12100200 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10562 WIIITE FIR Cf CONI'RACFOR:FOUR SEASONS ROOFING PERMITNO: 12100200
OWNER'SNAME: ZHOU CAROL PO BOX 1668 DATE ISSUED: 1029/2012
OWNER'S PIIONE: 4082717355 SANJOSE.CA 95109 PI IONE NO:(408)278-0330
❑ LICENSED CON IRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT(J PLUMB r1
License Class--_(�Lic.9 'T ��fo
1IEC11 r RESIDENTIAL(J COMMERCIAL r
Contmetor� Date_
1 hereby affirm that 1 am licensed un er the provisions of Chapter 9 JOB DESCRIPTION: BLDG 17-TEAR 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. I2"CDX PLYWOOD"I"1117N 30p fECr
UNDLRLAYlA ENT.INSTA LL 13 SOFT CERTAINTEED
"I hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to sell*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 Ivy
Section 3700 of the Labor Code,for the performance of die work for which(his
permit is issued. Sq.Ft Fluor Area: Valuation:$4500
\I'I'hIC,\N"1'CISR'I'I PIC.\'PION
I certify that I have read this application mid state that the above information is APN Number:35905113.00 Occupancy Type
correct.I agree to comply with all city and county ordinances and state laws relating
to building construction,mid 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 emi.I. Additionally,(he applicant understmidsmid will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR
with:dln -poii sourceregulatinsper the Copen inoMunicipal Code, ection 180 DAYS FROM LAST CALLED INSPECTION.
9.18.
Signal Date/I Issued by: Date:
"� Rj Gf2✓ Date:/U
❑ OWNER-BUILDER DECLARATION
hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS:
the following two reasons: NI roofs shall be inspected prior to any roofing material being installed.If a roof is
I,as owner of the property,or my employees with wages as their sole compensation, installed without firs(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 Applict Date:
construct the project(Sec.7044,Business&Professions Code).
•1 hereby affirm under penalty of perjury one of the following three AL1.ROOF COVERINGS TO 13E CLASS"A"OR BETTER
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATPRIAI 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 llcalth&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
Section 3700 of the Labor Code,for theerfor mance of the work for which this compliance with the Cupertino Municipal Code.Chapter 9.12 and the llcalth&
P Safety Code.Section 25532(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 the work for which this permit is issued I shall contaminants as defined by the Ray Arca Air Qualify Management District 1 will
not employ any person in any manner so as to become subject to the Worker's maintain compliance with the CujwrtinoMumcipal Code,Chapter 9.12 and the
Compensation laws ofCalifomia. If,after making this certificate ofcxemption,I V0n'
&Safety C de Se ,90 -533417/,411�and 25
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 nr• mho ized gen hate
AI'PI.IC\NI'CF.R'I'IPICA'1'ION C(ONS'IRUC-HON LENDING AGENCY
I certify that I have read this application mid state that the above information is
correct.I agree to comply with all city and county ordinances mid state laws relating I hereby aflimn that there is a construction lending agency for the performance of work's
to building construction,and hereby authorize representatives of this city to aver 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 liabilitiesJudgments,
costs,and expenses which may acerae 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 IITECI"S DECLARATION
9.18,
1 understand my plans shall be used as public records.
Signature Date
Licensed Professional
REROOF PERMIT APPLICATION
EM COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
70300 TORRE AVENUE•CUPERTINO.CA 95014-3255
CUPERTI NO I (408)777-3228-FAX(408)777-3333•buildinO(p)cuperlino.orD
PROJECTADD S;1 / r AP\e 6CJ
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CONTACT NAME ^ C PHOVE I O I E-NAIL
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STREaTADDRESSSO� ./L(_6_L9L—G_�,i/ CITY.STATE"ZIP/SFAX
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El OUNFR ❑ OwNER-RUR.DER ❑ Ou'NF.RAGENT J( CO`rTRACTOR ❑CONrRACTORAGENT ❑ ARCHRECT ❑ENGINF.F.R ❑ DEVELOPER ❑ TENAM
CONTRACTOR NAME LICENSE NLNISER LICENSE PE BUS.LIC v
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COMPANYNAMG SAME
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ARCHrrETrENGINEER NAME LICENSE NGMBER BUS.1.10.v
COMPANY NAME E-MAIL FAX
STREET ADDRESS I CITY.STATF_ZIP PHONE
USE OF ❑ SFD or Duplex ji Multi-Family' ROOF AREA; VALUATION:
STRUCTURE: ❑ Commercial 1 13S SQ
EXISTING ROOF TYPE: ❑BUILT-UPROOF ❑ASPI[ALT SHINGLES jMk OODSHAKFS ❑WOODSHINOLES ❑OTHER(SPECIFY)
RCMOVEiREPLACE 114FS IF NO. PLY\4'OOD /�!� ❑ PLYWD 11 OSB PITCH ROOF
1:1N w YF.0. .�// I 'N D • ❑ P ' Dx 'I LLASS' A
PROPOSED ROOF TYPE: ❑BUILT-UPROOF JR45PHALTSHINGLES 0N'00D91.AAES 01400DSHINGLES ❑OTHER ICC-ES REPORT
DESCRIPTION OF\\'GRN; - t
(lef,6Sa4,a*cl PreslAm4i"I came s6in es Color Ca,Ary CA ra-1
By my signature below.I certify to each of the following; 1 am the property owner or authorized agent to act on the properly owner's behrI f. 1 have mad this
application and the information I have provided is correct. 1 have read the Description of work and verify it is accurate. I aye.to comply withal)applicable local
ordinances and state laws relating to building cons tion. I a Drize represe tiv of Cupertino to enter the above-identified property for inspection purposes.
