12080033 CITY OF CUPERTINO BUILDING PERMIT
DUILDINGADDRI.SS: 20618GARDENSIDL'CIR CONfRACfOR:BRADSHAW ROOFING INC PERMITNO: 12080033
O\VNER'S NAME: KEVIN WHITT 1821 S BASCOM AYE I'\Ill 160 DA'Z'E ISSUED:081072012
OWN'ER'S PRONE: 4082469930 CAM I'll ELI.,CA 95008 PHONE NO:(408)24&9930
❑ LICENSED CONIRACI'OR'S DECLARATION
8`� BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
License Class ( Lic.d _�� r r 1-•
�f � i111ECH IRESIDENTIALCCOMMERCIALContracto (\pQ Date S
1 hereby affirm that I am licensed under Ute provisions of Chu pier 9 JOB DESCRIPTION:REMOVE EXISTING ROOF SYSTEM AND INSTALL NEW
(commencing with Section 7000)of Division 3 of the Business&Professions CLASS
Code and that nn'license is in full force and effect. A ASPHALT SHINGLES,12 SQUARES
hereby affirm under penalty of perjury line of the following bvo decho inions:
I have mid 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 perl'onnance of ate work forwhich this Sq.FI Floor Arca: Valuation:$6000
permit is issued.
AI'I'I.IC,\NI'CER'1'IFICA'I'ION APN Number:36232045.00 OccupancyType:
I certify that 1 have read this application and state that the above information is
correct.1 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 PERMIT EXPIRES IF WORK IS NOT STARTED
indemni fv and keep harmless the City of Cupertino against liabilities,judgments,
costs,and 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 mid will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source reg ilatiau per the Cupertino Municipal Code.Section -
9.18. � ,�
Signature �1,�{�yJ/ Datc� Issued by:��Aly �R7G Date:J/p_
❑ O\VNER-BUILDER DECLARATION
RE-ROOFS:
hereby affirm[tint I am exempt from the Contractor's License Lar for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is
the following two reasons installed without first obtaining an inspection,I agree to remove all new materials for
I,as owner of the property,or my employees with wages as their sole comp_nsation, inspection.
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business R Prolessions Code) Signature of Applicant: Date:
I,as owner of the property,am exclusively contracting with licensed contractors to
construct die project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
hereby affirm under penally of perjury one of the following three
declarations:
I have and will maintain a Certificate of Consent to self insure for Worker's HAZARDOUS N[ATER IA LS DISCLOSURE
Compensation,as provided for by Section 3700 of the Labor Code,for the I have read The hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California l Icalth&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 ofthe Labor Code,for the performance of the work for which this Safety Code.Section 25532(a)should 1 store or handle hazardous material.
AdditionallY,should I.use equipment lir des ices which emit hazardous air
permit is issued. contaminants as defined by the Bay Area Air Quaint/ilihmagemenl District I will
I certify that in the performance of die work ter which this permit is issued,I shall maintain cum pliance with the Cup erlinn Municipal Code,Chapter 9.12 and the
not employ any person in any manner so as to become subject to the)Yorker's Health&Safety Code.Sections 2550533,and 25534.
Compensation laws of California. If,after making[his certificate ofexemption.I r
become subject to the Worker's Compensmion provisions of the Labor Code,1 must Oh r or; t
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION CO,NS'I'RUCFION LENDING AGENCY
I certify that 1 have read this application and state that the above information is I hereby affimh that there is a construction lending agency for the performance of work's
correct. I agree to comply with all city ark]county orditimces mid state laws relating for which this permit is issued(Sec.3097,Cir 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 ,\RCII I"1'FCI"S DECLARATION
all non-point Source regulations per the Cupertino Municipal Code,Section
9.18. I understand my plans steal I be used as public records.
Signature Date Licensed Professional
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
IlaADDRESS: a/ / Q� A DATE: 08/06/2012 RFVIEWED BY: Beth
PN: BP#: dap gjQ�73 'VALUATION: $6,000
*PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD or Duplex PENTAMATION 1SFDWLR00F
USE: PERMIT TYPE:
WORK remove existin roofs stem and replace with Class A asphalt shingles
SCOPE
FEEID ROOF AREA
(s.f.)
1REROOFFRES 1 ,200
A/ech. Plan Check Plumb.Plan Check Elrc. Plan Cheek
Slech. Permit Fee: Plumb. Permil Fee: Elec. Permit Fee:
Other A/ech.hhcp. Other Plumb hasp. Other Elec. hap.
Alech. Insp. Fee: Plumb.Insp.Fee: Elec.Insp. Fee:
NOTE: This estimate does not include fees ohne to other Departments(i.e. Planning, Public Narks, Fire,Sanitaq Server District.School
District,etc.). These fees are based on the reliminarp information available and are on&an estimate. Contact the Dept for aahln 11 info.
