12090239 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21064 WHITE FIR Cr CONTRACTOR:FOUR SEASONS ROOFING PERMIT NO: 12090239
OW'NER'S NAME: ROGER WANG PO BOX 1668 DATE ISSUED:09272012
OWNER'S PHONE: 4087371360 SAN JOSE,CA 95109 PHONE NO:(408)278-0330
❑ /yLICENNSyED CON`rRACI'OR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
License Class ( —3 / Lie.9 Y �o�T r r r
/��L1(y������/��.y^ h1ECII RESIDENTIAL COMMERCIAL
Contractor Y/7`-I I xY�J Date �•. r- �%
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:TEAR OFF EXISTING WOOD SHAKE ROORINSTALL
(commencing with Section 7000)of Division 3 of the Business A Professions 1(_t"CDX
Code unit that my license is in full force and effect. CERTAIOD&308 FELT DENTIA LAYMENT.IN$TALL 17 SQ
CERTAINTEED PRESIDENTIAL COMP
I hereby affirm under penalty'of perjury one of the following mo 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 die work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$4500
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is APN Number:35905106.00 Occupancy Type:
correct.I agree to comply with all ciy and county ordinances and state laws relating
to building construction,and hereby authorize representatives of this city to enter
upon the abode 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 understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR
with all non-point source�gula ions per the Cupertino Municipal Code,Section 180 DAYS FROM ALLED INSPECTION.
9.18.
Sign. Date9-,?;7- 2 Issued by: Date:
❑ OWNER-BI DAWR DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of RF;ROOFS:
the following two reasons: All roofs shall be inspected prior to any roofing material beteg installed Ira roof is
I,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an insp• tion,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 3 Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to Signature of Appli Date:
construct the project(Sec.7044,Business B Professions Code).
I hereby affirm under penally of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BE ITER
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 office
1 have and will maintain Worker's Compensation Insurance,m provided for by California Ilcalth&Safety Code.Sections 2550.5,25533,acid 25534. 1 aill maintain
Section 3700 ollhe Labor Code,for the perfomtance of the work for which this compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health
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 became subject to the Worker's maintain compliance with the Cupertino Municipal Code.Chapter 9.12 and the
Compensation laws ofCalifomin. If,after making this certificate of exemption,I Ilea It &S afe •Code.Sections 25505.25533.and 25534.
become subject to the Worker's Compensation provisions of the labor Code,I muss
forthwith comply with such provisions or this permit shall be deemed revoked. mer or/
r. d agent Date a_�y� 1-2
/ oC
APPLICANT CERTIFICATION CONSTRUCI'ION LENDING AGENCY
I certify that I have read this application and state dial the above information is
correct.1 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 perfomtance of work's
to building construction,and hereby authorize representatives of this city to enter for which Otis 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 Ciy 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 ARCAITEC71"S DECLARATION
9.18.
1 understand my plats shall be used as public records.
Signature Date
Licensed Professional
j2v� v23`�
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO.CA 95014-3255
CUPERTINO (408)777-3228• FAX(408)777-3333•buildintl(o)cupertino.oro
PROIECr ADDREStZ/ -y/ C AP\e �� C
C
-O ! - 'I, / PHONE — --/- IE-MAILL ✓ 1
$TREE'I'ADDR CI STATE.LIP � FAX
G
CONTACT NAME PHONE EMAIL
STRELT ADDRESS TCZ CITV.STATF ZIP FAN
❑OU'NF.R ❑ OWNERRUILDER ❑ OWNER AGENT A(CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEF.R ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME LICE SENI:NIBER I IJCF.VSET'PE BUS,LIC.-
COMPANY NAAJE E-MAIL FAS
SAME NJ
SrRECT ADDRESS SoZ CITY.STATE ZIP 4 oSe Ls^ Q
I PHONE _O
ARCHI FECLENGINEER\AME LICENSE NUNIBER BUS.LIC.a 8
COFIPANY NAME E MAII. FAX
STREET ADDRESS CITY.STATE/.IP PHONE
USE OF ❑ SFD or Duplex Alf Multi-Family ROOF AREA: +e vucano% O
STRUCTURE: ❑ Commercial sa. $�Q
EXISTING ROOF TYPE: ❑BUILT-UPROOF ❑ASNIALTSHINGLES r`VOODSHAKF.S ❑W'OODSHINGLES ❑OTHER(SPECIFY)
REMOVF.:REPLACE 1'F.S IFN'O. PLYWOOD jet... ❑ PLYl1'D ❑ OSB PITCH: ROOF
❑ N \'F.R I KNE ❑ B' TYPE' X .1` A A
PROPOSED ROOF TYPE: ❑BUILT-UPROOF 26SPH.ALTSHINGLES 11 WOOD SHAKES ❑%%OOD SHINGLES ❑OTHER ICC-FS REPORT
DESCRIPTIONOFNI'ORK: � s6
IPni n4 PYS
I �,IIa �—► u e f0 =AS+aII � ZCD
s}w_ooc� +I,en 30# -e' i+ UINd tAcdI iAC�Oli
CerkoSnke*,A 9restdeo4i camp shie% les _ CtaleC : CnuA401 CA CO-Y
By my signature below.I certify to each of the following: I am the propeny owner or authorized agent In act on theproperty owner's behalf. I have read this
application and the inibrmation I have provided is correct. I have read the Description ol'WorR and verify it is accurate. I agree to comply with all applicable 1=1
ordinances and state laws mlatine to building cons Zion. I a oris Mixes e tiv of Cupertino to enter the above-identified property for inspection purposes.
