12080167 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20653 GARDENSIDE CIR CO\I'RAC'MR:BRADSHAW ROOFING PERMITNO: 12080167
INC
OWNER'S NAME: LU &WENQI CHANG 1821 S BASCOM AVE P1,113 160 DATE ISSUED:08/172012
OWNER'S PlIONF,: 4088739279 CAMPBELL,CA 95008 1'I IONF NO:(408)246-9930
❑ LICFNSIiD CO\1'RAC`fOR'S DECLARATION JOBDESCRIPTION: RESIDENrflAL COMDIERCIAI.
11"
License Class Lie.N 3007 TEAR OFF EXISTING SHAKE AND INSTALL 12 SQRS
CLASS
Contractor S Date ) A ASPHALT COMP SIIINCLES, COLOR.AGED I3Al2K
hereby affirm mud I am licensed under the provisions of Chapter 9
(commencing with Section 7000)of Division 3 of the Business S Professions
Code and that me license is in full force and effect.
1 hereby affirm under penalty of perjury one of the following two declarations:
I hae and will maintain a cenificate 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. Sq.FI Flour Area: Valualion:$6000
1 have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for toe performance of the work forwhich this ANN Number:36232025.00 Occupancy Type:
permit is issued.
APPLICANT'CERTIFICATION
I certify that 1 have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.l agree to conhplywith nil city and county ordinancesamd 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)agrce to Saye 180 DAY FROM LAST CALLED INSPE TION.
indemnify and keep harmless the City of Cupertino against Iiabilides,judgments,
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply Issued by: / I[ Date:
with all non-point so rc regulations per the upenino Municipal Code,Section
/'
I?— RE-ROOFS:
Signature Date All roofs shall be inspected prior to any rooting material being installed.If a roof is
installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
❑ OWN ER-BDu,DER DECLARATION 7 �2
Signature of Applicant Date:
herchy vlTirm that l tan exempt from the Contractor's License Law for one of
the following two reason: ALL ROOF COVERINGS TO BE CLASS"A"OR BE PIER
I,as owner of the property,or my employees with wages as their sole compensation,
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 conlmetors to IIA%ARUOIIS\I,\'I'Ii1tIA LS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of(lie
California Ilealth&Safety Code.Sections 25505,25533,and 25534. 1 will
1 hereby affirm under penalty of perj or) one of the following three and stain compliancy with the Cuperli no Municipal Coda Chu pier 9.12 it the
declarations: Ilealth S Safety Code.Section 25532(a)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally.should I use equipment or Jew ices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Ray Area Air Qua lily Management District
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&Safely Code,Sections 250)/.25 and 55 .
Section 3700 of the Labor Code,for the performance of the work for which this
Owner or authorized ager:
permit is issued. Dalc:u
I certify that in the performance of the work for which this permit is issued,I shall
not employ any person inany rammer so as to become subject to the Worker's
Compensation laws of California. If,after making this certificate of exemption,I CONSTRUCHON LISNIIING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is it construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANTCERT1 FICATION Lender's Address
1 cenify that I have read this application and state that the above information is
correct.I agree to comply with all city and comity 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 sae ,\RCI I I'I'PCI"S UIiCI„\R,\'PION
indemnify and keep harmless the City of Cupertino against liabilities,judgmeus,
costs,and expenses whidn may accme against said City in consequence of the 1 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 Dale
V ��
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 403-777-3228
C U P E RT I N O Fax: 408-777-3333
CONTRACTOR / SUBCONTRACTOR LIST
JOBADDRESS: PERMIT# r
OWNER'S NAME: PHONE#
GENERAL C0NTRACT6R: BUSINESS LICENSE #
ADDRESS:I CITY/ZIPCODE:
*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 BE SCHEDULI,D 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:
t
SUBCONTRACTOR BUSINESS NANIE BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing # s
Flooring /,Carpeting
6inolcu111 / Wood _
Glass,/Glazing
Heating. t
Insulation
Landscaping
�y Lathing
Masonry
Pinting / Wallpaper
Paving
Plastering
•' Plumbing
Roofing
Septic Tank
Sheet Metal
Shect Rock
Tile
Owner/Contractor Signature Date
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 2065 gardenside circle DATE: 08/14/2012 REVIEWED BY: bobs.
` 'PN: BP#: /,�',OU O `VALUATION: $6,000
*PERiMIT TN'PE: Building Permit PLAN CIIECK TYPE: Alteration / Repair
PRIMARY PENTADIATION
USE: SFD or Duplex PERM1tI'I"1'1'PE: 1SFDWLROO F
WORK remove existing shake instal A S
SCOPE
Xlech. Plan Check Plumb.Plan Check Elec.Plan Check
blecb.Permit Fee: Plumh.Permit Fee: Elec.Perndt Fre:
Other-Mech. insp. Other Plumb Insp. Other Glee.lnsp.
