SAN JOSE.CA 95109 PHONE NO:(408)278-0330
Ipl LICENSED CON'FRACI'OR'S DECLARATION
gG� BUILDING PERMIT INFO:'BLDC r ELECT❑ PLUI\1B 4
License.Class C-31 Lic.M —(7 0�(�d
�^� AIECFI CRESIDENTIAL(J . COMMERCIAL F-]
fJ
Contractor �i II.)L Dale
!hereby affirm that I am licensed under the provisions of Chapter 9 - JOB DESCRIPTION:TEAR OFF EXISTING WOOD SHAKE ROOF.INSTALL I2"
(commencing oitt Section 7000)of Division 3 of the Business'&Professions CDX
Code and that my license is in full force and effect. PLYWOOD&309 FELT UNDERLAYM ENT.INSTALL 13 SQ CLASS
A CERTAINTEED PRESIDENTIAL COMP
1 hereby affirm tinder penally of perjury one of the following loo declarations:
I have and willmaintain 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 pemnit is issued: -
I hav2 and willojaintain;Worker's Compensidiom Insurance;as provided for by ,
Section 3760-of the Labor Code,for the performance 6f Ole work for which this
Permit is issued. - Sq. FI Floor Arco: Valuation:$4500
APPLICAN I'CERTIFICATION
I certify that I have read this application mid slate lhtn the above inl'omration is APN Number:35905104.00 Occupancy Type:
correct.I agree to comply with all city and county ordinances and state laws relating
to building construction,and hereby authorize representatives 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• PERMIT EXPIRES IF WORT{ IS NOT STARTED
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and 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. q
Signature Date / �Z .r;/2 Issued b Dale: J
❑ OWNER-BUILDER DECLARATION
hereby affirm that I on,exempt from the Contractor's License Law for 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 Signmure of Applicant: Date:
construct the project(Sec.7044,Business&Professions Code).
1 hereby affirm under penally of perjury one of the following three ALL ROOF COVERINGS TO RIs CLASS"A"OR BETTER
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS 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
I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safely Code,Sections 25505,2.5533,and 2.5534. 1 will mninlain
Section 3700 of the Labor Code,for the performance of the work for which this compliance it ith the Cupertino Municipal Code,Chapter 9.12 and the Ileallh&
Safely Code,Section 2553_(a)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 One work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Qualify Management District I will
not employ any person in tiny manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Compensation laws of California. If,alter making This certificate of exemption,1 Health&Safety Code.Sections 25505,25533.and 25534.
become subject to the Worker's Compensation provisions of the Labor Code,I must
forthwith comply with such provisions or this permit shall be deemed revoked. Owner or etfl mrized a nit:
APPLICANT'CER'1'IFICKf10N CONSTRUCTION LENDING AGENCY
I 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 City 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 will comply
with all non-point source regulations per the Cupertino Municipal Code,Section ,\RCII I"I'FCI"S DFCL.\R,\TION
9.18.
I understand my plans shall be used as public records.
Signature Date
Licensed Professional
o
} I REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO,CA 95014-3255
C (408)777-3228- FAX(408)777-3333- building oupertino.orc
I
PROJECT ADDRESS APN- 2X-9
2 1068 /�ilT;To r,'f G�.
OWNERNi,\IE PHONE , ^I - E-NIAIL
STREE'I'.ADDRE5S Z�O6A N/h .TC cif1 . ( I CI�n/)P/�inn CA . -'I�t�l \'f FAN
CONTACT NAME PHONE E-MAIL
re I 0 - -0 301
STREt I'ADDRESS Sot ^ CITY.STATE ZIP FAR
nlna S�'. I San TcS2.