c
Signature of ApplicanUAgenD DRte: O12
SUPPLEMENTAL INFORMATION REQUIRED'op' OFFICEUSEONLY
_
If building is associated with a Home Owner's Association.provide letter PLAN CHECK TYPE ROUTING SLIP
ofapproval from HOA. ❑ OYER.THE-COUNTER ❑ BdaDINGPLANREv1Ew
Provide Planning approval to verify if there any restrictions. ❑ EXPRESS ❑ PLANNING PUN REVIEW
Provide copy of Manufacturer's Installation Specifications. ❑ STANDARD ❑ FIREDen
Provide signed copy of Cuperiino's Tear-011'Policy. ❑ onlere: '
NeroofApp_2011.doc revired 03//6/1/
r.
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: O✓ J WHITE FIR DATE: REVIEWED BY:
APN: BP#: 'VALUATION: 1$4,500
'PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD or Duplex PENTAMATION 1SFDWLROOF
USE: I I PERMIT TYPE:
NVORK TEAR OFF EXISTING WOOD SHAKE ROOF.INSTALL 1/2" CDX PLYWOOD THEN 30# FELT
SCOPE UNDERLAYMENT.INSTALL 13 SQ CERTAINTEED PRESIDENTIAL COMP SHINGLES.COLOR: 0
FEE ID ROOFAREA
(s.f.
1REROOFFRES 1,300
iL
bfe,,h.Plat;Cheek Plumb. Plan Check Elec.plan Cheek
Alech. Permit Fee: Plunth.Permit Fee: Flee. Pernii:Fee:
Outer Afeeh.Imp. OHIO-Plumb Snap. (, -Flee. hevp.
Hech.Insp. Fee: Plumb.Imp.Fee: Elw.Int,. Fee:
!VOTE: This estimate does not include fees due to other Departments(i.e. Planning,Public Warks, Fire,Sanitary Sever District,School
District,etc.). Thesefees are based on the prelininan in ornmlion available and are mdv an estimate. Contac!the De ! or addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff 7/1/12) FEE QTY/FEE MISC ITEMS
Pltm Check Fee:
S'uppL PC f ee
Phanb_/Mech.'Elec
Permit Fee: $195.00
Suppl. Insp.Fee
Phrmh.i:Nech.:Ekc
Plumb.'A11ech..Elec Permit Fee:
Caustruclion Tar:
Adminisnznive Fee:
Work Without Permit? O Yes (j) No $0.00
Athr:neerl Pleauting Fet:s:
Travel Documentation Fees:
i
Strong Motion Fee: IBSEISMCR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $196.50 $0.00 TOTAL FEE: $196.50
Revised: 10/01/2012
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•building(a)cupertino.org
PROIE A R /�, I APN a
O NAME (/�� 01 E-MAIL
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STREETADDRESS STATE.ZIP ., FAX
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11 ERSTAND AND AGREE TO THE FOLLOWING: p/
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$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 behalf. 1 understand and agree to mply with the re-roof policy stated above. I also understand that
smoke detectors and carbon monoxide detectors r uired to be installed in accordance with Sections R314 and R315 of
the 2010 Califomia Residentia
Signature of Applicant/Agent,_ Date:
ReroofPolicv_201 l.doc reviser/02/16/1 l