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12090116
CITY OF CUPERTINO BUILDING PERMIT BUILDINGADDRESS; 20664 GARDENSIDE CIR CONTRACFOR:BRADSHAW ROOFING PERMIT NO: 12090116 INC OWNER'S NAME: MAN SANG FONG 1821 S BASCOM AVE PMB 160 DA'Z'E ISSUED:09/132012 OWNER'S PHONE: 4083091256 CAMPBELL,CA 95008 PHONE NO:(408)246-9930 (� LICENSED CONTRA-C-I-'yOR'S DECLARATION JOB DESCRIPTION: RF,SIDENFIAL COMMFRCIAL License Class C Lie,4 / j a f RE-ROOF 12 SQ-TEAR OFF EXISTING, INSTALL NEW Contractor S w Dale ► 3 I , 2 ASPHALT SHINGLES CLASS A hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business& Professions Code and that my license is in full force and effect. 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 3700 of the Labor Code,for the performance of the work for whichthis permit is issued. Sq.FI Floor Area: Valuation:$6000 1 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 AI'N Number:36232015.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS F 28b'fL�CST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses whidn may accme against said City in consequence of die — ,I2 granting of this permit. Additionally,the applicant understands and will comply Issued by: Dale: with all non-point source egulatis per the Cupertino Municipal Code,Section 9.18. J RE-ROOFS: Signanur Date ��'2 All roofs shall be inspected prior to my roofing material being installed.If a roof is installed without first obtaining an inspection,1 agree to remove all new materials for inspection. ,} ❑ OWNER-BUILDER DECLARATION ' //� Signature of Applicant: W Date: 1 hereby alarm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVIiRINGS TO BE CLASS"A"OR BE 1'ITR 1,as owner of the property,or my employees with wages as their sole comlvnsation, will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to I IA'LARDOUS MATF,RIA S DISCLOSIIRIi construct the project(Sec.7044,Business R Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Ilealth&Safely Code.Sections 25505,25533,and 25534. 1 will I hereby affirm under penally of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 2.5532(x)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should 1 tae equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Qualily Management District 1 performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Ilealth&Safety Code,Section 25 0 (2553 nd 255 Section 3700 of the Labor Code,for Eu performance of(he work forwhich this - Owner or authorized agent: Uate: permit is issued. I certify that in the performance of the work for which this perrnit is issued,I shall not employ any person in my manner so as to become subject to the Worker's Compensation laws of California. If,atter making this certificate of exemption,I CONSTRUCHON LENDING AGFNC\' become subject to the Worker's Compensation provisions of the Labor Code,1 must I hereby affirm[bat there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. w'ork's for which this permit is issued(Sec.3097,Civ Q Lender's Name APPLIC NTCF,RTI FICATION Lender's Address I certify that I have read tlds application aid state that the above information is correct.I agree to comply with all city and county ordinances and sate 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,judgmena, ARCIHTECI"S DECLARATION costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date RERO©F PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION .. 