12080032 CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRESS: 20629GARDENSIDECIR CONTRACTOR:BRADS[IA\\'ROOFING INC P ERMITNO: 12080032
OWNER'S NAME: LARRY WAGNER 1821 S BASCOM AVL-PNIB 160 DATE ISSUED:08/072012
OWNER'S PlIONE.: 4082469930 CAMPBELL.CA 95008 PUONE NO:(408)2+69930
❑ LICENSED CONVfRAI•:
CfOR'S D (CLLARATION BUILDING PERI IIT INFO: BI.DG r ELECT r' PLUMB r
License Class ✓ -21-7/ 6
.f/.' Kcp AIECFI (- RESIDENTIAL.r COMi\•IERCIA I.r
Contracto Date_ `'dz1
hereby affirm that I am licensed wider the provisions of Chapter 9 3013 DESCRIPTION: REMOVE EXISTING ROOF SYSTEM AND INSTALL NEW
(commencing a ith Section 7000)of Division 3 of the Business&Professions CLASS
Code and that my license is in full force and effect. A ASPHALT SHINGLES,12
SQUARES
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 Sq.Ft Floor Area: Valuation:$6000
permit is issued.
APPLICANT CERT'IFICAT'ION AI'N Number:36232039.00 Occupancy T)pe:
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 mid 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 PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,mail expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,the applicant understands'and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. , - / G'/ Issued by: /V / �TG� Date:
Signature W ` Date U Q
❑ OWNER-BUILDER DECLARATION
RE-ROOFS:
I hereby affirm that 1 am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material beiig installed.Ira roof is
the following two reasons: installed without first obtaining an inspection,1 agree to remove all new materials for
I,as owner of the property,or my employees with wages as their sole compensation, inspection.
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business R Professions Code) Signature of Applicant: Date:
1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,.Business&Professions Code). ALL ROOF COVERINGS TO 13E CLASS"A"Olt BETTER
I hereby affirm under prmilry'of perjury one of the following three
declarations:
I have and will maintain a Certificate of Consent to sclf-insure for Worker's IL\%AKUOUS NL\"1'1:121,\IS DISCLOSURE
Compensation,as provided for by Section 3700 of the Labor Code,for lire I hove read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California I lealth&Safely Code.Sections 25505,25533,and 25534. I will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by 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 Safey Code.Section 25532(a)should 1 store or handle hazardous material.
Additionally,should I use equipment or devices which emit hazardous air
permit is issued. contaminants as defined by the tray Arca Air Quality Management District I will
I cenify that in the perfommnce of die work fonvhich this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's Health&Soft v ods.S etions 25505•''5533,and 25534.
Compensation(mss of California. If,after making this certificate of exemption,1 �
become subject to the Worker's Compensation provisions of the Labor Code,I mast U`(V, or tor' agent: �/� /�
forthwith comply with such provisions or this permit shall be deemed revoked !!!/�//W!N/�
late:
CONSTKIICI'ION LENDING AGENCY
APPLICANTCERTIFICATION
I certify that 1 have read this application and sale that the above information is I hereby affirm that there is a construction lending agency for the performance of work's
correct. I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.)
to building construction,and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
costs,and expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply ARCI I I'TECI"S DECLARATION
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. 1 understand my plans shall be used as public records.
Signature Date Licensed Professional
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: ' 06 Qy e; DATE: 08/06/2012 REVIEWED BY: Beth
APN: BP#: Lgoeooaa 'VALUATION: $6,000
*PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD or Duplex PENTAMATION 1SFDWLROOF
USE: PERMIT TYPE:
WORK remove existin roofs stem and replace with Class A asphalt shingles
SCOPE
FEEID ROOF AREA
(S.f.)
1REROOFFRES 1,200
,Rech. Plan Clmek Phanb.Phm Cheek Occ. Plate Cheek
htech. Perarit Fce: mamb. Permit Fee: Flec. Permit Fee:
Other,Afcch. hasp. Other Plumb Insp. Other Elm huap. Ll
Alcch. Lisp. Fee: Plumb.hup.Fee: Elm Insp.Fee:
NOTE: This estimate docs trot include fees due to other Departments(i.e. Planning. Public IVorks, Fire,Sanitary Server District,School
District, etc.). These fecs are based on the preliminarl information available and are only an cstimrate. Contact the Dept for acldit 7 info.
