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12100144 CITY OF CUPERTINO BUILDING PERMIT BUILDINGADDRESS: 10574 WIlITE FIR CT CONTRACTOR:POUR SEASONS ROOFING PERMIT NO: 12100144 OWNER'S NAME: BRINICOMBE FAMILY TRUST PO ROS 1668 DATE ISSUED: 10/192012 OWNER'S PIIONE: 6507258987 SAN JOSE,CA 95109 PlIONF.NO:(408)278-0330 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERDIIT INFO: BLDG I- ELECT r PLUMB License Class '� Lic.q f DIECH (- RESIDENTIAL r COMMERCIAL F7Contractor Date I hereby alTirm that i am licensed undera provisions of Chapter 9 JOB DESCRI PTION: RE-ROOF,REMOVE SIIAKE&-INSTALL PLYWOOD AND (commencing with Section 7000)of Division 3 of(he Business&Professions COMP Code and that my license is in full force and effect. SHINGLES 13 SQ CLASS A hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a cenificme 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 die performance of die work for which this permit is issued. Sq.Ft Floor Area: Valuation:54500 APPLICANT'CF,RTIFICATION I certify that I have read this application and state that the above inlbrination is APN Number:35905119.00 OecupnncyType: 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 indemnify and keep harmless the City of Cupertino against liabilities,judgments, PERMIT EXPIRES IF WORD IS NOT STARTED costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non-point source regulations per the Cupertino Municipal Code,Section 180 DAY M LAST CALLED INSPECTION. 9.1 WiJ21L=� S Date Issue by: Date: /U G � ❑ OWNER-BUILDER DECLARATION - hereby affirm that I am exempt from the Contractor's License Law for line of RE-ROOFS: the following two reasons: All roofs shall be inspected prior many rooting material being installed.If a roof is I,as owner of the property,or my employees with wages as their sale compensation, installed without firs(obtaining mi inspection,I agree to remove all new materials for will do the work,and the suucture is not intended or offered for sale(Sec.7044, ins ection. Business&Professions Code) ^ I,as owner of the property,am exclusively contracting with licensed contractors to Si azure f pp CmC Date:l!/ ly ll construct the project(Sec.7044,Business&Professions Code). i hereby uftirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BE'I'I'ER declarations: I have and will maintain a Certificate of Consent(o self-insure for Worker's BA%ARDOUS MATEIRIAIS DISCLOSURE 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 C(ide.Sections 2551)5.25533,and 25534. I will maintain Section 3700 of the Labor Code,for the performance of the 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,I shall contaminants as defined by the Bay Area Air Quality Manngement District 1 will not employ any person in any manner so as to become subject to the Worker's maintain cam plia nce with the Cupertino Municipal Code,Cho pter 9.12 and the Compensation laws of California. 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 mus( s forthwith comply with such provisions or this permit shall be deemed revoked. n or autl viz d7agc R• bate:�Q// APPLICANTCF11TI FICATION CONSTRUCHON 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 properly for inspection purposes.(We)agree to save Lender's Name indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the Lender's Address granting of this permit.Additionally,the applicant understands mid will comply with all non-point source regulations per the Cupertino Municipal Code,Section ARCIIITFCI"S DECLARATION 9.18. 1 understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO FEE ESTIMATOR— BUILDINGDIVISION f ADDRESS: 105f tl DATE: 10/18/2012 REVIEWED BY: jsg OMNI APN: BPH: -VALUATION: $4,500 'PERMITTI'PE: Minor Building Permit PLAN CHECK TYPE: Re-roof PRIMARYSFD or Duplex PENTAMATION 1SFDWLR0OF USE: PERMIT TYPE: WORK Reroof, remove shake instal plywood and comp shingles SCOPE FEE ID ROOFAREA (s.f.) 1REROOFFRES 1,300 t ,Meeh.Plan Check Plumb. Plan Check Elec. Plan Check Meeh.Permh Fee: Plumb.Pvw it Fee: Elec.Pernrir Fee: Orher,lfech.Insp. Odrer Plumb Insp. Ocher Eler. Insp. Ll ddech. Insp.Fee: Phoub. hup. Fee: Flee.Insp.Fee: