12090214 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21082 WHITE FIR CT CONTRACTOR:FOUR SEASONS ROOFING PERM IT NO: 12090214
Ow'NF-R'S NAME: YAMADA HIDEO PO ROS 1668 DA'Z'E ISSUED:09/252012
OWNER'S PHONE: 4087859160 SAN.IOSE.CA 95109 PHONE NO:(408(278-0330
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG (_ ELECT 0— PLUMB Cl.
C
License Class C-- CONTRACTOR'S
Lie.9 '-(—) ;I-k 0d
,,ffes� M
p ECH (- RESIDENTIAL r CCOMMERCIAL (✓
Contractor i"5 2-f 'N•
(C— - Date
hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION:TEAR OFF EXISTING WOOD SHAKE ROORINSTALL I2"
(commencing with Section 7000)of Division 3 of the Business& Professions CDX
Code and that my license is in full force and effect. PLYWOOD&30H FELT UNDF-RLAYMF-NT,INsTALL 13 SQ CLASS
A C17RTAINTEED PRESIDENTIAL COMP
hereby affirm under penalty of perjury one of the following two declarntions:
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:$4500
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is APN Number:35905097.00 Occupancy Type:
correct.I agree to comply with all city and count),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.mdwillcomply WITHIN 180 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.
Signature Date 9-2-.57--tz- Issued Date: l;'%_,e.1
❑ OWNER-BUILDER DECLARA'T'ION
hereby affirm that 1 am exempt from the Contractor's License Law far one of RE-ROOFS:
the Wining two rensons: 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 wages as their sole compensation, installed without first obtaining an inspection,I 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)
Los owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: Date:
construct the project(Sec.7044,Business&Professions Code). er
hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO RE CLASS"A"OR BF 1"I'ER
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's
nnznRDous aLrrERlnls D1scLosuRe
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 Health&Safety Coda Sections 25505,25533,and 25534. I mill maintain
Section 3700 of the Labor Code,for the performance ofthe work for which this compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Safety Code,Section 25532(a)should I store or handle hazardous material.
permit is issued. Additionally,should I use equipment or devices which emit hazardous air
I certify that in the performance of the work for which this permit is issued,l shall contaminants as defined by the Bay Area Air Quality 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 lmvs.ofCnlifomin. If,after 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 permit shall be deemed revoked. Owner or �zcd.agcnC Zs -E_
i Date:
APPLICANT CERTIFICATION CONSTRUCI'ION LENDING AGENCY
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 and 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 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 liabililies,judgnments,
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 ARCHITECT'S DECLARATION'
9.18.
I understand my plans shall be used as public records.
Signature Date
Licensed Professional
� -z") ° �
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO,CA 95014-3255
(408)777-3228• FAX(408)777-3333• buildinc dicupertino.orc
CUPERTINO 7
PROJECT:\UDRE55 AP>'=
/- / . ; _ 06, O
l�T �/�./
OWNER NAME i PHONEI E-MAIL
O I C 9T 6m
STREET'ADDRESS CITY-STATE.ZIP FAX
21oft, �/� : �e � .:;no�� CA 75J1
CONTACT NAME I rcdPHONE I O IO 30l ENTAIL
11 o Gaw2areS —8-
STREET ADDRESS SC2 nlnQ S+- CIT) STATE ZIP FAx
T 11102
❑OWNER G Ow NER-FIVILDER ❑ OWNER AGENT ,(CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINF.F.R ❑ DEVELOPER LI TENaNT
CONTRACTOR NAME ( LICENSENL'MBER I LICENSE T)'PE I BLS.LIC.
E •
4-12.109
COMPANY NAMEI E-MAIL I FAN
STREET ADDRESS CIT)'.ST\TE.ZIP
$02, I a CA.qS112.
PHONE -2 8-0
:ARCHI fEC,ENGINHER NAME LICENSE NUMBER BCS.LIC.•
COMPANY NAME E-MAIL FAX
STREET ADDRESS I CITY.STATE.%IP I PHONE
USE OF ❑ SFD or Duplex JC Multi-Family ROOF AREA: VALUATION: p
STRUCTURE. ❑ Commercial -D' 7 J Un
EXISTING ROOF TYPE: ❑BUILT-CPROOF ❑ASPHALTSHINGLES PCIVOODSHAIES ❑N'OpDSH1SGLES ❑DINER(SPECIFY)
RENIOV'F.:REPLACE )'ES IF NO. PLYY¢pOD {�U" ❑ PL,'vD ❑ OSB PITCH' ROOF
❑ N A)'F.R // ( THIfF:N .S L J 5 11'P S ')2
PROPOSEDROOFTYPE. ❑BUILT-UPROOF /.ASPHALT SHINGLES ❑t)OODSHAtiES ❑v OOD SHINGLES 13 OTHER ICC-ES REPORT.
DFSCRIPTIONOF U'ORR:
S�i r>t_T�oo� Sw�22 fo ►�2 E r
w cod +6 e n
se Presider+;ol conn S61 o.
By my signature below.1 ceC.ifp to each of the following: 1 am the property o,ner or authorized agent to act on the proper'o)tner'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 relatine to building cons cion. I ayhorize represe tiv of Cupertino to enter the above-identified propertyfor inspection purposes.
