12100202 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10566 WI1ITE FIR CT CONT'RACT'OR:FOUR SEASONS ROOFING PERMIT NO: 12100202
OWNER'S NAM F,: GONG'QINWEI AND LI TING PO BOX 1668 DA'T'E ISSUED: I0129P012
OWNER'S PHONE: 4089961428 SAN.IOSE,Cx 95109 11II0NF.NO:1408)278-0330
❑ LICF.NSR.D CON I'RACI'OR'S DECLARATIOi. r r Ci
,7 00j BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class,\ �' Lic.N �/ D
NIECll r RESIDENTIAL r1 COAIDIERCIAL r
Contractor Date /��
1 hereby affirm that 1 ora licensed under a provisions of biapter 9 JOB DESCRIPTION:BLDG 17-TGxR OFF EXISTING WOOD SHAKE
(commencing with Section 7000)of Division 3 of the Business&Professions ROOF.INSTALL
Code and that my license is in full force and effect. 12"CDX PLYWOOD THEN 30Y FELT
UNDERLAYMENT.INSTALL 13 SOFT CERTAINTEED
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:$4500
APPLICANTCERT-I FICyTION
I certify that I have read this application and state that the above information is APN Number:35905115.00 Occupancy T pe:
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 WORK IS NOT STARTED
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Addition)))ally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR
with all not Isou ce regul. mq erthe Cupenino Municipal ode Section 180 DAYS FROM LAST CALLED INSPECTION.
9.18. // //
Sign l DatdO �/ �� Issued by: Date: /O
❑ OWNER-RUILDER DECLARATION
hereby affirm that 1 am exempt from the Contractor's License 1.8w for(Inc of RE-ROOFS:
the following two reasons: All roofs shall be inspected prior to my roofing aterial beirg installed If a roof is
I,as owner of the property,or my employees with wages as their sole compensation, installed wig1launm'm inspectio" . to remo.all new materials fo� ewill do the work,and the structure is not intended or offered for sale(SC0.7044, inspection.
business&Profess ions Code)I,as owner of the property,am exclusively contracting with licensed contractors toSignature oDate., /
construct the project(Sec.7044,Business&Professions Code). -
hereby affirm under penalty of perjury one of the following three ALI,ROOF COVERINGS TO BE CLASS"A"OR BETTER
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOIIS MATERIAI 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&Safety Code,Sections 25505.25533,and 25534. I will maintain
compliance with the CupertinoMunicipal Code,Chapter 9.12 and the Ilealth&
Section 3700 of the Labor Code,for the performance of the work for which This
Safety Code,Section_553_(u)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 die work forwhich this permit is issued I shall contaminants as defined by the Br y Area Air QualityManagement District I will
not employ any person in my manner so as to become subject to the Worker's mains ' mplinnee with the Cupertino Municipal Code.Chapter 9.12 and the
Compensation laws of California. If,after making this certificate ofesemption,1 11 h Safely Co c .05,25533,and 25534: /
become subject to the Worker's Compensa lion provisions of the Labor Code,I must
forthwith comply with such provisions or this permit shall be deemed revoked Ow er or a mrize a c
e: r
APPI.ICANI'CISR9'IPICA-I-ION CONSTRIICI'ION LENDING AGENCY
I certify thin 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 ARCHITECT'S DECLARA'T'ION
9.18.
1 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
GUPERTINO (408)777-3228•FAX(408)777-3333 • huildingr5cupertinoo..org
O PAN1E (p b • PHONE D E-MAILAIA
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SIRE�nIy{r�yt /.C/ C14 STATE.ZIP FAX
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CONTACT NAME eNE PHOE-MAIL
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STREET'ADDRESS 5'452 14,6crt iti S I CITY.STATE,71P/��� FAR
❑OW'NFR ❑ OWNER-RUILDER ❑ OWNFRAGENT Jf CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENAW
CONTRACTOR NAME LICENSENUNIBER LICENSE PE BUS,LIC,u
F�taf S_Cg5 ►2 O'
COMPANYNAME SAME
E-NLAIL FAX
STREET ADDRESS CITY.STATE.ZIP PHONE
S0 I a chse C 8-0
ARCHI rECT/ENGINEER NANIE LICENSE NUMBER BUS.LIG n
COMPANY NAME I E-MAIL. FAX
STREET ADDRESS , I CIT1'.STATF ZIP PHONE
Al/
USE OF ❑ SFD or Duplex Muhl-Family ROOF AREA: VALUATION:
STRUCTURE: Cl Commercial 1 13 S sQ
EXISTING ROOF TYPE: ❑BUILT-UPROOF ❑ASPnALTSHISGLES 0%VOODSHAAES ❑%OODSHINGLES ❑0171F.R(SPECIFY)
RENIOVF.)REPLACE IFNO. HPLYI'MD / bT' ❑ TPLVYN''D OSB ROOF
11 NF0 a YFRS CDY Pf
'12 'LASS, A
PROPOSED ROOF TYPE: ❑BUILT-UPROOF XASPHALTSHINGLES ❑ll'OODSII.AEES EI WOOD SHINGLES IJ OTHER ICC-ES REPORT
DFSCRIPDON OF WORK:
nar $ ICOX
t t
_!j,wtzod +60A 30# rtnAe LIMC.n . FTnawj_j S_ .
