12080294 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21085 WHITE FIR CT CONTRACTOR:FOUR SEASONS ROOFING PERMIT NO: 12080294
OWNER'S NAME: BANGALORE JAYARAM G AND LINGAIAFI PR PO BOX 1668 DATE ISSUED:08292012
OWNER'S PHONE: 4082179842 SAN JOSE,CA 95109 PHONE NO:(408)278-0330
R_ LICENSED CONFRAC7FOR'S DECL.ApRATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB
License Class C-39 Lie 4 W 7 Oa I DO r r r
/� MECII RESIDENTIAL COMMERCIAL
Contractor FS a t INC, - Date 8 -a4 -12
1 hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION:TEAR OFF WOOD SHAKE AND INSTALL 13 SQFT CLASS A
(commencing with Section 7000)of Division 3 of the Business&Professions COMP SHINGLES
Code and that my license is in full force and effect.
hereby affirm under penally of perjury one of the following two declarations:
1 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 Sq.F(Floor Area: Valuation:54500
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
ARN Number:35905072.00 Occupancy Type:
APPLICANT'CERTIFICATION
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 card state Imus relating
to building construction,and hereby authorize representatives of this city to enter PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes. (We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION.
granting of this permit. Additionally,the applicant undersumds and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. Issued by:9 i /�' i��%G� Date:ej _C7 9
2 �l
Signature D
ate
❑ ON'NF.R-BUILDER D F.CLA RATION RE-ROOFS:
r. T All roofs shall be inspected prior to any roofing material beitg installed.If a roof is
1 hereby affirm that 1 am exempt from the Contractor's License Lawfor one of installed without first obtaining an inspection,I agree to remove all new materials for
the following two reasons: inspection.
I,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sce.7044, Signature of Applicmt Date: 8-.29-1,2
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to
constmct the project(Sec.7044,Business& Professions Code). AL1,ROOF COVERINGS TO BE CLASS"A"OR BETTER
1 hereby affirm under penalty of perjury one of the following three
declarations: IIA7.ARDOUS MATERIALS DISCLOSURE:
I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the
Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code.Sections 25505,25533,and 25534. 1 will maintain
performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material.
Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air
permit is issued. contaminants as defined b)'the Bay Arca Air Quality Management District I will
maintain compliance with the Cupertino Municipal Cade,Chapter 9.12 and the
1 certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534.
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of Cal ifomia. If,after making this certificate of exemption,I Owner l h riz
become subject to the Worker's Compensmion provisions of the Labor Code,I must Date.
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCf10N LE;YDING ACENCI'
APPLICANT CERTI FICATION I hereby affirm that there is a construction lending agency for the performance of work's
1 certify that 1 have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.)
correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name
to building construction,mid hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the ,\RCIIITFCI"S DECLARATION
of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records.
9.18.
Licensed Professional
Signature Date
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: White fir ct. DATE: 08/27/2012 TREVIEWED BY: bobs,
APN: RP#: 'VALUATION: 1$4,500
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY SFD or Duplex PENTAMATION 1SFDWLR00
USE: PERMIT TYPE:
WORK tear off wood shake and install comp shingles.
SCOPE
`-
mss.-
.:� y.;g.
Meeh. flan Check Plumb. Pion Check F.lec.Plan Cheek
mech. Permh Fee: Plumb. Pernik Fee: lilac. Permit Fee:
Other,Vech.Imp. Other Plumb Insp. Other Elce.Insp.
.lde& Imp. Fee: Plumb. /up.Fee: Elec.Insp.Fee:
NOTE: This estinmte does tot include fees due to other Departments(i.e. Planting, Public (Yorks, Fire,Sanitary Sauer District,School
District,etc). These fees are based at the prelitninar3 information available and are onh,at estitttale Contact the De t or addtt'I info.
