12070214 CITY OF CUPERTINO 13UILDING PERMIT
BUILDINGADDRIiSS: 20650GARDENSIDECIR CONTRACTOR:BRADSHAW ROOFING PERMITNO: 12070214
OWNER'S NAME: OSWALD&VIRINDA D'SA 1821 S BASCOM AVE,I'M13 160 DATE ISSUED:07127R012
OWNER'S PHONE; 4084465292 CAMPBELL.CA 95008 PHONE NO:(408)246-9930
❑ LICENSED CON'IRACfOR'S DECLARA'T'ION
BUILDING PERMIT INFO: BLDG - ELECT PLUMB "
License Class ^�-1 Lie � ' � D1ECIIr RESIDENTIAL F.—
COMMERCIAL r.
Contractor Date
hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION: REMOVE EXIS'T'ING WOOD SHAKE ROOFING AND
(commencing o th Section 7000)of Division 3 of the Business RS Professions INSTALL NEW
Code and that my license is in full force and effect. CLASS A ASPHALT SHINGLES(CERTAINTEED-AGED BARK)
hereby affirm under penally of perjury one of the following loo 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 ollhe 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 die work for which this Sq.Ft Floor Area: Valuation:$6000
permit is issued.
A PILL]CAVI'CEI RTI FICATION ,\PN Number:36232034.00 OccupancyType:
I certify that I have read this application mid state that the above information is
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 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,lire applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-paint source relifilationeer the Cupertino Municipal Code,Section
9.18. I
Issued by:��f�/✓ �Tli� Date: 7-1Z7-J0..
Signalurc Dalc �a�
❑ O\\'Milt-Ii111LUliR UL;CL,\R,VI'ION
RE ROOFS:
1 hereby affirm that I tan exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is
[lie following rwu reasons: installed without first obtaining an inspection,I agree to remove all new materials for
[,as owner of the property,or my employees with wagesras their sole compensation, inspection.
will do the work,and the structure is not intended or offered for sale(Sce.7044,
Business S Professions Code) Signature of Applicant: Date:
I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business R Professions Code). ALL ROOF COVERINGS TO 131;CLASS"A"OR BF,'I-1'ER
hereby affirm under penalty of perjury one of the folluaing three
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's DA%ARDOUS MATERIALS DISCLOSURE
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
perfant ance of the work for which this permit is issued. California Ilealth S Safety Code,Sections 25505.255334 and 25534. 1 will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Jlunicipal Code,Chapter 9.12 and the Ilealth S
Section 3700 ofthe Labor Code,for the perfomnanee 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 Arca Air Quality Management District I will
I certify that in the performance of the 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 any manner soils to become subject it,the Worker's I Icallh S Safely Code.Sections 25505,25533,and 25534.
Compensation laws ofCalifomia. If,after making this certificate of exemption,1
become subject to the Worker's Compensation provisions of the Labor Code,I must O 1e' . Ihori nge it:
lorthm ith comply with such provisions or this perinit shall be deemed revoked. 71 inn
u'rl.lc,\N r cFlrru lc,rrloN CONSTRITMON LENDING AGENCY
I certify that I have read this application and state that the above information is I hereby affirm that there is a constmclion lending agency for the performance of work's
correct.I agree to comply with all city and county ordinances Land 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 Name
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
gaming of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section ARCHITEM"S DECLARATION
9.18. 1 understand my plans'shall be useda public records.
Signature Date Licensed Professional
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
:121 ADDRESS: 20650 Gardenside Cir DATE: 0 7/2612012 REVIEWED BY: Sean
APN: BP#: . X07 'VALUATION: 56,000
*PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD or Duplex PENTAMATION 1 SFDWLROOF
USE: PERMIT TYPE:
WORKRemove existing wood shake roofing and install new class A asphalt shingles.
SCOPE
FEE ID ROOF AREA
s.f.
1REROOFFRES 1,200
A4ech.Plan Check Phrn+b.Plan Check Elec.Plan Check
Much.Permit Fee: Plumb. Penns Fee: Elec. Pe,nir Fee:
Other A4ech.Insp. Other Phanh hssp. Other Elec.Insp.
114ech.hasp.Fee: Month.Insp.Fee: Elec.hap.Fee:
NOTE: This estimate does not include fees due to other Departments(Le. Planning, Public Works, Fire,Sanitary Sewer District,School
District,etc). Thesefees are based on the preliminan information available and are only an estimate. Contact the De t or addn't info.