Signature of ApplicanUAgent: k Date: yr
SUPPLEMENTAL INFORIMATIOtNI REQUIRED OFFICE USE ONLY
_ If building is associated vvith a Home Ow'ner's Association.provide letter PLAN'CHECK TYPE -ROUTING SLIP
of approval from HOA. ❑ ,OVER-TTIFrCOUNTER ❑ BUILDISOPLANREVIEW
Provide Planning approval to verify ifthere any rCSIri coons. ❑ FaPRF55 ❑ PLANNING PLAN REVIEW
_ Provide copy of Manufacturer's Installation Specifications. ❑ STANDARD ❑ FIRE DEPT
Provide signed copy of Cupenino's Tear-OIT Policy. ❑ OTHER:
ReroojApp_2011.doc revised 03/16/11
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
Im ADDRESS:,t LA DATE: REVIEWED BY:
APN: BP#: 'VALUATION: 1$4,500
*PER,111T TYPE: Minor Building Permit PLAN CIiECK TYPE: Re-roof
PRIAfARI SFDor Duplex PENTADIATION 1SFDW1_R00F
USE: PERMIT TYPE:
WORT: TEAR OFF EXISTING WOOD SHAKE ROOF.INSTALL 1/2" CDX PLYWOOD &30# FELT
SCOPE UNDERLAYM ENT.INSTALL 13 SQ CERTAINTEED PRESIDENTIAL COMP SHINGLES.COLOR: 13
FEEID ROOFAREA
(S.f.)
1REROOFFRES 1,300
3fcrh.Plan Chdrk Plumb. Plan Check Elea Plan Check
Tech. Permit Pae: P/anth.Pam:Fee: Fix. Permit Fee:
01herMv is.Irsp. 011jer Plseb Insp. 0/hen.Fhwa harp.
Hech./nrys Fee., Plumb.In"p.Fee: %ter./AV). Few•
NOTE: This estinune does not include fees due to other Departutents(i.e. Planning,Public Works, Fire,Sanitary Se ,er District,School
District,etc.). These feev are hared on the prelininart in ornmtion available and are ordp an estimate. Contact the Dept for addn7 info.
FEE ITEMS (Fee Resolution 11-053 F.8 711111) FEE QTY/FEE T MISC ITEMS
Plan Check rec.:
Supp/.PC Fee
Phanh.Allech.:Elec
Permit Fee: $195.00
Suppl. lasp Fee
PI anh.:`.hlech.:Elec
1'1umh..iblech.:E1ec Permit Fee:
COnSIMVtian Tar:
Administrative Fee:
Work Without Permit? O Yes Q No $0.00
Aelvemced Planning Fees:
Travel Documentation Fees:
i
Strone Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Blde Stds Commission Fee: IBCBSC $1.00
SUBTOTALS:' $196.50 $0.00 TOTAL FEE. $196.50
Revised: 07101/2012
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
ALBERT SALVADOR, P.E.,C.B.O.,BUILDING OFFICIAL
CUPERTINO 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228• FAX(408)777-3333`buildina(atcupertino.oro
PROJECT'ADDRES / ` APSp
OR:CER VA\ PHONE E-MAIL
STREET ADDRESS C Y.STATE.!P12b FAX
CO]TRACrO E LICV ADM DER LICEE TPIi 'l Bus.LI +/
COUP 7 E-MAIL FAX
STREEI'ADDRLS 0� C Y -E,'. I 9`� _ y
Al
1 UNDERSTAND AND AGREE TO THE FOLLOWING: / U
1. The re-roof project shall comply with all applicable provisions of the 2007 California Building Code.
2. You must schedule all needed inspections a minimum of one day before the requested inspection date.
Please schedule inspections online or call (408)777-3228 between 7:30-3:30 (Mon-Fri).
3. Tear-off roof inspection is required. Please call for tear-off inspection after the roof is torn off and all
the nails/fasteners have been removed. Any and all dry-rotted wood shall be replaced prior to this
inspection. A building inspector will be available within one hour.
There are special hours for this service: 7:30 — 10:30am and 1:00— 3:30pm (Mon—Thurs);
7:30 — 10:30am and 1:00— 2:30pm (Friday).
4. Ifplywood.is installed, a plywood nailing inspection is required.
5. In-Progress roof inspection is required. Call for an in-progress roof inspection to verify building is
weather light after installation of approximately 25% of the roofing material.
6. New roof coverings shall not be applied without first obtaining all inspections 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.
7. A final inspection and approval shall be obtained from the building inspector when the re-roofing is
complete. To receive a final sign-off, the following items will be verified:
a. Flat roofs shall have a minimum of 1/47' per foot of slope and must 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.
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: 1 am the property owner or authorized agent to act
on the property owner's 1 understal and agree to comply with the re-roof policy stated above.
Signature of ApplicanUAge -4 i_4yz _ Date:110,
ReroolPolicl_2010.doc revised 05/17710