FEE ITEMS (Fee Resolution 11-053 E/T 7/1/11) FEE QTY/FEE I i141SC ITEMS
Plan Check Fee: $0.00 1,300 S.f.. Re roof
Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 $195.00 IREROOFRES
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. FeeQ Reg. 0 OT 0.0 1 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Conn uciion Tax:
Administrative Fee: Q
Work Without Permit? O Yes (D No $0.00 E)
Advanced Planning Fee: $0.00 Select a Non-Residential (D
Travel Documentation lees: Building or Structure
i
Strong Motion Fee: 1RSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: /eCRSC $1.00
- -- ,�---,-,__, ;
xjSURTOTALS.�:) $1.50 $195.00 �� TOT�LFEE $196.50
Revised: 07/01/2012
j , g (-) z �y
REROOF PERMIT APPLICATION
COMMUNITY,DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTIN0 (408)777-3228• FAX(408)777-3333•buildinDEboupertino.orcl
PROJECT ADDRESS APNv
Z/085- /7 �
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OWNERNAME 'TAr0. n PHONE E-NAIL
J A R0.A 0.10(e Q
STREEr AODRESs /OD CI " STATE.ZIP FAX
S e So
14
CONTACT NAME I PHONE E-MAIL
-0 30
STREET ADDRESSCITY.STATE.ZIP FAX
❑OWSFR ❑ OWNER-RUILDER C1 .,/OWNER AGENT J� 0O 71I ACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTORNANE LICENSENUMBER LICENSE 'PE BUS,LIC.•
2
COMPANY SAME E-MAIL FAX
SAME
STREET ADDRESS CIT,',STATE.ZIP PHONE
Sol a oSe C 8�0
,ARCHTTEC ,ENGIN'EER NA\IE LICENSE NUMBER BUS.LIC.
COMPANY NAME I E-NIA1L. FAx
STREET ADDRESS CITY.STATE ZI P PHONE
LSE OF ❑ SFD or Duplex JC Muld-Family ROOF AREA: Af VALUATION: p
STRUCTURE, ❑ Commercial $ 5'0
EXISTING ROOF TYPE; ❑BUILT-CPROOF ❑ASPII.ALTSHISOLES jIIlI!wOODSHAEES ❑WOOD SHINGLES 001HERISPECIFYI
RENIOVE:REPLACE OYES I IFNO. PLYWOOD ❑ PLYWD ❑'OSB PITCH; ROOF
❑ K • \'F.R 1 '\ ❑ .a' 1'YP X 'I A A
PROPOSED ROOF TYPE; ❑BCILT.UPROOF XISPHALTSHINGLES ❑N'OODSIIAI:ES ❑\\OODSHISGLES ❑OTHER IMES REPORTS
DESCRIPTION OF\\'ORE;
1�Ztt
se a
By my signature below.I cenify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I have provided is correct. I have read the Description of Work and verify it is actuate, I agree to comply with all applicable local'
ordinances and sate laws relating to building cons tion. 1 Vwrize repreu tiv of Cupenino to enter the above-identified property for inspection purposes.
Sigrwture of ApplicanUAg<nE Date: it O
SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY
_ If building is associated\\'ith a Home 0\vner's Association.provide letter If
ROUTISC SLIP
-
of approval from HOA. OL.1 \'ER:THGCOUNTERBLJ UILDING PLAN REVIEW
Provide Planning approval to vcrify if there any restrictions. ❑ EXPRESS ❑ PLANNINC PLAN REVIEW'
_ P/rov�de'copy of Manufacturer's Installation Specifications. ❑ STANDARD ❑ FTREDEPF
P� rovide Signed copy of Cupertino's Tear-Off Policy. ❑ OTHER:
ReroofApp 1011.doc revised 03116/11
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
p(408)777-3228• FAX(408)777-3333•building a(�.cupertino.Ora
PROJECTADDRESS /Op C APYK
OWNER NAME PHONE E-MAIL
F (/Off- a -960(0,7—
STREETADDRFSS �f CIIA. STATE FAX
ZS_ lam/ ! l- uCA 9rdLY-.
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC.4
COMPANY NAME E-MAIL FAX
Foup .Sews S
STREET ADDRESS CnT ,STATE.ZIP PHO E
SpZ
".pew —Toxe_ CA 4SI12 oI 118-oMa
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. 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 I/<" 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. 1 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 11315 of
the 2010 California Residential Code.
Signature of Applicant/Agent: Date: 9X27—/Z
ReraoJPolicv_201Lrloc revised O2li6/I l