12090238 CITY OF CUPERTINO BUILDING PERMIT
13IJI LDING ADDRESS: 21066 WIi ITL'FIR CT CO,NTRACFOR:FOUR SEASONS ROOFING PF,RMITNO: 12090238
OWNER'S NAME: FLOOD MARGARITA - PO BON 1668 DATE ISSUED:09272012
OWNER'S PHONE: 4087250879 3AN.IOSE,C\ 95109 PHONE NO:(+08)278-0330
LICENSED CON'TRACTOR'S DECLARATION
(_
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BUILDING PERMIT INFO: BLDG ELECT r PLUMB ❑
License Class C"31 Lie.H "/11 0��O0 r r' r;
FS
` p , 11/ ry DIECII RESIDENTIAL '' COMMERCIAL
Commctor 1'S?_ �Vy G Date —I — y2�—f -
I hereby affirm D�licensed under the provisions of Chapter 9 JOB DESCRIPTION:TEAR OFF EXISTING WOOD SHAKE ROOF.INSTALL
(commencing with Section 7000)of Division 3 of the Business&Professions 12"CDN. -
Code and that my license is in full force and effect. PLYWOOD&30#FELT UNDERLAYh1ENT.INSTALL 13 SQ
CERTAINTEED PRESIDENTIAL COh1P
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 3700of 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:$4500
APPLICANT CERTIFICATION
I certify that I have read this application and slate that the above information is APN Number:35905105.00 Occupancy Type:
correct.I 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 '
indemnify and keep harmless the City of Cupertino against liabilities,judgments, PERMIT EXPIRES IF WORK IS NOT STARTED
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYSO PERMIT ISSUANCE OR
with all non-point source regulations per the Cupertino Municipal Code,Seetian Igo DA liAST CALLED INSPECTION.
9.18.
Signature Date�� o� Issued lav: Date:
❑ OWNER-BUILDER DECLARATION
hereby affirm that 1 am exempt from the Contractor's License Law for one of RE-ROOFS:
the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
I,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,1 agree to remove all new materials for
will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection.
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: Date: 9-dam f'I
construct the project(Sec.7044,Business&Professions Code).
1 hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUSMATERIALS S DISCLOSURE
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 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 Ilea 7th&Safely Cade,Sections 25505.25533,and'5534. I will maintain
Section 3700 of the Labor Code,for the performance of the work for which this compliance with the Cupertino Municipal Code.Chapter 9.1_and the Ilealth&
Safety Code.Section 2553_(a)should I store or handle hazardous material.
peril is issued Additionally,should I use equipment or devices which emit hazardous air
I certify that in the performance of die work for which this permit is issued I shall contaminants as defined b) the Ray Area Air Qualim Management District I 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 Imes of California. If,alter making this certificate of exemption,I Health&Safety Code,Sections 25505,25533,and 25534.
become subject to the Worker's Compensation provisions of the Labor Code,I must
forthwith comply with such provisions or this peril shall be deemed revoked. Owner o. nth :A7ed agent.
ate: _!
API'I:IG\N'I'CF.R'I'I FIGk'r10N CONSTRUCr1ON LENDING AGENCY
I cenily that I have read this application and state that the above information is
correct.I agree to comply with all city and county ordinancesand state laws 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 peril is issued(Sec.3097,Civ Q
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name
indemnify and keep harmless theCity 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 ARCBlTFCI"S DECLARATION
9.18.
1 understand my plans shall be used as public records.
