12090023 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20671 GARDENSIDE CIR CONTRACTOR:BRADSHAW ROOFING INC PERMIT NO: 12090023
OWNER'S NAME: NEWCOMER DALE E AND MARY A 1821 S BASCOM AVE PMB 160 DATE ISSUED:09/102012
OWNER'S PIIONE: 4089738534 CAMPBELL.CA 95008 PHONENO:(408)246-9930
LICENSED CONTRACfOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT (J PLUMB IJ
License Class —1
_ _ Lic.H --/-r � � S g C7 r r r'1
ContmctorG,
Q MEC1I RESIDENTIAL CCOMMERCIAL/IC 1\`l 'Datc�]10J_A 2
1 hereby affirm that I am licensed under the provisions of Chapter 9 30B DESCRIPTION: REMOVE EXISTING WOOD SHAKE ROOFING.INSTALL
(commencing with Section 7000)of Division 3 of the Business&Professions 1200
Code and that my license is in full force and effect. SOFT NEW CLASS A COMPOSITION SHINGLES(AGED DARK)
1 hereby affirm under penalty of perjury one of the following Mo 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 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 Sq.Ft Floor Area: Valuation:$6000
permit is issued.
APPLICANFCERTIFICATION APN Number:36232003.00 Occupancy Type:
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
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 die 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 regulationsegla �peerr the Cupertino Municipal Code,Code,Section -f 0 — I Z
9.18. Cc/�[r tr.Jt 4ln a•L
O �,2 Issued by: Dale:
Signature z Date
❑ O VNF,R-BUILDER DECLARATION
Rh:ROOFS:
herchy affirm that I am 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
the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
1,as owner of the property,or my employees with wages as their sole compensation, inspection. _
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code) Signature of Applicant: Date: 9J/0//
1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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 sett-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the 1 here 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,m provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Ilealth&
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 the work forsvhich 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 so as to become subject to the Worker's Ilealth&Safety Code,Sections 25505,25533,and 25534.
Compensation Imus of California. If,after making(his certificate ofexemption,I
become subject to the Worker's Compensation provisions of(he Labor Code,I mustyner o a ori agent: y�o/rz
forthwith comply with such provisions or this permit shall he deemed revoked. t Date:
\I'1'LICANI'CI:R'1'IPIC.\9'ION CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is I hereby affirm 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 stare 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.('Ale)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 ARCUITEC'I"S DECLARATION
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18, 1 understand my plans slall be used as public records.
Signature Date Licensed Professional
REROOF PERMIT APPLICATION '.
r. COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO.CA 95014-3255
CUPERTINO (408)777-3228 • FAA(408)777-3333•buildinaOcuoertino.oro
PROJECT ADDRESS ^ I APN O v 00 2)
0 ERNAhffi pot,u n O \ �j �j'Lvf ki N _ n EMAIL
STREETAp E CITY, STATE,ZIP 7 F.V(
CONTACT NAME PHONE E.W.U.
STREET ADDRESS CITY,STATE,ZIP FAX
❑OwNFA ❑ OwNzR.BL-II.DER ❑ OtITtERAGEN`r COtn1LACTOR ❑CONIRACTORAGENT ❑ .ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTMCT RNAAffi 4CE1S�affiER LICENSETYPE BUS.LIC.. 30
COMPANY NAh¢ E.L{ 1Jr n� FAX
STREET AODRFSS _ CgY,STATE IP PHONE
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ARCHITEC IENGWEER NAME LICENSE NWffiER BUS.LIC.s
COMPANY NAME E-h1AR. FAX
STREETADDRESS __// CITY,STATE ZIP PHONE
USE OF ❑ SFD or Duplex M
ulti-Family, ROOF AREA: VALUATtQpy�ry ep
STRUCTURE. ClCOnamercial �`
ExISTINGROOFTYPE:�/OBUILT-UPROOF ❑.ySPHALT SHINGLEC hLt4'OOD SHAKES tVOpD SHINGLES ❑ HFR
OT (SPECIFYI
REMOVE/REPLACE LYtiS ff NU, PLYA'OOD Y' ❑ PLriVD ❑OSB PrrcK ,l ROOF
❑ s c y, I K, < ❑ vS- ❑Cox
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF &rASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT
DESCRIPTIONOFWORX' 7 ` G
1\ 1
By my sigrumae below,I cemiy to each of du following: I am the property owner or authorized agent to act on the property owner's behalf. I have read tho
application and the information 1 have provided is correct. [have read Ate Description of Work and verify itis accurate. [agree in comply with all applicable local
ordinances and state laws relating to bbuilliq wrnt��rt}}r ion. I au�oriz/�repraenratives of Cupertino to enter the above-identiC/�A proPenY Cor inspection purposes.