❑OwNF.R ❑ ON'NER.HL'ILDER ❑ 0WNERAGENT XICONTILACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGI\'FFR ❑ DEVELOPER ❑ TENANT
CONTRACTOR N;AAIE LICENSENL'MBER LICENSETYPE BL'S.LIC.•
Fo.u.c�sae9 -4-7-LI oa c-a9 I ai3aa
COMPANYNAMB C.IAIL FAX
STREET ADDRESS CITY.ST.\TE.21P PHONE
SO'Z, o, 052 C -Z S-0
ARCHITECLENGINEER NAME I LICENSE NUMBER I BUS.LIC.^
COMPANYN:AME I E-NIAIL FAX
STREET ADDRFSS I CITY.STATE.ZIP I PHONE
LSE OF ❑ SFD or Duplex If Multi-Family ROOF AREA: \:ALUAT10S:
STRUCTURE: ❑ Commercial / $ L/ j(�
El ;
EXISTING ROOF TYPE: ❑BUILT-UPROOF ASPHALT SHINGLES GOOSHAKE:S ❑\VOODSHINGLES 001HER(5PECIF\}
REMOVF. REPLACE ATIYES IF NO. PLYI\ODD jdtz" Cl PLIl\'D 11 OSB PITCH: ROOF
ElN . AYFR . I THICKNESS ❑ s- 1\'PE' DY 'I LA A
d
PROPOSED ROOF TYPE. ❑BUILT-UPROOF /.ASPHALT SHINGLES ❑e'OOD SHAKES ❑\s OOD SHINGLES El OTHER IMES REPORT:
DFSCRIPTION OF\FOR::: ,/Z E f
7N�ae n4 on S�alte
e 0# aer�en+ . Flnallu - i
140400A PreS1Arft+&.i
6� a
By my signature below.I certify to each of the follo%ving: I am the property oltner or authonzed agent to act on the property owner's behalf. 1 have read ribs
application and the information I have provided is correct. I have read the Description of Work and verifv it is accurate. I agree to comply with all applicable local
ordinances and state IaWs relating to building const- tiona orize represe� tiv of Cupertino to enter the zbove-identilled property for inspection purposes,
Signature of ApplicanVAeent: Date: aO
SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY
_If building is associated With a Home 0\\ner'S Association.provide letter PLANK CHECK TYPE ROUTING SLIP
ofapproval from HOA. ❑ OVER.THE-COPNTER ❑ BUILDING PLAN REVIEW
Provide Planning approval to Verify if there any restrictions. ❑ ECPRFSS ❑ PLANXING Pl.A9 REVIEW
Provide copy of Manufacturer's Installation Specittiications. ❑ STANDARD ❑ FIREDEPT
Provide signed copy of Cupenino's Tear-Off Policy. ❑ OTHER:
ReroofApp_1011.doc revised 03116111
12091 02v�
CITY OF CUPERTINO
FEE ESTI O BUILDING DIVISION
ADDRESS: o (r DATE: REVIEWED BY:
APN: BP#: *VALUATION: 1$4,500
*PERMIT T1'PE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD or Duplex PEERMIT TYPE:NTAMATPE: 1SF0WLR00F
USE: P
WORK TEAR OFF EXISTING WOOD SHAKE ROOF.INSTALL 1/2" CDX PLYWOOD& 30# FELT
SCOPE UNDERLAYMENT.INSTALL 13 SQFT CLASS A CERTAINTEED PRESIDENTIAL COMP p
FEEID ROOFAREA
s.L
1REROOFFRES 1,300
t -
Heeh.Phut Cheek Plumb. Plan Check Elec,Plan Check
ble:h. Permit Fee: P/umh.Permit Fee: FE/,r. Permit Fee:
01110-Mech.Insp. Olhej Pivadr hup, plhew Elec..lnsp.
Hech.lm/t. Fee: Pluarb.htap.Fee: filer./nsp. Fee:
NOTE: This evinunte does not includefees due to otter Depanmentr(i.e. Planning,Public Works, Fire,Sanitary.Sewer District,School
District,etc.). Three fees are based nn the prelitrinat3 in ornuaian available and are adv an estinmte. Contact the Dept for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 Elf 7/1/11) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Suppl.PC Fee
Phanb../.Vech..Elr<:
Permit Fee: $195.00
Suppl. Insp Fee
Phanh..Mcch.:Elec
Phtmh.1,Wach..-Elec.Permit Fee:
Construction Tax:
Administrative Fee:
Work Without Permit? O Yes (D No $0.00
A dvanced Planning Feta:
Travel Docarmntation Fees: A.
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1:00
1.
SUBT.OTAL;SS $196.50 $0.00 TOTALFCG ; $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(a)cuoertino.org
PROJECT ADDRESS 'f 1068 li) l. � Ftf G+. APNb
OWNER NAME nL �GO �w VI PHONE E-MAIL
H a� 6so--78'& 6-701
STREET ADDRESS w r CIN,ST F ZIP !-n FAX
SRMG Ai0 .�V
CONTRACTOR NAME I L4 LICENSE NUMBER LICEff TygBUS.LIC.#
a o X11 �t
COMPANY NAME E-MAIL FAX
ou SG..r o/tS
STRF.ETADDRFSS CITY.STAT IP P ONE
SoZ Nornin S+- a 'To S¢ CA 9 .' -le-0330
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 S 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 11314 and R315 of
the 2010 California Residential Code.
Signature of Applicant/Agent: Date: -12 Y-12
ReroofPo1icv_201 l.doc reviser)02/16/11