FEE ITEMS (Fee Resolution 11-053 Elf 7/1/11) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Supp/. PC Fee
Plri nb./A4ech./EIec
Permit Fee: $180.00
Suppl. Insp Fee
Plunb./A9ech./Elec
Plumb./Afech./Elec Permii Fee:
Construction Tax: EJ
Achnntistrative Fee:
Work Without Permit? O Yes Q No $0.00
Advanced Planning Fees:
Travel Documentation Fees:
Strong Motion Fee: 1BSEISA11CR 50.60 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC S1.00
SUBTOTALS: $181.60 $0.001 TOTAL FEE: $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
(408)777-3228• FAX(408)777-3333•buildingrakugertino.org
PROJECT ADDRESS O APN6 r
O ERm P ONE �J E-MAIL
STRE ADD S CITY. TATE,ZIP FAX
C Cr0 NA 1E LIMNSE NTJMBE LICENSE TYP aUS.UC.a
\ i1
COMPANY NAME E-MAI M FAX -7-) MID- _ d
STETADDRESS ` , \J ` CITY.STATE.ZIP 1 ONE
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. ProgressInspectionis 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, 1 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. 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:
RerooJPo1icv_2011.doc revised 02116/11
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
C U P E RT I N O Fax: 408-777-3333
CONTRACTOR / SUBCONTRACTOR LIST
JOB ADDRESS: 6 PERMIT#
OWNER'S NAML': rS C,�g4 PHONE # a L( O
GENERAL CONTRACTOR: ( BUSINESS LICENSE #
ADDRESS: f V CITY/ZIPCODE: rt -25
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL 13E SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing-
Electrical
inishingElectrical
Excavation
Fencing
Flooring / Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting/Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
7b 7
Owner/ Contractor Signature Date
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT- BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO,CA 95014-3255
CUPERTINO (408)777-3228• FAX(408)777-3333•buildinO(cDcuoertino.orO
PRuIECT ADDRAPN n
OWNER NAAB / PHONE E-MALL
STREET.ADDRESS COY', STATE•ZT I FAX
• r
CONTACT NAME PHONE E-t WL
STREET ADDRESSCRY,STATE.ZIP FAX
❑ OWNER ❑ OWNER•BUI.DER ❑ OwNERAGENT CONTRACTOR ❑CONiRACTORAGENT ❑ ARCHITECT ❑ENCXKF R ❑ DEVELOPER ❑TENANT
CONTRACT RNAME LICENSENUGBER LICENSE TYPE BUS.LIC.tl
7
COMPANY NAME E�\L{ �< n� FAX --)(Y)-
q3
STREET ADDRESS CT',STATE IP PHONE
f-C n
ARCHITEC IENGI fiER NAME LICENSE NUMBER BUS.LIC.C
COMPANY NAME E-MAM FAX
STREET ADDRESS CITU',STATE.ZIP PHONE
USE OF ❑ SFD or Duplex ❑ Multi-Family,; ROOF AREA: vALUA TIO N:
STRUCTURE. ❑ Commercial �.�a
EXISTING ROOF TYPE- ❑BUILT-UP ROOF ❑ASPHALT SHINGLES m WOOD SHARES tvOOD SHINGLES .❑OTHER(SPECIFY)
REMOVE REPLACE S M IF,NO !Y
. 11 PLYWOOD ' ❑ PLYtYD ❑OSB ROOF
❑ O eRc Y THICKNESS. ❑ y3- E ❑C PITCH: :12 fLASS A
PN?POSEDROOFTYPE: ❑BUILT-UPROOF 2 ASPHALT SHINGLES 11 WOOD SHAKES ❑WOOD SHINGLES ❑OTHER [CC-FS REPURTtl
DESCRIPTION OF WORK: •�
r `
By my signature below,l certify to each of the bllowing: I=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 it is accurate. 1 agree ID tmmply with all applicable local
ordinances and state laws relating to bubulllgill ansH ion. I au oriz/glrepreSfimuives of Cupertino to enter the aab1o/ve-identifi d property for inspection purposes.
Signatureof.4pplicvn/Agent.�A//.(�L.� n0 _ L/ Date:
SUPPLEMENT.AL INFORMATION REQUIRED OFFICE USE ONLY
If building is associated with a Home Owners Association,provide letter - ? PLAN CHECBTYPE- ROUTING SLIP-
f
of approval from HOA. OVER-THE,COUNTER ElBUD.DING PLAN REVIEW,
_Provide Planning approval as verify if there any restrictions. etPREss ❑ "PLANNINs PLAN REVIEW
_Provide copy of Manufacturer's Installation Specifications. ❑ STANDARD ❑ FIRE DCPT
Provide signed copy of Cupenino's Teal'-Off Poli y. ❑ OTHER:
RerwfApp_201 1.doc revised 03116!11