12090167 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21092 WHI'T'E 17IR CT CONT'RACT'OR:FOUR SEASONS ROOFING PERMITNO: 12090167
OWNER'S NAME: VIDYA SINIIA&AJI'1'KUMAR PO 13OX 1668 DATE ISSUED:09/192012
OWNER'S PHONE: 4084019075 SAN JOSE,CA 95109 PHONE NO:1.108)278-0330
tR:--- LICENSED COXI'RACfOR'S DECLARATION
O ^c BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
License Class GJq �/ ^I Lie.# \ / Or�ti-( r —, r
PIECFI RESIDENTIALr—,
F_Fpt_'A Ic- Date C1_1 1 p—Ir�
I hereby, affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:TUR OFF ENISTING WOOD SBAKE ROOF.INSTALL 13
(coin menci ng with Section 7000)of Division 3 of the Business& Professions SQRS
Cudc and that my license is in full force:md effect. I2"CDX PLYWOOD,THEN 30N FELT UNDERLAYMENT.
INSTALL CERTAINTEED PRESIDENTIAL COMPOSITION
I 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:54500
,\I'1'LICA\t'CI?RTI1'IC.\'PION
I certify than I have read this application and state that the above information is APS Number:35905092.00 Occupancy Type:
correct, I agree to comply with all city and county ordinances and slate 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 ofCupeninoagainst liabilities,judgments, PERMIT EXPIRES IF WORK IS NOT STARTED
costs,and expenses which may accrue against said City in consequence of the
granting 01'this permit. Additionally,the applicant understands and will comply WITHIN Igo DAYS OF PERMIT ISSUANCE OR
with all non-point source regulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION.
9.18. .f
Signature Dam / / 9 _ �2 Issued by: Date:
❑ OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License 1-mv for one of RF:ROOFS:
the following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is
1,as owner of the property;or my employees with wagesas their sole compensation, installed without first obtaining an inspection,I agree to remove all new materials for
will do the work,and the suucture 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 Applicant: Date:
construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERS\ . '1'0 BE CLASS"A"OR BETTER
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURECompensation,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 health&Safety Code,Sections 25505.25533,and 25534. 1 will maintain
Section 3700 of the Labor Code,for the performance of the work for which this compliance with the Cupertino Municipal Code,Chapter 9.12 and the I lealth&
Safety Code.Section 25532(x)should I store or handle hazardous material.
permit is issued. Additionally,should 1 use equipment or devices which emit hazardous air
1 certify that in the performance of the work for which this permit is issued,1 shall contaminants as defined by the Bay Area Air Quality Management District 1 will
not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Compensation laws ofCaliforniz. If,aller nmking this certificate of excnnption,I health&S:dety Cndc,Sections 25505,25533,and 25534.
become subject to the Worker's Compensation provisions of the Labor Code,1 must
forthwith comply with such provisions or this permit shall be deemed revoked. Owner r a rued agent:
Date:
APPLICANT CERTIFICATIONCONS'I'RIICI'ION LENDING AGENCY
certify that I have read this application and state dam the above information is
correct.I agree to comply with all city and county ordinances and state Imus 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
9.18. ARCII ITEC.I"S DECLARATION
I understand my plans shall be used as public records.
Signature Date
Licensed professional
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(Zi)cupertino.arg
PROJECT ADDR S AP-N# C/S 62
, Itn `/� 351
OwNERNAM P6&) E-MAIL
IAJ / o^'CJ
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STREET ADORES z , R CIT. STATE.]ale 17 �j�O/ FAX
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CONTRACTOR NAME LICENSE NUMBER/O LICEre4 TYPE BUS.LIC.N � _7� -Z3
COMPA ' NAME
E-MAIL L (' FAX
EPDE.]Jo
11411
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1 UNDERSTAND 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 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: f nz�f /2
ReroofPolicv_201 l.doc revised 02/16///
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 21092 White Fir Ct DATE: 09/14/2012 REVIEWED BY: Sean
APN: 3,5 ppm D a BP#: ��0 qp�� 'VALUATION: $4,500
*PERMITTYPE: Minor Building Permit [PLAN CIIECKTV E: Re-roof
PRIMARY Multi-Family Dwelling Buildina is PENTAMATION 1R2ROOF
USE: 3 Stories O Yes E) No PFRNfIT T)'PE:
WORK Tear off existing wood shake roof. Install 1/2" CDX plywood then 30# felt underla ment. Install
SCOPE Certainteed Presidential Composition shingles. Color: Country Gray.
