12090176 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20651 GARDENSIDE CIR CONTRACTOR:BRADSHAW ROOFING INC PERMIT NO: 12090176
OWNER'S NAME: LU ZIHONG AND ZIIENG ZHAOi IUI 1821 S BASCOM AVE,PNIB 160 DATE ISSUED:09/192012
OWNER'S PHONE: 4083091256 CAMPRhLI.,CA 95008 PHONE NO:(408)2459930
LICENSED C0NTRAC`fOR'S DECLARATION r r
3 � BUILDING PERMIT INFO: BLDG " ELECT ' PLUMBLicense CI "" Lie.d
M
2 ECH r RESIDENTIAL J COMMERCIALContmctor LL) Date/ O /z
hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: REMOVE EXISTING WOOD SRAKE ROOF AND INSTALL
(commencing with Section 7000)of Division 3 of the Business& Professions NEW
Code and that my license is in full force and effect. COMPOSITION SI'IINGLES(AGED BARK)CLASS A 12 SQFT
hereby affirm under penalty of perjury one of the following two declurations:
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 perfommnce of die work for which this Sq.Ft Floor Area: Valuation:$6000
permit is issued.
APPLICANT CERTIFICATION APN Number:36232008.00 Occupancy Type:
I certify that I 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
indemnify 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 and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. G
/ %/2x/2 Issued by: ��N IL 9TG� Date:
Signature//�. Date
❑ O\YNF.R.BUILDER DECLARATION
RI:ROOFS:
I hereby alarm that 1 am exempt from the Contractor's License Low 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,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 stmcmre is not intended or offered for sale(Sce.7044, /-
Business&Professions Code) Signature of Applicant: 6 Date:
1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGSTO BE CLASS"A"OR REITER
I hereby affirm under penalty of perjury one of the following three
declarations: HAZARDOUS MATERIALS DISCLOSURE
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 I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California Ilealth&Safety Code.Sections 25505,25533,and 25534. 1 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 Safety Code,Section 25532(a)should I store or handle hazardous material.
Additionally,should I use equipment or devices which emit hazardous air
permit is issued, contaminants as defined by the Bay Area Air Quality Management District I will
I certify that in the performance of die work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
not employ any person in my mmaner so as to become subject to the Worker's Health&Safety Code,Sections 25505.25533,and 25534.
Compensation laws of California. If,after making this cenilicate of exemption,1
become subject to the Worker's Compensation provisions of the Labor Code,I must 0w e a ized//rf/elfnt:
forthwith comply with such provisions or this permit shall be deemed revoked. Hate:2, 2- ,JZ—
APPLICANTCERTIFICATION CONSTRUCTION LENDING AG&N'C\'
I certify that I have read this application and state that the above information is I hereby affimn 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 Nume
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 ARCII I"I'FCI"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
REROOF PERMIT APPLICATION k :
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERT'lN 0 (408)777-3228• FAX(408)777-3333•buildinofccuoertino.or0
PROJECT ADDRESS APN e
OWNERN""S n f,+,(•,1 E-MAIL
U �
STREET ADDRESS r C \ CIT.' STATE.ZIP FAX
b J 1qc�nj 11
CONTACT NAME PHON E.NLA1L
STREET ADDRESS CITY.STATE IIP FAX
❑ OWNEt ❑ OVVNFR-BUILDER ❑ Ott'NERAGErT CONrR�CTOR ❑CONTRACTOR AGENT ❑ .ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACT RNANIc LICENSENUMBER LICEISE TYPE BUS,LIC.=
7 JCS sc:'�
COMPANYNAME E.W �C (N FAX _
STREET ADDRESS _ CRl',STATE IP PHONE
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ARCHTTECTIENGLYEFA NAME LICENSE NUNS ER BUS.LIC.!
COMPANY NAME EMAIL FAX
STREET:NDRESS CID'.STATE.21? PHONE
USE OF ❑ SFD Or Duplex.Mufti-Family. RODF AREA: vALUATIo
STRUCTURE. ❑ Commercial S � C Q eJ0
EXISTMOROOFTYPE: ❑BUR.T-UPROOF ❑ASPHALTSHR:OLES hLw'ODo SHAKES ❑WOODSHINGLES ❑OTHER(SPECIFY)
REMOVE!REPLAPLYY.•OOD t5• ❑ PLYIVD ❑OSB KICK ROOF
❑ O c 'L THI K c ❑ iS' I IE ❑ DX '12 CLASS'
PROPOSED ROOF TYPE: ❑BUILT-UP ROOFdsPJ1ALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT=
DESCRIPTION OF 1YORK: `
_Cy1
By lily signature below,I certify to each of the follo%ine: I am the property owner or authorized agent to act on the property owner's behalf 1 have read this
application and the information I have provided is correct. I have read the Description of Work and verify itis accurne. I agree to comply with all applicable local
ordinances and state lass relating to bullilinitwn��//''yy bn. I au��/yori/zq�representatives of Cupertino ro enter the+ahlove•idenuf/fid property for inspection purpose.