Signature of ApplicanUA¢enl: �-/�� �,�� Dale: �O
SUPPLEMENTAL INFORMATION RFQUIRED OFFICE USE ONLY
_ If building is associated)vith a Home 0"ner'S.Association.provide letter PLAN CHECA TYPE ROUTING SLIP
of approval from HOA. ❑ OWER-THE{OUSTER ❑ BUILDING PLAN REVIEW
Provide Planning approval to veri fp if there any restrictions. ❑ EXPRESS ❑ PLANNING PLAN REVIEW
Provide copy of Manufacturer's Installation Specifications. ❑ STANDARD ❑ FIRE DEPT
Provide signed copy of Cupertino's Tear--Off Polic%. ❑ OTHER:
ReroojApp_101 l.doc revised 03116111
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS:,�)10R `� U.N , Y ,DATE: REVIEWED BY:
APN: BPq: "VALUATION: $4,500
*PERMITTI'PE: Minor Building Permit PLAN CI I ECK TYPE: Re-roof
PRIMARY SFD Or Duplex PENTAA1ATION 1SFDWLR00F
USE: PERMIT TYPE:
WORK TEAR OFF EXISTING WOOD SHAKE ROOF.INSTALL 1/2" CDX PLYWOOD& 30# FELT
SCOPE UNDERLAYMENT.INSTALL 13 SQFT CLASS A CERTAINTEED PRESIDENTIAL COMP p
FEEID ROOFAREA
(S.f.) -
1REROOFFRES 1,300
dfeeh.Plan Check Plumb. Plan Check Eler.Platt Check
Aleah. Permit Pee: Piumh.Pomit Fee: Flee. Permit Fee:
Other Mach.lrzp. Od1er Plumb Insp. 0111eg.Flea.hap.
E17-
Alech.Imp. Fee: Plmub.hv"P.Fee: filer.Insp. Fee:
NOTE: This estimate docs not include fees due to other Departments(Le. Planning,Public Works, Fire,Sanitag Seu-er District,School
District,etc). These fees are based an the prelininart information available and are odv an estimate. Contact the De t or addn'I info.
FEE ITEMS [Fee Resolution 11-053 ER 7/1/111 FEE QTY/FEE p1ISC ITEMS
Plan Check Fec:
Suppl.PC Fee
Phrath.i:Nerh.;'F1ec
Permit Fee: $195.00
Suppl. besp Fee
Plunth..,MecklE•ler
11lumh.,•'Mevh.:E1ec Permit Fee:
Construction Tar:
Administrative Fee:
Work Without Permit? 0 Yes (j) No $0.00
Ach•anced Plrnming Fees:
Trm-el Documeniation Fees: A
Strong._Motion Fee: 111SEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.001 1
SUBTOTAL r $196.50 $0.001TOTAL FEE: $196.50
Revised: 0710112012
REROOF TEAR-OFF POLICY
rneenu IMITY nEVFI.OPMFNT DEPARTMENT•BUILDING DIVISION
ALBERT SALVADOR,P.E.,C.B.O.,BUILDING OFFICIAL
C U P E RT I N O 10300 TORRE AVENUE• CUPERTI NO, CA 95014-3255
(408)777-3228• FAX(408)777-3333•buildino(d)cupertino.orp'
PROJECTADDRESS APN n
OWNER\AME PHONE E-MAIL
01
STREETADDRPSS SA tAC- CIT' TATIi.ZI AD t..C7A Rn FAX
C/ LtLf
CONIRACIOR NAME LICENSE'U,N O O LICENSEYP HUS.LIC.n
COMPANY NAME E-MAIL Q FAX
duf Saai'o.�$ Ew
STREET ADDRESS �Z CITY.ST, . 'IP P ONE
aF-x'78-G33o
1 UNDERSTAND AND AGREE TO THE FOLLOWING:
1. The re-roof project shall comply with all applicable provisions of the 2007 California Building Code.
2. You must schedule all needed inspections a minimum of one day before the requested inspection date.
Please schedule inspections online or call (408)777-3228 between 7:30-3:30 (Mon-Fri).
3. Tear-off roof inspection is required. Please call for tear-off inspection after the roof is torn off and all
the nails/fasteners have been removed. Any and all dry-rotted wood shall be replaced prior to this
inspection. A building inspector will be available within one hour.
There are special hours for this service: 7:30 — 10:30am and 1:00— 3:30ptn (Mon—Thurs);
7:30 — 10:30am and 1:00— 2:30pm (Friday).
4. If plywood is installed, a plywood nailing inspection is required.
5. In-Progress roof inspection is required. Call for an in-progress roof inspection to verify building is
weather tight after installation of approximately 25% of the roofing material.
6. New roof coverings shall not be applied without first obtaining all inspections 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.
7. A final inspection and approval shall be obtained from the building inspector when the re-roofing is
complete. To receive a final sign-off, the following items will be verified:
a. Flat roofs shall have a minimum of/4" per foot of slope and must 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.
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: 1 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.
Signature of Applicant/Agent: Date:
ReronfPolicv_2010.doc revised 05/17110