ClerkalfkkseA PreSided+,a.l come s6tnwles CaIftr : Coun4 C C 0-
By
By my signature below.I certify to each of the following: I am the propcny owner or outhonud agent to act on the property owner's behalf. I have read this
application and the information I have providedis correct. 1 have read the Description of Wort:and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building cons tion. I a prize represe civ offupenino to enter the above-identified property for inspection purposes,
Signature of ApplicanUAgent: Date: O 2
SUPPLEMEWAL INFORMATION REQUIRED OFFICP.USEONLY
If building is associated with a Home Owner's Association.provide letter PLANCHECATYPE ROUTING SLIP '
ofapproval from HOA. ❑ OYER-TH OVN-TER ❑ BUILDINCP1,ANREV1Ew
Provide Planning approval to verify if there any restrictions. Cl EXPRESS ❑ PLANNING PLAN REVIEW
Provide copy of Manufacturer's Installation Specifications. ❑ STAND.RD ❑ MRF.DEPT
Provide signed copy of Cupertino's Tear-Off Policy. ❑ OTHER:
Heroojdpp_2011.doc revised 03/16//1
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`building(cDcupertino.org
PROJEC'Y&VS'�� — APN a
O VAME rJJ P V� / E-MAIL
STREEr DDRESS CI TATE.ZIP2 FAX
e
CONTRA NS'AAM` A'Q�L LICE' NUMB E LICEV 7 BUS�Lis.
CO. NAM E-MAIL FAX
STREM .ST E P -7
09
NDERSTAND AND AGREE TO THE FOLLOWING: ((
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/" 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 mon We detectors r ired to be installed in accordance with Sections R314 and R315 of
the 2010 California Residenti Co
Signature of Applicant/Agent: Date:
RerooJPolicv_20l Lrloc revised O2/l6/ll
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: WHITE FIR DATE: REVIENI'ED BY:
APN: BP#: 'VALUATION: $4,500
*PERMITTYPE: Minor Building Permit PLAN CII ECKTYPE: Re-roof
PRIMARY SFD or Duplex PENTAMATION 1SFDWLR00F
USE: I I PERMIT TYPE:
WORK TEAR OFF EXISTING WOOD SHAKE ROOF.INSTALL 1/2" CDX PLYWOOD THEN 30# FELT
SCOPE UNDERLAYMENT.INSTALL 13 SQ CERTAINTEED PRESIDENTIAL COMP SHINGLES.COLOR: p
FEE ID ROOF AREA
(s.f.
1REROOFFRES 1,300
:1 feeh. Pim;Cheek P/uahb. Plan Check Flee.Plan Check
:41ech. Permit Fee: P/umh,.Permit Fee: Elec. Perini:Fee:
O'lier Heck Lap. Other Plumb hup. Otb(o Elec.Ince.
,I'lech.Insp. Fee: Pbmrb. Insp.Fee: Fler.Ince. Fee:
NOTE: This estimate does not include fees due to other Depanntents(Le. Planning Public Works,Fire,Smhitag Sewer District,School
District,etc). Theve ees are based on the preliainan information available and are adv an estinhale. Contact the De t or addn'I info.
FEE ITEMS (Fee Resolution 11-053 Ell: 711112) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Suppl.PC Fee
Phanb.."Afech.Elec
Permit Fee: $195.00
Suppl. Lrsp Fee
Plumb./Meeh.,Elec,
Phtmh:'_L1ech.:Elec:Permit Fee:
Coustru tion Ta.c:
Aelminisnative Fee:
Work Without Permit? O Yes Q No $0.00
Arhnneed Planning Fee_c:
Travel Documcniation Fees: A
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: iBCBSC $1.00
SUBTOTALS: $196.50 $0.001 TOTAL FEE;, $196.50
Revised: 1 0/0 11201 2