12100148 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10582 WHITE FIR Cf COIN 1'RACI'OR:FOUR S17ASONS ROOFING PERMIT NO: 12100148
OWNER'S NAME: CHEN HAOIIANG AND LAI LI I'D BOX 1668 DATE ISSUED; 10/19/2012
OWNER'S PHONE: 4082721014 SAN.IOSE.CA 95109 PHONE NO:(+08)278-0330
•❑./ LICENSED CONTRACT'OR'S DECLARATION
/1 BUILDING PERMIT INFO: BLDG r ELECT r1 PLUMB r
License Class Lie.H r F, [1
DIECII RESIDENTIAL C011D1ERCIAL
Commctor Uate//S�
1 hereby affirm that I am licensed un the provisions of Chapter 9 •1013 DESCRIPTION:RE-ROOF,REMOVE SFIAKE&INSTALL PLYWOOD AND
(commencing with Section 7000)of Division 3 of the Business&Professions COMP
Code and that my license is in full force and effect. SHINGLES 13 SQCLASS A
hereby affiim 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 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
permit is issued. Sq.F't Floor Area: Valuation:$4500
APPLICANT CERTIFICATION
1 certify that I have read this application and state that the above information is A PN Number:35905123.00 Occupancy T)pe:
correct.I agree to comply with all city and county ordinances and state Imus 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, PERMIT EXPIRES IF WORK 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 WITHIN0 DAYS OF PERMIT ISSUANCE OR
with all non-point source regulatims per the Cupertino Municipal Code,Section 180 DAY OM LAST CALLED INSPECTION.
9.
Data"/ Iss�d )': � Dote:
t
❑ O\VNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law for one of RE:ROOFS:
the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
I,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I agree to remove all new materials for
will do the work,and the structure is not intended or offered for sale(Sec.7044, insp lion.
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to g� ture of A lice :
Date
construct the project(Sec.7044,Business&Professions Code).
1 hereby affirm under penalty of perjury one of the following three ALL ItOOF COVERINGS TO ISE,CLASS"A"OBI;I'I'F,R
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's IIA-LARDOUS MATERIA S 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 Ilealth&Safety Code.Sections 25505,25533,and 25534. 1 sill 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 Ilcilth&
Safeh•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 forwhich this permit is issued,I shall contaminants as defined by the IN'v Area Air Quality Management District I will
not employ any person in any manner so as to become subject to the Worker's maintain cam plin are with(he Cupertino Nlu nisi pal Code.Chn pier 9.12 and the
Compensation laws of California. If,after making this certificate of exemption,I Health&Safety Cade.Sections 25505,25533,and 25534.
become subject to the Worker's Compensation provisions of the Labor Code,I must
forthwith comply with such provisions or this permit shall be deemed revoked. O tar or xu razed eat ?�
ate:
APPLICANT CERTIFICATim CON4RIICI'ION 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 of firm that there is a construction lending agency for the performance of vork's
to building construction,and hereby authorize representatives of city to enter for which this permit is issued(Sec.3097,Civ C.)
upon the above mentioned property 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 and will comply
with all non-point source regulatims per the Cupertino Municipal Code,Section ARCHITECI"S DECLARATION
9.18.
1 understand my plans shall be used as public records.
Signature Date
Licensed Professional
12-
CITY
2CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
f. ADDRESS:� C>5 O � W�I e DATE: 10/18/2012 REVIEWED BY: lsg
APN: BP#: -VALUATION: $4,500
£PERMITTYPE: Minor Building Permit PLAN CIIECK'rVPE: Re-roof
PRIMARY SFD or Duplex PENTAMATION 1SFDWLR00F
USE: PERMIT TYPE:
WORK Reroof, remove shake instal plywood and comp shingles
SCOPE
FEEID ROOFAREA
s.f.
1REROOFFRES 1,300
Xlech. Plan Check Plumb.Plan Check Flee.Plan Check
Meeh. Permit Fee: Plumb.Permit Fee: Flee.Permit Fee:
Other Hech. Insµ Other Plumb Insp. Other Elec. Insp. Ll
.11ech.hasp.Fee: Plumb. hr.,p.Fee: Elee.Insp. Fee:
NOTE:.This astinrate does not includejeav due to other Departments(i.e. Planning, Public Works, Fire,Sanitary Sewer District,School
District,etc). These eer are based on the prelfininart information available and are onb-an estimate. Contact the De t or addn'1 info.
FEE ITEMS (Fee Resohnion 11-053 Eff 7///121 FEE QTY/FEE DIISC ITEMS
Plan Clteck Fee:
suppl. PC Fee
Plumb.Lldech.lElec
Permit Fee: $195.00
Suppl. Insp Fe e
Phtmb.111eclt.lEl ec.