FEE ITEMS (Fee Resohttion 11-053 E(L 7/1/11) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Sapp(. PC Fee
Plumb.6blech./F,lec
Permit Fee: $180.00
SuppL Insp Fee
Phonh./Ale ch./Elec
PlumbAl,lech./F_lec Permit Fee:
Construction Tax:
Administrmive Fee:
Work Without Permit? O Yes 0 No $0.00
Advanced Planning Fees:
Travel Docunnentalian Fees: A
Strong Motion Fee: IBSE/SAHCR $0.60 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00
SUBTOTALS: $181.60 $0.001 TOTAL FEE: $181.60
Revised: 07/01/2012
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
CUPERTINO
(408)777-3228- FAX(408)777-3333-building(d)cupertino.org
PROIECT O S APN0
OM'NERNAME ` e T P?04h
kg 7 LA ,fa. c� E-MAIL
STRE A ORE$ CIN, STATE.ZIP y O FAX
l C
COVMCTOR,NA,VE i LICENSENUMBE LICENSE TYPA. BUS.LIC.M
1-) (o
COMPANY NAME CL
M FAX l
/ ^
STREET AQ4 SS CITY,STATE.ZIP ONE
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 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. 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 minimutn 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 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: 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:
ReroofPolirr_201 Ldoc revised 02/16111
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
C O P E RTI N O Telephone: 408-777-3228
Fax: 408-777-3333
CONTRACTOR / SUBCONTRACTOR LIST
JOB ADDRESS: PERMIT# 0 003 3
ONVNEWS NAME: PHONE#
GENERAL CONTRACTOR: BUSINESS LICENSE#
ADDRESS: ;Z 9e e_ V t CITY/ZIPCODE: SCLA aese S
*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. / y
I am not using any subcontractors:
Signature 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
REROOF PERMIT APPLICATION R
COWAUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
C U P ERT!N O (408)777-3228 • FAX(408)777-3333•building aacucertino.org
PROJECT ADDRESS a O p C f,S, .ARN e _ _O
OWNERNAME 1\ J\ C I PHONE () 6LAqgE-MAIL
STREET ADDRESS` `q CTT, STATE,ZP� O I FA.Y
!� r
CONTACT NAME PHONE E-MAIL
STREET ADDRESS CITY,STATE ZIP FAX
❑OWNER ❑ OWNER atnDER ❑ owNER.AGENT COtr1A1CF0R ❑CONTRACITRAGE.NT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACT RNANIE LICENSE NUMBER LICENSETYPE BUS.UC
CO PANY401E E-MU V� (\C
50
STREET ADDRESS CfTI',STATE IP PHONE `ice
it
Cf n
ARCHITELTIEBGLNEER NAME LICENSE Ntk(BER BUS.LIC.I
COMPANY NAME E-MAIL F.AX
STREET ADDRESS CITY.STATE ZIP PHONE
USE OF ❑ SFD or Duplex ❑ Multi-Family. ROOF.AAEA: VALUXTTION: - o
STRUCTURE. ❑ Commercial ��I" �J Qo-
EXISCINGROOFTYPE: ❑BUILT-UPROOF ❑ASPHALT SHINGLES mWOODSHAiGES ❑WOODSHINGLES ❑OTHER(SPECD'Y)
REM04E,REPLACELYtES PLYWOOD :5" ❑ PLYWD ❑OSB PRCH .(� ROOF :1
❑ O 9 R J.. THHCK e . ❑ :,- TYPE ❑ DX
PROPOSEDROOF TYPE: ❑BUILT-UPVOOF ASPHiLTSHINGLES ❑WOOOSHt RPC C3 WOOD SHINGLES ❑OTHER ICC-ES REPORT
DESCRIPTION OF WORM: C.
• By my signature below,I certify W each of the following: I am the property owner or authorized agent to act on the property owners behalf. I have read this
application and die information I have provided is correct. 1 have read the Description of Mork and verify it is accurate. 1 agree to comply with all applicable local
ordinances and stare laws Mating to bu�illl�m/g on ion. I au oriz preservatives of Cupertino to enter the above-identified property for inspection purposes.
Sigmamre ofApplicardAgem:��1.(iSs� Da t<: 7�a ra aC)}z
SUPPLEbUENTAL INFORMATION REQUIRED OFFICE USE ONLY
_If building is associated with a Home Owners Association,provide letter PLAN CFTECK TRE ROUTING SLIP
of approval from HOA. ❑ OVER-THE-COUNTER ❑ BUILDING PUNRIMEW
_Provide Planning approval N verify if there any restrictions. ❑ EXPRESS ❑ PLANNING PLAN REVIEW
_Provide copy of Ma ufacturer s Installation Specincatiens. ❑ STANDARD ❑ FIRE DEPT
Provide signed copy of Cupertino's Teat-Off Policy. ❑ OTFtER:
Reroofdpp 201 Ldoc revised 03'1 dR I