SiMmmureofApplicant/Agene�A/L.!/C�Z-P�IGCJ't� Date: ��o��/ _a��Z
SUPPLEMENTAL INFO1h4ATION REQUIRED OFFICE USE ONLY
_If building is associated with a Home Owncrs Association,provide letter PUN CT¢CK TYPE ROUTING SLIP
of approval from HOA. ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW
_Provide Planning approval to verify if thereany restrictions. ❑ EXPRESS ❑ PLANNING PLAN REAIEW
_Provide copy of Manufacturer's Installation Specifications. ❑ Z-T,vttiARD ❑ FRE DEPT
Provide signed copy of Cupenino's Tear-Off Policy. ❑ OTHER:
Reroofdpp 2011.docrevised03/12'11
Bldg Stds Commission Fee: IBCBSC $1.00
1 1
SUBTOTALS: 1 $181.601 $0.001 TOTAL FEE: 1 $181.60
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•building(ftuoertino.org
PROJECT ADDRESS t C• _ APN a
O ER NAME Qh �( PHONE E-MAIL
ekjj
IPLA
4Q9 q73-C32kI
STREET ADDAdS CITY.STATE.ZIP FAX
C 'TRACTO NA. E LICFNSENUMBER LICENSE NP BUS.LIC.d,
I 1L \ 1
COMPANY NAME E-MAI \� t�L' FAx - --)^
STRIt ADDRESS ` ' ` . ; C� CITY.STATE,ZIP 1 ONE l�
V 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 Y" 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: 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:��l�J _L
RerooJPo1i"_2011.doc revised 02116111
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 20671 Gardenside Cir DATE: 09/04/2012 REVIEWED BY: Sean
APN: BP#: 'VALUATION: $6,000
*PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY Buildina is PENTAMATION 1R2ROOF
USE: Multi-Family Dwelling >3 Stories O Yes O No PERMIT TYPE:
WORKRemove existin wood shake roofing. Install new Class A composition shingles (Aged Bark).
SCOPE
FEE ID ROOFAREA
s.f.
1REROOFMRES 1,200
Alech. Plan Check Plumb. Plat Check Flee.Plan Cheek
Meeh. Permit Fee: Plumb. Permit Fee: Elec.Permit ree:
Other Mech.Insp, Otter Plumb Insp. ED Other Elce.Insp.
,b/ech.Insp. roc: Plumb. Insp. Fra: Flee.Insp. rec:
NOTE: This awintate does not includelecv due to other Departments(i.e. Planting, Public Works, Fire,Sanitary Sewer District,School
District,etc. . These eev are baser/on the relintinan•information available and are ath•an estimate. Contact the Dept or addn't info.
FEE ITEMS (Fee Revolution 11-053 E1T. 711111) FEE QTY/FEE MISC ITEMS
Plan Check ree:
Supp/. PC ree
Phmtb.11le ch./Flee
Permit Fee: $180.00
Suppl. Insp Fee
P1tmb.A%1ech./F1ee
Plunih.11fech.10ec Permit Fee:
Construction KLY:
ddminiclrarire ree:
Work Without Permit? O Yes Q No $0.00
Advanced Planning Pees:
Travel Docionentation rets:
Strong Motion Fee: IBSESwICR $0.60 Select an Administrative Item
Bide Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $181.601 $0.001 TOTAL FEE: $181.60
Revised: 07/01/2012