Phinrh.111ech.lElec Permit Fee:
Consrrrrction Tac:
Administrative Fee:
Work Without Permit? O Yes (F) No $0.00
Advanced Planning Fees:
Trcmel Documerttation Fees:
Strong Motion Fee: IBSEISAIICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.001 1
• �.y SUBTOTALS:',, $196.50 $0.00 TOTAL FEE:,; $196.50
.L=
Revised: 10/01/2012
� ZIo� I � �
E2REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTINO (408)777-2228 • FAX(408)777-3333• Cu'(dinGna cunertino.om
PRUIECI'w. S G ^ :l"N•4. )5✓I/-�
Lel ?j
OWNG
I'%
PHO`Eto
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�� CIT' ST.iTE.J.IP SDF'�x
c -r
CONTACT NAME PHOVF O _ __ 6-7.161 BpLVL
eTREtEr ADDRESS CITY.S'rATF_ZIP FAX
SO21-lau.Un.c—
❑ nwv FR ❑ DINNER-AMDER D nWNPR Af.LNi .1I ran ❑CONTRACTOR AGRNT 0 ARCHITECT ❑ ENG:NFXR ❑ Df:VF,IOPER ❑ T AW
CONTRAM OR NAMEC LICENSE NUM317.R LICIENNSE PE BUS.LIC,a
CGC�LSL'aS94S_goaFl '12 O -
COMPANY N"m E-a4Ao. FAX
STREET ADDRESS CITY,STATE,].I P PHONE.
Sex I O o e C 'O
ARCH[MCRENGIN'SER NAME. I,ICENSF.NUMB ER BUS.LIC b
COMPANY NAME B-,MAIL FAX
STREET ADDRESS CITY.STATE.Y.I P PHONE
USE or O SFD or Duplex JC Multi-FamilyI ROOF AREA: VALUATION:
STRUCTUC)RE: COnumemial !
EXISTING ROOF TYPE: ❑GuiLT-UP ROOF 13ASPIIAI.TeHIN01,ES PeWOODSHAKF.S OwOODSHI,NGL65 ❑OTHaR(SPECIFY)
RtNIOYFIRF.PI:ACE VFS IP NO. PLY\GOOD Y' ❑ PLYWO 00s. PrrC H. OF
❑ No ra T Cgc-sc, ❑ s,xi- lycD :12 .I As A
'
I
dd CC-F
❑ t►
PROPOSED ROOF TYPE:
RULT-UPROOF YWHALT SHINGLES ❑WOOD SHACES ❑WOOD SHINGLES ❑OTHER E 0.EPORT tl
DESCRIPTION OF)FORK:
Teor ems' axis{�oLA-1a�.a�^•��1a�C2.safz�. 71:ns-I+a11 � � CD
By my signature below,1 cenify Io ench of the rollo)Ying: I am the property owner or authorind Agent In act on the propertyowner';behalf. I have mad thle
npplieatinn and the information I have provided is eo,=t. I hAVC read the OaCription of Nark Bnd verily it is'aeeurate. 1 sgrce to eemply with ell applicable local
ordinances and state laws miating to building con,W.tlon. I a� mriZc mprtof Cupenlno ro entm the above-Identillcd prnperty for Ins(.Iactian purposes.
Signature of ApplicanVAgcnt: Date: O
SUPPLEMENTAL INFORMATION OFFICE USE ONLY T
_If building is associated with a Home Owner's Associntion,provide letter PLAN CHECK TYPE ROUTIRC Sue
ofapproval from HOA. ❑ OVER-TRE-COIfNTF,R ❑ SIIILDI.VC PLAN REVIEW
P;nvide Planning approval[O verify if there any restrictions. ❑ f:XPRFSS ❑ PLANNING FLAN REVIEW ,
_ Provide copy of Manufacturer's Instnllatiun Spcoificntions. ❑ sTANnnan ❑ Prnr,nn"
Provide signed copy of Cupertino's Tcar-01T Policy. ❑ OTHFR:
HemoJAnp_2011.doc rev;md 03116111
REROOF TEAR-OFF POLICY
0 COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE• CUPERTINO, CA 95D14.3255
CUPERTINO
(408)777-3228• FAX(408)777-3333•6ullding0cuoerllno.org
Pacer .AX c5z' /, I APNO
qw TRN afE vv PN NE E-MAIL
STREET ADDRESS CI , TATE ZI r'U
CONT yAME iJt:C`1 ENUMPF.0. LICE'N il'PE BUS.LIC:4
COn1 AMO (� E-MNL PAX
STREET V\ C STA
Ct
I L .DERSTAND AND AGREE TO THE FOLLOWING: O [/
i. 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 (bat
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. Tenr-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 Nailiny 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 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 die 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: I am the property owner or outhnrized agent to act on the
property owner's behalf. 1 understand and agr .- to mply with the re-roof policy stated above. 1 also understand that
smoke detectors and carbon �noxt e dete required to he installed in accordance with Sections R314 and R315 of
the 2010 California Resi ential de.
Signature of Applicant/Ager Date:
ell ReroofPohc7_2011.doc revurd 02/1(/11