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12090243 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRIiSS: 21056 WI IrrE FIR Cf CONIfRACI'OR:FOUR SEASONS ROOFING PERMITNO: 12090243 OWNER'S NAME: MURRAY BUGENIA PTRUSTEE PO BOX 1668 DA'Z'E ISSUED:09272012 OWNER'SPBONE: 4085310904 SANdOSF.,CA 95109 PIIONENO:(408):78-03.70 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG C ELECT Ci PLUMB r License Class C�3q Lie.9 /G6 r_ r C ,Ay RR �7--�� MECII RESIDENTIAL COMMERCIAL Contractor Date 7.6>--�'= hereby affirm that I am licensed under the provisions of Chapter 9 306 DESCRIPTION:TEAR OFF EXISTING WOOD SHAKE ROOF.INSTALL (commencing with Section 7000)of Division 3 of the Business&Professions 12"CDX PLYWOOD&304 PELT UNDGRLAYMENI'.INSTALL 13 SQ Code and that my license is in full force and effect. CERTAINTEED PRESIDENTIAL COMP 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 Arca: Valuation:$4500 APPLICANT CER-I'IFIG\'PION I certify that I have read this application and state that the above information is APN Number:35905110.00 OccupancyType: correct.1 agree to comply with all city and county ordinances and state Imus 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 WORD 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 18 IT ISSUANCE OR with all non-p . tsource re_gul ions per the Cupertino Municipal Code,Section 180 DA FROM LA ED INSPECTION. 9.18. Signaw Date7'O��—�� Issued by; Date: ❑ OWNER-BUILDER DECLARA'T'ION hereby affirm that I am 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 beteg installed.If a roof is I,as owner of the property,or my employees with wages as their sole compensation, installed withou 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. �7 Business&Professions Code) �4y 7 I,as owner of the property,am exclusively contracting with licensed contractors to Signature of ApplimnP Date: construct the project(Sec.7044,Business&Professions Code). hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's IIAZARDOUS SLST'ERIAI S 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 Ilealth&Safely Code.Sections 25505.25533,and 25534. 1 will maintain compliance with the Cupertino Municipal Code.Chapter 9.12 and the health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code.Section 25532(x)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 forwhich this permit is issued.I shall contaminants as defined by the Bay Area Air Quality Management District I will not employ any person in any 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,after making this certificate of exemption,I Ilcallh&Safety Co e,Se/W.ions 25505,25533,and 25534. become subject to the Worker's Compensation provisions of the Labor Code,I must / w r r auth ienC n -2_ fortbrith comply with such provisions or this permit shall be deemed revoked. Date: `/'a 7^ APPLICANI'CF.RTI FICA TION CONSTRUCTION LENDING,%GENCV 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 Imes 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 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 ARCIIITF-CI"S DECLARATION 9.18. 1 understand my plans shall be used as public records. Signature Dam Licensed Professional oZ� ( 3 REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 GUPERTINO (408)777-3228• FAX(408)777-3333•buildingocuDertin�o-.rorct PROIER:\UD�ES15/Q. APSv / G I lJ OWNER PHONE E-MAIL 0 STREET-AU 'lDCI STATE,ZIP FAX ir C4% . ,its-0114 CONTACT NAME PHONE E-MAIL � -0 30 STRELIADDRESS5,62— S CITY.STAIF,ZIPwarlllAq FAX ❑Ox'NF.R ❑ OWNER-RUILOER ❑ OWNER AGENT 'I COWRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT C'ONrRACTOR NAME LICF.NSENUMBER LICENSEE PE BUS.LIC. COMPANY NAME E-MAIL FAX SAkE NJ STREET ADDRESS CLTV.STATE.ZIP I PHONE -O f_l S"07-S"07- a cSe C OE ARCH:TECTIENGINBER NAME LICENSE NUMBER BUS.LIC.