12090245 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21052 WHITE rIR CT CONTRACTOR:FOUR SEASONS ROOFING PERMIT NO: 12090245
ONVNER'S NAPIE: LUM DARREL WAND CI IERRYL O TRU IPO BOX 1668 DATE, ISSUED:09272012
OWNER'S PHONE: 4082861201 SAN.IOSE.CA 95109 PHONE NR(408)278-0310
❑ LICENSED CONTRACTOR'S DECLARATION' BUILDING PERMIT INFO: BLDG r ELECT ❑ PLPLUMBr
Z /
License Class C_ J/ Lie.4 /7 7,.2<0f3 r r r
� MECII RESIDENTIAL � COpID1ERCL�L
Contractor 12yA L�-1_ Datc�Z—
hereby affirm that I am licensed under the provisions of Chapter 9 306 DESCRIPTION:TEAR OFF EXISTING WOOD SHAKE ROOP.INSTALL
(commencing with Section 7000)of Division 3 of the Business&[Professions I2"CDX
Code and that my.license is in full force and effect. PLYWOOD&30N FELT NLAYMENT.INSTALL 13 SQ
CERTAINTEED PRESIDENTIAL COh1P
I 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 done work for-which this
permit is issued. Sq.Ft Floor Area: Valuation:54500
%PPI,I CAN'T'CER'ru;IC,\9'ION
I certify that I have read this application and state that the above information is APN Number:35905112.00 Occupancy Type:
correct.I 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 W K 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 F PERMIT ISSUANCE OR
with all non-point source regulations per the Cupertino Municipal Code,Section 180 D S FRO T CALLED INSPECTION.
9.18.
Signaturea � / Date 9'a7— /Z Issued by: Dale:
❑ OWNE,R-RUILDER DECLARATION
hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS:
the follmving Iwa reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
I,as owner of the properly,or my employees with wages as their sole compensation, installed without first obtaining an inspection,1 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 Applim Date:
construct the project(Sec.7044,Business&Professions Code).
1 hereby affirm under penally of Perjury one of the following three ALI,ROOF COVIiRINGS TO BEI CLASS"A"OR BETTER
declarations:
1 have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS NIATERIA 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
1 have and will maintain Worker's Compensation Insurance,as provided far by California Ilealth&Safety Code.Sections 25505.25533.and,5534. 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 9.1_and the Ilealth&
Safety Code,Section_553_(x)should I store or handle hazardous material.
permit is issued Additionally,should I use equipment or devices which emit hazardous air
I cenifv that in the performance of die work I'or 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 the Worker's maintain compliance with he Cupertino Municipal Code,Chapter 9.12 and the
Compensation Imus of California, If,after making this certificate ofexemption,I Ilealth S Safety de S tions 25505.2.5 ,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 revokedmer or tori. Date. 2
AI'I'LICANI'CER'I'IFICA'1'ION CONSTRI147-11ON 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 die 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 ARCI I ITECI"S DECLARA'T'ION
9.18.
I understand my plans shall be used as public records.
Signature Date
Licensed Professional
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING.DIVISION
10300 TORRE AVENUE •CUPERTINO,CA 95014-3255
CUPERTINO (408)777-3228• FAX(408)777-3333•building(ccupertino.orG
PROJECT:IUD 5 i_ C AP\c
OWNER NAME v PHONEd -/ E-MAIL
Ir
l
STREET'. RE CIT' STATE-Z11 FAX
D Z e r So
CONTACT NAME PHONE E-)TAIL
STREET ADDRESS CITY.STA IF..ZIP FAY
SO2 S cin3ose-. qTt
❑OWNER ❑ OWNER-BUILDER ❑ OWNFR AGENT J( CONTRACTOR ❑CO. ACTOR AGENR ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME LICENSE MEMBER LICENSET PF BUS.LIC•
COMPANY NAME I E-MAIL FAX
STREET ADDRESS CITY.SLATE ZIP I PHONE S_O
SoZ a ose C
ARCHrrECTIENGINEER N'A?IE LICENSE NUMBER BUS.LIC.