SignatureofAliplicn✓Agenr. U /_Ry`hl�i—C�T/>'L/ Date: ' /�adol r7(�1Z
c
SUPPLEMENTAL INFORIMATION REQUIRED OFFICE USE oIYLY
_If building is associated with a Honte Ossner s Association,provide letter -PLAN CHECK TYPi� Rovnxc stip
of approval from HOA. OVER-TIE-COUNTER BUILDING PLAN RCVTEW
Provide Planning approval to verity If there any restrictions. EXPRESS PLANNING PLAN REVIEW
_Provide copy of Manufacturers Installation Specifications. ❑ srervu,taD ❑ MEDEPT
Provide signed copy of Cupertino's Tea,'-OfT'Poli y. •OTHER:
RerogfApp_1011.doc rwised 03,'1 dV11
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 20651 Gardenside Cir. DATE: 09/19/2012 REVIEWED BY: Sean
APN: BPtl: 'VALUATION: $6,000
*PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD Or Duplex PFRMI LOTION 1SFDWLROOF
USE: PERMIT l'l'PE:
WORK Remove existing wood shake roof and install new composition shingles (Aged Bark).
SCOPE
FEEID ROOFAREA
s.f.)
1REROOFFRES 1,200
Nlech. Plan Check Plumb. Plan Cheek Flee.Plan Check
Mech.Permit Fee: Plumb. Permit Fee: F.lec.Permit Fee:
Other,llech.Insp. Other Plumb Insp. Ll I Other Elec.Insp.
E17-
Ilech.lnrp.Fre: Plumb. hup. Fee: Elec.Insp,Fee:
A'OTE: This euinrate does not includefeev due to other Departments(i.e. Planting, Public Works, Fire,Sanitary Sewer District,School
District,etc.). These feev are based at rite prelinzinan information available and are on&an estinuae. Contact the De t or aildn 7 info.
FEE ITEMS (Fee Resolution I1-053 E/f 7/1/1 l) FEE QTY/FEE MISC ITEMS
Plan Chuck Fee:
Supp/. PC Fce
Plumb./SAech./Elec
Permit Fee: $180.00
Suppl. Insp Fee
Phimb.Allech./Elec
Plumb.Ablec/1./Elea Permit Fee:
Construction Tar:
Administrative h-ee:
Work Without Permit? 0 Yes (] No $0.00
Advanced Planting Fees:
Travel Docinnenlatinn Fess:
Strong Motion Fee: IBSEISMICR $0.60 Select an Administrative Item
Blda Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $181.60 $0.00 TOTAL FEF,: $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
(4018)777-3228• FAX(408)777-1{3333•building(D�cupertino.arg
PROTECT ADDRESS AP\q ] / (1 ,• OO
OWNERNAMEn LL) ICNE O _�'( E-MAIL
STREET ADDRESS CI `STATE.ZIP y1 FAX
C TRACTO NAY E LICENSEN'UMBF. LICENSE TYP BUS.L M
t
COMPANY NAME E-MAI t� EAx ?/_2 - y
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STREET ADDRESS V
` , ; C� CITY.STAMZIP NONEwkn
I 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 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: lam the property owner or authorized agent to act on the
property owner's behalf. I understand and agree to comply withihe re-roof policy stated above. I also understand that
smoke detectors and carbon monoxide detectors are required
It installed in accordance with Sections R314 and 11315 of
the 2010 Califomia Residential Code
Signature of Applicant/Agent:
ReroofPolio,_201 l.doc revised 02/16111
I F 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
t .
CONTRACTOR / SUBCONTRACTOR LIST
J013 ADDRESS: PERMIT#
OWNER'S NAME: PHONE#
GE'NE'RAL CONTRACTOR: {z BUSINESS LICENSE#
ADDRESS: LCITY/ZIPCODE: O
*Our municipal code requires all businesses working in the city to have a Cih• 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 am not using any subcontractors: wiL
Signature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS-NAME BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical. -b-
Excavation
Fencing
Flooring/ Carpeting
Linoleum /Wood t (�
Glass /Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing .;
Septic Tank
Sheet Metal
Sheet Rock
1 Tile
Owner/Contractor Signature Date