FEE ID ROOFAREA
s.f.
1REROOFMRES 1,300
bteeh, flan Check Plumb.Plan Cheek Elec. Plan Check
Mech. Permit Fee: Plumb.Permit Fee: Elec.Permit Fee:
Other,11ech.Iasi). Other Plumb Insp. Li I Other Flee.Insp. El
Adech.hup. Fee: Plumb. Gap. Fee: Flce.Insp.Fee:
NOTE: This estimate does not include fees clue to other Departments(i.e. Planning, Public II'orks, Fire,Sonitaty Sewer District,School
District,etc. . These ees are based on the preliminan in onnation available and are arth,an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 11-053 EIL 7/1/lll FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Suppl. PC Fee
PlumVil,lech./Elec
Permit Fee: $195.00
Supp/. htsp Fee
Phonh./d1ech.11;lec
Plumh./IhIech./EleO Permit Fee:
Construction Tax:
Administrative Fee:
Work Without Permit? O Yes (j) No $0.00
Advanced Planning Fees:
Tram/Documentation Fees:
Strong,Motion Fee: IBSF.ISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $196.50 $0.00 TOTAL FEE: $196.50
Revised: 07/01/2012
t✓ �i
REROOF PERMIT APPLICATION
COMMUNITY IDEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO.CA 95014-3255
CUPERTINO (408)777-3228• FAX(408)777-3333•buildinO(O�cupertino.orD 42,0��/
PROJECT ADDRESS O ' 6 APN o :3 J OS
OWNER NAME S� q • /611
.,1 ( e PHOUE `Jl E.\1AIL
STREET ADDRESS ^ O Y �f T l( CI STATE ZIP I FAX
G M
CONTACT NAME PHONE E-MAIL )
$TRE!r ADDRESS�O n
L ./14^rAn S+ CITY.STATE.IIP FAX
gol CA . qst ii
❑ONNFR ❑ Ou'NER-BUILDER ❑ OUNER,AOEAT J( COWRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME LICESEN SUTERI I.ICENSE 'PE BUS.LIC.-esti
213 Q-21
COMPANY NAME E-MAIL
5AM E
FAN
1
STREET ADDRESS CITY.ST,\TE.21P
PHONE
T'l a o e CA,qsili8-0
ARfHITECT.ENGI VEER?:AVE LICENSE NUMBER BUS.LIC.
CO.MPANV NAME I E xLAIL
FAX
STREET ADDRESS d CITY,STATE/IP PHONE
JI
USE OF ❑ SFD or Duplex Multi-Fal ROOF AREA: VALUATION: -
STRUCTURE: ❑ Commercial c �O
'EXISTING ROOF TYPE: ❑BUILT-L'P ROOF ❑ ��II//ASPHALTSHINGLES rWOODSHAKES ❑U'OODSHINGLES ❑O'HER(SPECIFY)
RENIOVEAEPLACE YES IF NO. PL: 1:1 ❑ PLl'\aD ❑OSB PITCH; ROOF
❑ N YFRe
,,/ THICKNESS ❑ 3,8- T1. , x 111i :1 CI A A
2
PROPOSED ROOF TYPE: ❑BUILT-UPROOF 6SPHALTSHINGLES ❑WOOD SHAKES ❑UOOD SHINGLE$ ❑OTHER IMES REPORT.
DESCRIPTION OF U'OR6:
lAlf
rl �waaa +Len '30-4— 9614-
^ r
• a
Rr my signature below'.I certify to each of the following: I am the propem'o\Aner or authonud agent to act on the propem 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 accurate. I agree to comply with all applicable local
ordinances and state laws relating W building cons tion, I Vol represe tic c of Cupertino to enter the above-identified property for inspection purposes.
Signature of ApplicanUAgent: Date; p
SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY
If building is associated With a Home 0\cner's Association,provide letter PLAN'CHECFTYPE ROUTING SLIP
of approval from HOA. ,$1 OYER-THE{OUNTER
BUILDING PLAN REVIEW
Provide Planning approval to vcri fp:(there any restrictions. ❑ EXPRESS ❑ PLANNING PIAN REVIEW
Provide copy of Manufacturer's Installation Specifications. ❑ STANDARD DF
IRE DEPT
_Provide signed COPY of Cuperlino's Tear-OR Policy. _ ❑ OTHER,
Heroofdpp_2011.doc revised 03/16/11