COMPANY NAME E-MAIL FAX
STREET ADDRESS I CITY.STATF ZIP PHONE
USE OF ❑ SFD or Duplex JC Multi-Family ROOF AREA: VALUATION: 0
STRUCTURE: ❑ Commercial S 5-"o
or
EXISTING ROOF TYPE: ❑RUILT-UP ROOF ❑ASPII.ALTSHINGLES PGOODSHAKES ❑WOODSHINGLES ❑OTHER(SPECIFY;
REMOVE(REPLACE VIES I IF NO. PLYWOOD id: ' ❑ PLYWD ❑OSB PITCH' .IZ ROOF
❑ NO YF'R ,,�.// HI I;X ElT PE' CDX
LL� CLASS' A
PROPOSED ROOF TYPE; ❑RUILTUPROOF 1/.4SPHALTSHINGLES ❑WOODSHAKES 0W001 SHINGLES ❑OTHER IPC-ES REPORT
OFSCRIPTION OF WORN;
�+o►ll Z" cD?s
+6eA 30# 4' 1T pndErl_ o�nna ' . F�nwLlsg_�_i.eC
ae •v a
By my signature below.I certify to each of the following: I am the property 0%"cr or authorized agent In act on the property owner's behalf. I have read chis
application and the information I have provided is correct, 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 lion I a orize represe tiv c of Cupertino to enter the above-identified property for inspection purposes.
Signature of ApplicanUAgenC Date: 0 2
SU11PLEMENTAL INFORMATION RIiQUIRED OFFICE USE ONLY
_If building is associated With a Home Owner's Association.provide letter •PLAN CH ECK*PE -ROUT(NC sue
of approval from HOA. ❑ OVER-THE-COUNTER ❑ SUILDINGYLANREVIEW
Provide Planning approval to verify if there any restrictions. O EXPRESS ❑ PLANNING PIAN REVIEW
_ Provide copy or Manufacturer's Installation Specifications. ❑ STANDARD ❑ FTREOE"
Provide signed copy of Cupertino's Tear-Off Policy. - ❑ OTHER;
ReroojApp_7011.doc revised 03/16/11
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: �2 (�S h-t_ —I—K DATE: REVIEWED BY:
APIN: BP#: 'VALUATION: 54,500
*PERMIT Tl'PE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD or Duplex PENTANIATIO
N 1SFDWLR00F
I USE: PERMIT TYPE:
-,YORK TEAR OFF EXISTING WOOD SHAKE ROOF.INSTALL 1/2" CDX PLYWOOD &30# FELT
SCOPE UNDERLAYMENT.INSTALL 13 SQ CERTAINTEED PRESIDENTIAL COMP SHINGLES,COLOR: p
FEEID ROOFAREA
(S.E)
1REROOFFRES 1,300
iF
Ater#. Phat Check Phonh. Plan Check Elee Plan Chick
:Aleah. I'ern;h Fee: P?vnth.Permit Fee: Elec. Pern:ir Fee:
Other Atech.Anp. 0111er P/uu:h hu'p. Ll I Othta-F.lec. L1.sp.
A1mh.Imp. Fee: P/un1h. Trap.Fee: tiler.Iny. Fee:
!VOTE: This co?nate does not include fees due to other Departments(i.e. Planning,Public Works, Fire,Sanitary Sewer District,School
District,etc.). These feev are based on the prelininan in ornmtion available and are otdv at estimate. Contact the Dept for adrht'I info.
FEE ITEMS (Fee Resolution 11-053 Eff 7/1/11) FEE QTY/FEE MISC ITEMS
Plain Check Fee:
SappL PC Fee.
Phenh 111erh.;Elec
Permit Fee: $195.00
Suppl. Imp Fee
Plum#.%tYfech.:Elec
Phtmh._1lecH.:Elec Permit Fee:
ConstnlGion Tax:
Aelntinistrutine Fee:
Work Without Permit? Yes Q No $0.00
Advanced Planning Feta':
Trim&Doclmnemation Fees:
Strome Motion Pee: IBSEISA9CR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTa LS:, $196.50 $0.001, TOTAL FEE;;- $196.50
Revised: 07/01/2012
----------------
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT.2 auu.nlnlr ralvlclou
ALBERT SALVADOR, P.E.,G.B.O., BUILDING OFFICIAL
CUPERTI 4O 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228• FAX(408)777-3333•building0cupertino.orD
PROIECTADDRESS /u d;2i� V
(_V i1 lN PS q kt C \� A
OWNER NAME C� PHONE �� \^�\ IAIL
Gcc QM.I`
STREET ADDRESS - CIT'.ST :,%IP
CONTRACIORNAME LICENSENUM 'R �^ LICEN T'P BUS.LIC.-
%
COMPANYNAME r E-MAIL FAX
0nS 0� t
STREET ADDRESS CITY.S LI N
Sol. 5dL* CA
I UN ERSTAND AND AGREE TO THE FOLLOWING:
I. 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. If plywood 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 tight 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'A" 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 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: 1 am the property owner or authorized agent to act
on the property owner's behalf. I under tand an agree to comply with the re-roof policy stated above. /
Signature of Applicant/AgenDater 0-1 Datei
W
RernafPnlic}'_20I0.doc revised OS/l7/10