FEE ITENIS (Fee Resolution 11-059 Flt' 71111 1) FEE QTY/FEE N'IISC ITEN1S
Plem Check Fee:
Suppl. PC Fee
Plumb.Ale(AlElec
Permit Fee: $180.00
Suppl. Incl) Fee
PlumbAlIech./F.lec
Plumh.Alec/l./F_lec Permit F'ee:
Construction Tux:
Administrative Fee:
Work Without Permit? O Yes 1@ No $0.00
Advanced Pluming Fees:
Travel Documentation Feet: A
Strong Motion Fee: 1BSF.ISAI/CR $0.60 Select an Administrative Item
Bida Stds Commission Fee: IBCBSC 1 $1.00
SUBTOTALS: 1 $181.60 $0.00 'TOTAL FEE: 1 $181.60
Revised: 07/01/2012
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE - CUPERTINO,CA 95014-3255
CUPERTINO
(406)777-3228• FAX(408)777-3333•building(alcuoertino.org
PROJECT ADDRESS APNu 3�a _ 3a - 039
OWNER NAME r 1 ,lI C�e� PNONE �Cf•] E-MAIL
S, ET aEss C Ut J6 [\S �� C arv.�ATE zi c, � 7�J L FAx
C TBACTO NA,tE .� LICE\SENUMBER R LICENSEI) BUS.LIC.N
1
COMPANYNAME E-MAI bat PAX -77 - e�Z
STREET 200
ADD S - CI TY.STATE.ZIP ONE �l7
l S CE
I UNDERSTAND AND AGREE TO THE FOLLOWING:
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 plvwood 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. Proeress 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 5126.00. 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 Residential Code /
Signature of Applicant/Agent: Date:
Reroo/Po1icr_201 Ldoc revised 02/16111
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
C U P E RTI N O Fax: 408-777-3333
CONTRACTOR / SUBCONTRACTOR LIST
JOB ADDRESS: PERMIT# a0 OU
OWNER'S NAME: PHONE#
GENERAL CONTRACTOR: BUSINESS LICENSE#
ADDRESS: 2 \1 i CITY/ZIPCODE: 5 30se $
*Our municipal code requires all businesses working in the city to have a City of Cupertino-business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE. I _
I am not using any subcontractors:
Signature Date
Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring/ Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting/Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
REROOP PERN11 T APPLICATION R
G
COMMUNITY DEVELOPIbiENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO,CA 95014-3255
CUPERTtNO (408)777-3228• FAX(406)777-3333•buildingecucertino.ora
Sao goon
PROJECT ADDRESS
OWNER NAS PHON Ing^ E- IAIL
SIitEEr.iDR 5 C- S C CIT'!, STATE,CL)PeZIP ^� CKa I FAX
CONTACT NAME r.-, PHONE ` V 1.E-ALAI.
'STREET ADDRESS CITY,STATE. ZIP FAX
❑ OWNER ❑ OWNER-BUILDER ❑ OWNERAGET CONTN.ACTDR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACT RNAAIE LICENSENUSIBER LICENSE TYPE BUS.LI
�. c
COMPANY NAME E-AL> �L n� FAX .
STREET ADDRESS CITY',STATE fP PHONE
_ (LC
n
ARCHITECTIENGINEERNA E LICENSENU!,MER BUS.LIC.0
COarPANY NAME E-MAIL FLAX
STREET ADDRESS I CT',STATE.ZIP PHONE
USE OF ❑ SFD or Duplex ❑ Multi-Family. ROOF AREA:
f VALUATION:
SMUCruRE. ❑ Commercial L S
EXISTINGROOFTWE:: 11BUILT-UPROOF ❑ASPHALTSHINGLES m0.'OODSHAE:FS WOODSHINGLES ❑OTHER(SPECOT,
REMOVE iREPLACE IF NO. /,I� PLY\t'o0O a" ❑ PLTw 13 OSB P" ROOF
PROPOSEDROOFTYPE' ❑BUILT-UPROOF &6HALT SHINGLES ❑WOOD SHtAES 13 WOOD SHINGLES ❑OTHER ICC-FSREPORTC
DESCRIPTION OF WORK; .-C ` C.
1
By my signature below,1 certify to each of the following: 1 am the property owner or authorized agent to act on the property owner's behalf. l have read This
application mid the information 1 have provided is correct. 1 have read the Description of Work and verify it is accurate. l agree w comply with all applicable local
ordinances and state laws relating toybuuillyiinng ons/v}-K��urt I nu nz epresentatives of Cupertino to enter die+oblove-id<ntif it pmp<rry for inspection purpose.
Signature ofAppl iwndAgenr. ,V/.(iLi�!_y Date: /�o� IQn�Z
SUPPLEMENTAL INFORD7ATION REQUIRED OFFICE USE ONLY
_If building is associated with n Home Oteners Association,provide letter PLAN CHECK TYPE ROUTING SUP
of approval from HOA. ❑ OVER-THE-COUNTER - ❑ BUILDING PLAN REVIEW
Provide Planning approval to verify if there any restrictions. ❑ EXPRESS ❑ PLANNING PLAN REVIEW
_Provide copy of Manufacmter's Installation Specificadens. ❑ STANDARD ❑ FIRE DEPT
Provide signed copy of Cupertino's Tear-Off Policy. ❑ OTHER:
Rerooflpp 2011.doc revised 03/7611