,Hach.Insp.Fee:' Plumb. hup. Fee: Elec.hap. Fee:
NOTE: This eviimute does not include jeev rote to other Departnents(i.e. Planning, Public Works. Fire,Sanitary Server District,School
District,etc.). Thesefees are baser/on the treliminnrr information available and are onle an earinuhte. Contact the Dept for adn/n'I info.
FEE ITEMS (Fee Resolution 11-053 E(T 7/1/11) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 1,200 s.f. Re-roof
SuppI. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 $180.00 IREROOFRES
PME Plan Check: $0.00
Permit Fee: $0.00
SuppI. Insp. Fee-.0 Reg. Q OT 0,0 1 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Constntction Tac:
Administrative Fee: O
Work Without Permit? O Yes Q No $0.00 E)
Advanced Planning Fee: $0.00 Select a Non-Residential G
Travel DocronentununFaes: Building or Structure
i
Strom Motion Fee: IBSEISb91CR $0.60 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $1.60 $180.00 TOTAL FEE: $181.60
Revised: 07/01/2012
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-buildino(adeuoertino.ora
PROJECT ADDRESS o i 1S ^ APN X
OWNER NAME Lo PBON
3 a E-MAIL
STREET ADDRESS CES.
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�U I � Cf� \SoI 1 FAX
C CIO NA fE LICENSE NV MBE LICENSE TYP BUS uc..L:,
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COMPANY NAME
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E-MAI - PAx
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STREETADD S CITY,STATE.21P NONE
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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%" 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. 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: Date:
ReroolPolicn_?O1 I.doc revised 02/16111
REROOF PERMIT APPLICATION
�. COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CU PERTlNO (408)777-3228 • FAX(408)777-3333•building0cupertino.or0
/x080/62
PROJECT ADDRESS APN e -
OWNER NAA I t _ II PQ�E _C' Q. E-ANIL
STREET dDDRESS^0 6 s q 1�(ls 1 C[T'U'-(STAT Z I 1 O ' I FAX
prLNQ CA
CONTACT N.N[E a( PHONE E-ALAIL
STREET ADDRESS CITY,STATE,ZIP FAX
❑OwNM ❑ O\VNFIt-0UfI.OER ❑ OWNERAGEYT COMAACTOR ❑CONTRACTOR AGENT ❑ ARCIMU ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONitWCr RNAStE LICENSENUMBER LICENSE TYPE BUS.LIC.a
-? 30S S'
C&PANYNAA¢ E-FLA �C n� FAX - !,� .
STREET ADDRESS CITY',STATE tP PHONE �U
�tjCkj
n
ARCHITELTIENGINEER NMIE LICENSE NUMBER BUS.LIC.a
COMPANY NAME E,IAIL FAX
STREET ADDRESS CITY,STATE.ZIP PHONE
USE OF ❑ SFD or Duplex ❑ Multi-Family- ROOF AREA: VALUATION:
STRUCTURE. ❑ Cornmercial ��.Q0 O S Q Q n
EXISTING ROOF TYPE,:: O BUILT-UP ROOF ❑ASPHALT SHINGLES EXI-0OD SHAKES ❑WOOD SHINGLES ❑OTHER(SPELTY,
REa1GV-E REPLACE PI(es IF NU. PIriA'OOD 1!" ❑ PLYWD 13Osa PITCH: ROOF
❑ D xLA' c THH c - ❑ r ' TY'PE' 13 CDX A
PROPOSED ROOF TYPE. ❑BUILT-UP ROOF ASMM-T SHINGLES ❑WOOD SHIRES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT d
DESCRIPTION OF WORK;
1 c e
• By my signature below,I certify to each of the follo\ving: I am the property owaer or authorized agent to act on the propene owners behalf. I have read this
application and the information I have provided is correct. I have read the Description of\York and verify it is accurate. I agree to comply with all applicable local
ordinances and state Imus relatingm bubuil/cam ton on. I au n/z�re_pruenotives of Cupertino to enter the above-identiC(yed propetry Cor inspection purposes.
SignsturcofApplirantlAgent: /.(/Ci_ �7'ti Date: �Io�E'-J ante-7
SUPPLEMENTAL INFOMATION REQUIRED OFFICE use ONLY
_If building is associated\vith a Home 0%nees Association,provide letter PLkN CFECKT%TE ROUTING SLIP
ofapproval from HOA. ElOVER-THE-COUNTER11 BUILDING PLAN REVIEW
_Provide Planning approval ED verity if there any restrictions. ❑ EXPOS ❑ PLANNING PLAS REVIEW
_Provide copy of ManufaL'mmr s Installation Specifications. ❑ s-TASDARD ❑ FIRE DEPT -
Provide signed copy of Cupertino'i Tear-Off Policy. ❑ OTHER:
Reroajdpp_2011.aoc reviseA03:1 d/11