12060148 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10558 RED FIR CT CONTRACTOR:FOUR SEASONS ROOFING PERMIT NO: 12060148
OWNER'SNAME: AHMGDIJiALILANDGHAZALA PO BOX 1668 DATE ISSUED:0612512012
IN I-
Pl IONF.: 4082102261 SAN JOSE,CA 95109 PHONE NO:(408)278-0330
ya'' LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
Licenseclass_C"3q Lica Li-M108 r r r
FSK ,
MECH RESIDENTIAL COMMERCIAL
Contractor FSK, Itic. Date 6- ZS-/Z.
hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION:I EAR OFF EXISTING WOOD SI IAKF,INSTALL COMP
(commencing with Section 7000)of Division 3 of the Business&Professions SHINGLES CLASS A 13 SQFT
Code and that my license is in full force and effect.
1 hereby affirm under penaltyof 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 work for which[his permit is issued.
I have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Floor Area: Valualion:$4500
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION \PN Number:35905007,00 Occupancy Type:
I certify that I have read[his application and stale that the above information is
correct. I agree to comply with all cit)'and county ordinances and state laws 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[he 180 DAYS FROM LAST CALLED INSPECTION.
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. Issued by: Date: G-' -/�—
Signature Date "I
❑ OWNER-BUILDER DECLARATION RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed.If a roof is
hereby'affirm that 1 am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all nese materials for
the following two reasons: inspection.
1,as mvner of[he property,or my employees with wages as[heir sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec7044, Signature of Applicmt: Dale: 6—Z5-'12
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,13usiness&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1 hereby affirm under penalty of perjury one of the following three
declarations: HAZARDOUS MATERIALS DISCLOSURE:
I have and will mainmin a Certificate of Consent to self-insure for Worker's 1 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 Ilealth&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 Ilealth&
I have and will maintain Worker's Compensation Insurance,as provided for by Safety Cade.Section 25532(a)should I store or handle hazardous material.
Section 3700 ofthe Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air
pcmnit is issued. contaminants as defined by the Bay Area Air Quality Management District 1 will
maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
I certify that in the performance of tlne work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534.
not employ an),person in any manner so as to become subject to the Worker's
Compensation laws ol'Califomia. If,Aller making this certificate of exemption,I Ownertit f, enl:
become subject to the Worker's Connpensalion provisions of the Labor Code,I must 43 Data
forthwith connpl)'with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING ACE:NCV
APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of ut rk's
I certify that I 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 stale laws relating Lender's Name
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property'for inspection purposes.(We)agree to save Lender's Address
indenmify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the
granting of this permit Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
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
REROOF TEAR-OFF POLICY
COMMUNITYDEVELOPMENT DEPARTMENT•BUILDING DIVISION
ALBERT SALVADOR, P:E., C.B.O., BUILDING OFFICIAL
CUPERTINO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•building0cuoertino.org
PROJECT ADDRESS - APN4
s
OWNERNAMEJ PHONE E-MAIL
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STREET ADDRESS OSSA CITY, STATE�P FAX
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CONTRACTOR NAME LICENSE NUMBER LICENSLXPE BUS.LIC.a 4 11 OR
COMPANY NAME E-MAIL (r FAX
STREET ADDRESS .CITY TE,ZIP PHONE
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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 theisheathing 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"'/a" 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, 1 certify each of the following is true: 1 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. 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 Residential Code.
Signature of Applicant/Agent: Date: 6'2S lZ
ReroofPnliry_?011.dor revised IJ?/16111
CITY OF CUPERTINO
FEE ESTIMATOR— BUILDING DIVISION
ADDRESS: 10558 red fir ct. DATE: 06/25/2012 REVIEWED BV: bobs.
APN: BP#: 'VALUATION: 1$4,500
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY Multi-Family Dwelling Buildina is PENTAMATION 1R2ROOF
USE: >3 Stories Yes � No PERMIT TYPE:
WORK tear off existing wood shake install comp shingles.
SCOPE
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bop. /R•r I:Irr. bop. Il'rr
NOTE: This estimate does not include fees due to other Departments(i.e. Planning, Public Narks, Fire,Sanitary Sewer District,School
District,etc. . These fees are based on the prelindna information available and are only an estimate Contact the De t or arldn'l info.
FEE ITEMS (Fcc Resolution 11-053 Eff 71111/1 FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 1,300 s.f. Re-roof
Suppl. PC Fee: Q Reg. Q OT FO,0 Fhrs $0.00 $182.00 /RER001MRE
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee.0 Reg. Q OT 0,0hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
(m.vh III lion /,I.\.
idmini,'ll(ahc
Work Without Permit? O Yes 0 No $0.00
Advanced Plannin, Fee: $0.00 Select a Non-Residential E)
7rarrl 1?n,uuu"111nlinn /•ccs; Building or Structure Q
I
Su'on, Motion Pee: IBSEISMICR $0.50 Select an Administrative Item
131d, Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $1.50 $182.001TOTAL FEE: $183.50
Revised: 06/30/2012
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REROOF PERMIT APPLICATION
_ COPIMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300TORRhAVENUE CUPERTINO'CA950143255
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CUPERTINO
(408)777 3228( FAX''(408)777 3333 bulldinggCuoertino-org
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