+ COMPANY NAME E-MAIL FAX STREET ADDRESS CITY.STATF_ZIP PHONE USE OF ❑ SFD or Duplex Y, Multi-Familv ROOF AREA: VALUATION: STRUCTURE! ❑ Commercial aayy �JQ_ LS"Q EXISTING ROOF TYPE: ❑BUILT-UPROOF ❑ASPIULT SHISGLES JKVOODSHARES ❑WOODSHINGLES ❑OTHER(SPECIFY) REMOVF.:REPLACE YF.S IF NO. PLYWOOD id1ic' ❑ PLY(\'D ❑ OSB P11 CHROOF CLASS ❑ N -LAYERS ICENF ❑ 5,s' :)? A PROPOSED ROOF TYPE: CI BUILT-UP ROOF yiiSPH.ALT SHINGLES 11 WOOD SHAKES ❑IIOODSHISGLES ❑OTHER ICC-FS REPORT M DESCRIPTION OF N'ORN: Pluu3c)OA +lLen ' CEf�wSn'�sec� Prestdenk�ol cena�5�inw�eS (inlet : Cn-�un� 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. I have read this. application and the information I have provided iS correcL. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relatine to building Cons Lion. )a- ori ze represe tiv c o;'Cupertino to enter the above-identified property for inspection purposes. Signature of ApplicanUAgenE Date:4421 Pal.2_ SUPPLEMENTAL INFORMATION R17QUIRED OFFICE USE ONLY _If building is associated with a Home Owner's Association.provide letter PLAN CHECK TYPE -ROUTING SLIP Of approval front HOA. ❑ .OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW Provide Planning approval to vcrify if there any restrictions. ❑-EXPRESS ❑ PLANNING PINK REVIEW Provide copy of Manufacturer's Installation Specifications. ❑ STANDARD ❑ FIREDEPT Provide signed copy of Cupertino's Tear-Off Policy. ❑ OTHER: ReroojApp_Nll l.doc revised 03/16117 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 0 C, —fin-- DATE: REVIEWED RY: APN: RP#: *VALUATION: $4,500 *PER,MITTYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof PRIMARY SFD or Duplex PENTAMATION 1SFDWLR00F USE: PERb11T TYPE: 19 WORK TEAR OFF EXISTING WOOD SHAKE ROOF.INSTALL 1/2" CDX PLYWOOD &30# FELT SCOPE LIN DERLAYM ENT.INSTALL 13 SO CERTAINTEED PRESIDENTIAL COMP SHINGLES.COLOR: 0 FEEID ROOFAREA (s.L) 1REROOFFRES 1,300 Hoch.Pl:m Check Phunb.Plan Chca:k Elea Plan Check ;tlierh. Permit Feer P/untb.Permit Fee: Elec. Permh Fee: O/he)-Heck Ins/:. Other Plumb brsp. Other Elec. brsp. Hech.Imp. Fee: Plumb.Im"P.Fee: Etec.Insp. Fee: NOTE: This estimate does not include fees due to other Departments(i.e. Planning,Public Nrorks, Fire,Sanitary Sewer District,School District,etc.). These fees are based on the prelininan•in ornmtion available and are adv an astinmte. Contact the Dept for addn'I info. FEE ITEMS (Fee Resohuion 11-053 E(f 7/1/111 FEE QTY/FEE D11SC ITEMS Phan Check Fee: Supp(.PC Fee Phonh.;''1Verh.!Elec Permit Fee: $195.00 Suppl, Lisp Fee Plumh_-'lWcrh..Elcc Permit Fee: Construction Tax Administrative Fee: Work Without Permit? O Yes (D No $0.00 Ach•un<ed Planning Fees: Trcme(Documentation Fees: i Strong Motion Fee: 18SEISM/CR $0.50 Select an Administrative Item Bldg Sids Commission Fee: /eCeSC $1.00 SUBTOTALS: $196.50 $0.00 TOTAL FEE: 1 $196.50 Revised: 07/01/2012 REROOF TEAR-OFF POLICY 0 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•building0cuoertino.orn PROJECT AD S APNa A JO i OWNERN Pon_ �r O E-MAIL STREET ADDRESS C ,STATE,ZIP 7 FA% b � 0� CONTRACTOR NAMLICENSE NUMBER LIC E TYPE BUS.LIC.a STREET PA ME E-MAIL FAX ADD S -2 .5 - JP P ^- 9 r � (J NDERSTAND AND AGREE TO THE FOLLOWING: d I. 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 Residentia de. Signature o(ApplicanUAgent: Date: �'-o� ReroofPolicr_2011.doc remised 02/l6/I I