NOTE:.This estimate does not includejees due to other Departments(i.e. Planning, Public Works, Fire,Sanitary Sewer District,School District,ere). These ees are based on the preliminarl information mmilahle and are onh,an eminrale. Contact the De 1 or addn 7 info, FEE ITEMS(Fee Resolution 11-053 Eff UM21 FEE QTY/FEE MISC ITEMS Plan Check Fee: Supp/. PC Fee Plumb./ddech./Flee Permit Fee: $195.00 Suppl. Insp Fee PhonLAVIech./Elec Phmrh.lHech.lElee Permit Fee: Construction Tut-: Administrative Fee: Work Without Permit? O Yes (j) No $0.00 Adrancecl Planning Fees: Treivel Documentation Fees: � Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 �.- SUBTOTALS: $196.50 $0.00 TOTAL FEE1 $196.50 Revised: 10/01/2012 IZ 1 REROOF PERMIT APPLICATION Ell COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION . 10300 TORRE AVENUE •CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333 • bulldlnq(G?cupertino.arD ?"ECT n D ssT2Z APs ��// G I OW NAME. PHONE P.NAIL 71 STRC•ET.n P Cli STATE.ZIP I FAX G S-o CONTACT NAMe PHOFC E-MAIL L�r�ds Caz_c s oB- 28-0330 STREkn'ADORFYS CIiV,STATE, 7n0 PAX Sc'L _ urnina 5-�-. I .Sc�ZoS� CLl 511. ❑OWNF'i ❑ OWNRK-sIIa.aER ❑ OW'Nf,R,nGENT 1eC01TRACrOR ❑rONTRACTORAGeNT ❑ ARCHITECT ❑ ENOINRFR ❑ 0aVE1.OPER ❑ TENANI CONTRACTORNANIE LICF.N5-NCMDER LICENSCT Pa BUS LIC.II �nur_S.ewSec��oafin�,� 2.1 opt COMPANYN'AME5 E-MAR. I rAS AME STREET ADDRESS CITY.STATE.ZIP PHONE 0 - a OSe C I - e-o ARCNITECTFF.NULCEER NANIR LICIiNSE IJL'PIRF.R Rus.I.IC b COMPANY NAME CMAII. V FA% STREET ADDRESS 1 CITY.STATF Z.11' PHONE, USE OF ❑ SFD or Duplex Sir Multi-Family ROOF nnrn; vALI:AT,Ce,: �Dg_ STRUCTURr:• O Comin-.rcial rj y S0 EXISTING ROOF TYPE: ❑BUILT-IJPROOF ❑ASPHALT yirn GLES 1XW'00a SNAKF< ❑w000SHINGLLS ❑0111F..RISPECIFY) RC.MOVF./REPLACE ❑YES ( IF NO. PLYWOOD Jew, ❑ PLYWO ❑ OSB PITCHROOF AYRR3 —1�Thl1. 3'QI6...__--_ -.L\ Y I_.' ya A PROPOSED ROOF TYPE: ❑BUILT-UPROOP 045PMALT SHMOLES ❑WOOD SHAKES 13 WOOD SHINGLES ❑OPHP.R �CC-CS REPORT DESCRIPTION OF WORK. —4-1414-0-0a 14-00a ±64n o�;e�c�Qct s.�.d_ee�'e 4l—e�am.P s��e�...C o(sem : C�.yn-k,e•�Gt� By my slgnature below.I certify to each of the folln•A'Ing; I not the prnpenv owner or nuthnnmd agent to act an the pmporTy other's tchalf. 1 have read this applieorion and the information I have provided is correct. I have read the Description of Work and veriCy It IS acca a:c, I agree to comply with all applicable Ictal nrdinsnces and stare lows relating to lollding conn t—io�n`II a aria reprise 'civ••of Cuptrtlno 1a curer the AhDva-IdcrWflcd propcmy for inspection purposes. SIppaure of Applicam/Agemr -OVA :).to: SUPPLEMENTAL INFORMATION REQUIRED OFFICE use ONLY 1 f building is associated with a Home Owner's Association.provide letter PLAN CHECK Tl'PF. ROUnNC SLIP of approval from HOA. ❑ OVERATir-COuN'TCR ❑ OIIILDINC PLAN REVIFA' _Provide Planning approval to verify if there any matri6ons. ❑ EX-PRESS ❑ PLANN'INC PJ.AN-REVICW _ Provide copy of Mnnufne%iavr's Installation Specifications. ❑ srnr+a.wo ❑ PrRpoc" Provide signed copy of CupLnino's Tear-Off Policy. ❑ OTHER: Hr.rogfApp_301 I.doc revised 03116111 2 REROOF TEAR-OFF POLICY COMMUNITY DEVELOPMENT 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-building0cuocrtino.org PROJECT AD OP.SS_ ,y ` APNH Ot ' NAME �� ! "-�1 I r0 ' -7 E-MAIL 7,95 STREET ADDRESS CIT ('$TATE ZIP FAX G 0 coN,x R r+nve LICElSuciff E n1!4 BUS,u I CO P 'VAMP. E-MAIL FM STREET A 1 IIZZNTA 9 P N Q I U ERSTAND 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 - 3:30pin (Mon-Thurs) or 7:30 - 2:30pin (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 YA" per foot of slope and demonstrate there is no ponding. b. Listings front 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 ttve: I am the property owner or authorized agent to act on the property owner's behalf. I understand and agree to c nply with the rc-roof policy stated above. I also understand that smoke detectors and carbon monoxide detectors 1rcd to be installed in accordance with Sections R314 and R315 of the 2010 California Rcsidcn ' dc. Signature of ApplicandAgent: Date: RrrnolPoliny_7011.doc rcvi.ved 02176/11