Signature Date
Licensed Professional
REROOF PERMIT APPLICATION 0
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTINO (408)777-3228• FAX(408)777-3333 •buildincipcupertino.ora
PROIEC-rADORESS APNc 3✓ I O� �
G
OW WA NAME PHONE D �O E-MAIL
MEE'I'ADDRESS^ O / / CI STATE,ZIP FAX
CONTACT NAME PHONE E-MAIL
e y�t-2Tt-o33o�
STREET ADDRESS S6
2 S CITY.STAI'F.ZIP Ae .Q FAX
+-
13 OWNER ❑ OUNER-RUILDER ❑ OW'NERAGENT �TOR ❑CO]RRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME LICENSEA'LAIBER LICF.NSET PE BUS.LIC.-
` COMPANY SAME E-MAIL FAX
STREET ADDRESSSOZ CITY.STATE.ZIP Q O ^ PHONE e_O
ARCHITEC-PENGINEERNAME LICENSE.NUMC
NUMBER BUS,BUS.LIA O
COMPANY NAME E-MAIL. FAX
STREET ADDRESS I CITY.STATE ZIP PHONE
USE OF ❑ SFD or Duplex JC Multi-Family ROOF AREA: VALUATION:
STRUCTURL ❑ Commercial ,�IIyy S S�
EXISTING ROOF TYPE: 13 BUILT-UP ROOF CIr
ASPHALTSHINGLES `VOOO SHAKES ❑WOODSHINGLES ❑OTttER[SPECIFY)
REMOVF.:REPLACE OFYES IFNO. PLYWOOD :'i ❑ PLYWD ❑OSB
PITCH; 0.00E
❑ N YER � ICKCE � 11B' P � C X '1 7` A '
PROPOSED ROOF TYPE: ❑BUILT-UPROOF y.ASPB.ALTSHINGLES ❑W'OODSHAKES 11 WOOD SHINGLES ❑OTHER ICC-ES REPORTd
DESCRIPTION OF W'ORf:: Ya"
Cox
w&k_oA +LeA 304 At-+j uAderl_oa;mcA _E!A011 ieSA'a3`1
TAiA�aaa PreSidelkC4 canon "61nwl es _ L'oler : Counlry Gray
By my signature below.I certify to each of the 110110wing: I am the propeny 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. 1 have read the Description of work andverify it is accurate. I agree to comply with all applicable local
ordinances and state laws relatine to building cons oriac represe tiv c o
tion. I af Cupenino to enter the above-idemified property for inspection purposes.
Signature of ApplicanUAgent: Date; sa 12
SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY
_If building is associated With a Home Owner's Association.provide letter PLAN CHECK*PE -ROUTINGSLIP
ofapprovel from HOA. ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW
Provide Planning approval to verify if there any restrictions. ❑ EXPRESS ❑ Pun;NINc Pun'Rev1Ew'
Provide copy of Manufacwrer's Installation Specifications. ❑ STANDARD ❑ FIRE DEPT
Provide signed copy of Cupertino's Tear-Off Policy. ❑ OTHER:
ReroojApp_2011.doc revised 03/16/11
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•buildino(a)cuoertino.orri
PROJEC�D ESj _ •-,� APN4
O NAME n ^ PDQ a� EMAIL
STREET ADDRESS Y K C ,STATE, IP /u FAX
CONTRACTOR
LICEN O�I aER LIC SE TY BUS.LIC.
\IAi C e/
COMPA. M4E E-MAIL FAX
A
STREETADDR P N
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 VV 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. 1 understand and agree to comply with the re-roof policy stated above. 1 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 Residen ' ode. _
Signature of ApplicanUAgen Date:
RePvoJPo1icv_201 Ldoc revised 02/16111
CITV OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
1214 ADDRESS: `z U��D DATE: REVIEWED BY:
APN: I BP#: 'VALUATION: $4,500
*PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD or Duplex PENTADIATION 1SFDWLR00F
USE: PERMIT TYPE:
YORK TEAR OFF EXISTING WOOD SHAKE ROOF.INSTALL 1/2" CDX PLYWOOD &30# FELT
SCOPE UNDERLAYMENT.INSTALL 13 SQ CERTAINTEED PRESIDENTIAL COMP SHINGLES.COLOR:
FEEID ROOFAREA
s.f.
1REROOFFRES 1,300
ilec h. Pl m Cheek Plumb. Plan Check Flec.Plan Check
;Ileah. Permit Fee: Plunth.Petatit Fee: Flet. Permit Fee:
Other:ILv.'h.Gap, 0111er Plumb hup. Olhar Elm /mp. Li I
,Nch.Iam. Fee.' Plumb.Inep,Fee: Fler.Imp. ree:
NOTE: This evtinutte roes not include fees due to other Departments(i.e. Planning, Public Works, Fire,Sanitary Sewer District,School
District,etc. . These eev are baser/on the prelininan information available and are onlr an estimare. Contact the De t or addn7 into.
FEE ITEMS (Fee Resolution 11-053 E27/I/1 U FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Supp/.PC Fee
Elam h.:l�ech.i1;7ec
Permit Fee: $195.00
SuppL btsp Fee
Pltimb.,'':1 aech.:Elec
Phtmh.:btecha'Vec Permit Fee:
Constntetion Tor:
Aelministralive Fee:
Work Without Permit? O Yes G) No $0.00
Arlraneed Planning Fees:
Travel Documentation Fees:
Strong—Motion Fee: IBSFIS,NICR $0.50 Select an Administrative Item
Blde Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $196.50 $0.00 TOTAL FEE: $196.50
Revised: 07/01/2012