10300 TORRE AVENUE•CUPERTINO.CA 95014-3255 CUPERFINO (408)777-3228 • FAQ((408)777-3333•buildinJfacuoertino.orci \' I PROTECT ADDRESS J-,A V f e APN K v n r�-� I 1S . OWNER NASPH NE E-M1IAfL/� STREET.ADDRESS 1� Cfl-k'. ATE ZIP FAX nS O� Cca CIS CONTACT NMIE PHONE - E-hU1L STREET ADDRESS CRY,STATE.LP FAX ❑O"WER ❑ OWNER-K31-DER ❑ O%VNERAGENT CONTRAMR ❑CONIEACTORAGENT, ❑ AMOTECT ❑ENGINEER ❑ DEVELOPER ❑TENA CONTRACT RNASIE LICENSE NUSIOFA LICENSE TYYE BUS.LIC.e (J Jb� CONPANYNAS@ Ef t{ AG hC FAx Mu STREET ADDRESSCITY.STATE IP PHJNE - �� q ARCHrrECNENO WEER NAME LICENSE NUMBER BUS.LIC.s CONVANY NAW - E-SUR FAX STREET ADDRESS MY.STATE ZIP PHONE USE OF ❑ SFD or Duplex ❑ (`IUlti-Farnil V, ROOFAREA: VALUATION: STRUCTURE. ❑ Convnereial �g no • (O `c'� Q-o M. STING ROOF TYPE,,:....,,//❑BUILT-UPROOF ❑AZPHALTSHWGLES EKOODSHAKES lbWOODSHiNGLES ❑OTHER(SPECa'Y) REAIOVE raEPLACE LYfES IF NO. PLY':'OOD !V ❑ PLY)YD ❑ OSBPRCTt f(2 IF ❑ n • c; 2 THE"i c. ❑ iS ❑ DX PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT: DESCRIPTION OF`,VORK: 1 f By my signature below,I cent} W each of the ibllOwin=: I am rhe property owner or authorized agent to act an the propCOW owner's behalf. I have read this application and the information I have provided is correct. I have read one Description of Work and verify itis accurate. I agree to comply with all applicable loci ordimnees and Smm lass relating t buit in colnsy on. l au oriz representatives of Cupertino to enter the above•idendi d property for itupection purposes. Signature of ApplicantlAgent: CA� / Date: 7�2 r,,Zan 2— SUPPLEMENTAL SUPPLEMENTAL INFORMATION REQUIRED OFPTCE USE Om ' If building is associated with a Home Owners Association,provide letter PLAN CHECK T\PE ROUTING SLIP of approval from HOA. CI ov -THE-COUNTERDIC PLAN RENTER' _Provide Planning approval to verify if there any restrictions. - Cl EXPRESS ❑ PLANNING PLA\RESTER• _Provide COPY Of MRaUfacnlrer s Installation Specifications. ❑ STANupRD ❑ rME DEPT roe signed copy of Cupenino's Tear-Off Policy. ❑ OTHER: Reroofdpp 2011.doc revised 03116/11 CITY OF CUPERTINO. FEE ESTIMATOR— BUILDING DIVISION ADDRESS:'2l9 G G 'Ygardenside circle DATE: 09/12/2012 REVIEWED BY: bobs. \ APN: BP#: 'VALUATION: 1$6,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY SFD or Duplex PENTADIATION 1SFDWLROOF USE: PERMITTYPE: tVORK remove existing roof. Install new asphalt shingles 1200 s.f. SCOPE 1�1�_i,.•• r -_ - 7 I.. ,Neth. Pion Check Phunb. Plun Check Elec..PlanCherk btech. Permit Fee: Plumb.Permit Fee: Flec. Permit Fee: Other Afech. Insp. Other Plumb Insp. Other Eler.Insp. .ilr.ch.hup. Fee: Plumb. hup. Fee: Dec.hasp.Fee: NOTE: This estimate does not include fees due to other Departments(i.e. Planning,Public Works, Fire,Sanitary Sewer District,School District, etc). Thesefees are based air lite prelitninary information available and are onh,an estinmte. Contact the De t or addn't info. FEE ITEMS (Fee Resolution 11-053 E71 7/1/11) FEE QTY/FEE 7 MISC ITEMS Plan Check Fee: $0.001,200 s.f. Re-roof Suppl. PC Fee: 0 Reg. OOT 0.0 hrs $0.00 $180.00 IREROOFRES PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee-.0 Reg. O OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Cons'iruciion Toc: Administrorice Fee: O Work Without Permit? O Yes 0 No $0.00 (2) Advanced Planning Fee: $0.00 Select a Non-Residential 0 Tremel Docinnentalion Fees: Building or Structure 0 i Strong Motion Fee: IBSEISMICR $0.60 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS:' TOTA,L--FEE ;4- $1.60 $180:00 i $181.60 Revised: 07/01/2012 REROOF TEAR-OFF POLICY 2 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(a)cuoertino.org PROJECT ADDRESS V C r NO _ O 1 S OWNER NAME C PN NE gg E-MAIL STREET ADDRESS CITY.STATE.ZIP FAX t A. C 'TRACTOI�NAS LICENSE NUMBER LICENSE TYP BUS.LIC. ` t I1 - COMPANY NAME E-A1AI `^ M F . 8 STREET ADDRESS ` , ` , a,P ` C� CITY.STATE ZIP J 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 1/0 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. 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: ReroofPolicY-201 I.doc revised 03/16111