12060146 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10554 RED FIR CT CONTRACTOR:FOUR SEASONS ROOFING PERMIT NO: 12060146
OWNER'S NAME: I lUl FREDERICK K AND MARY T PO BOX 1668 DATE ISSUED:06/252012
OWNER'S PHONE.: 5107976886 SAN JOSE,CA 95109 PI]ONE NO:(408)278-0330
JR' LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
License Class C—3 f Lic.q 4*7 2-10 0
n A1ECH r RESIDENTIAL r COMMERCIAL r
Contractor FSR-I 10C• Date 6-2r- 12
hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:TEAR OFF EXISTING WOOD SI TAKE,INSI'ALL COMP
(commencing with Section 7000)of Division 3 of the Business&Professions SHINGLES CLASS A 13 SQFT
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 which this permit is issued.
I have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Floor Area: Valuation:$4500
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
APN Number:35905005.00 Occupant)Type:
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
cored.I agree to comply with all city and county ordinances and state laws relating
to building construction,mid hereby authorize representatives of this city to enter PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property lot inspection purposes. (We)agree to save
indemnify and keep hamrlessthe City ofCupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,and expenses which may accrue against said City in consequence ofthe l80 DAYS FROM LAST CALLED INSPECTION.
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. Issued bya�� Date:
Signature Date �2
❑ OWNER-BUILDER DECLARATION RE-ROOF'S:
All roofs shall be inspected prior to any roofing material being installed.If a roof is
hereby affirm that l am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for
the following two reasons: inspection.
1,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, Signature of Applicant: Date: W/
Business&Professions Code)
I,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 BE TER
I hereby affirm under penalty of perjury one of the following three
declarations: IIA%ARDOUS MATERIALS DISCLOSURE
I have and will maintain a Certificate of Conscnt to self-insure for Worker's t have read the hazardous materials requirements under Chapter 6.95 of the
Compensation,as provided for by Section 3700 of the Labor Code,for the California l leallh&Safety Code,Sections 25505.25533,and 25'34. 1 will maintain
performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code.Chapter 9.12 and the Health&
I have and will maintain Worker's Compensation Insurance,as provided for by Safely Code,Section 25532(a)should 1 store or handle hazardous material.
Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air
permit is issued. contaminants as defined by the Bay Area Air Qualify Management District 1 will
maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
I certify that in the performance of die work for which this permit is issued,I shall Ilealth&Safety Code,Sections 25505,25533,and 25534.
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of Cal ifomia. IC after making this certificate of exemption,1 Owner u rine 1:
become subject to the Worker's Compensation provisions of the Labor Code,I must Dater
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LF:NDINf.AGENCY
APPLICANT CERTIFICATION I hereby affirm thm there is a construction lending agency for the perfommnce of work's
I certify that I have read(his application and state that the above information is for which this permit is issued(Sec.3097,Civ C)
correct. I agree to comply with all city and county ordinances and state laws relating Lender's Name
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the
granting of[his permit.Additionally,the applicant understands and will comply ARCI IITF.CT'S DECLARATION
with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall he used as public records.
9,18.
Licensed Professional
Signature Dale
REROOF TEAR-OFF. POLICY
COMMUNITY DEVELOPMENT DEPARTMENT'-BUILDING DIVISION
.ALBERT SALVADOR, P.E.X.B:O., BUILDING OFFICIAL
CUPERTINO 10300 TORRE AVENUE.-:CUPERTINO, CA 95014-3255
(408)'777-3228-FAX(408)777-3333-buildingAcuoertino.orD
PROJECT ADDRESS OSS APN N
OWNERNAME ej4 iC PHONE SIO-1911-eager= E-MAIL
STREET ADDRESS I CITY, STATE. FAX
ar4jAft CA fto 144
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC.4
(=—gq
COMPANY NAME EMAIL FAX
STREET ADDRESS CITY.STATE.ZIP PHONE
Se 2Sims -O
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 Y4" 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 fora tear-off or plywood nailing inspection and the 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, 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. I also understand that
smoke detectors and carbon-monoxide detectors:are required to be installed in accordance with Sections 11314 and R315 of
the 2010 California Residential Code.
Signature of Applicant/Agent: Date: d-
Re,on/Polico_201 1.doc revised 02116111
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 105664red fir ct. DATE: 06/25/2012 REVIEWED BV: bobs.
APN: BP#: 'VALUATION: $4,500
^PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY Multi-Family Dwelling Buildina is PENTAMATION 1R2ROOF
USE: >3 Stories 0 Yes 0 No PERMITTVPE:
WORK tear off existing wood shake install comp shingles.
SCOPE
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NOTE: This estimate does not include fees due to other Departments(ie. Planning, Public Works, Fire,Sanitary Sewer District,School
District,etc. . These fees are based on fhe prelimina information available and are only an estimate. Contact the De 1 or addn'I info.
FEE ITEMS (/ a Resolution 11-051 ElL 7/1/11) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 E5K s.f. Re-roof
Suppl. PC Fee: (j) Reg. 0 OT FO.0 I hrs $0.00 $182.00 IREROOFWRE
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee:Q Reg. 0 OT F0.0Thrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Cint,'lrrlrrion 7���:
;I iGpinr.arnri r,r lar: 0
Work Without Permit? 0 Yes E) No $0.00 0
Advanced Planning Fec: $0.00 Select a Non-Residential E)
71-irrl /1o(lmwwuli'm Fees Building or Structure 0
i
Soong Motion I'ec: IBSEISMICR $0.50 Select an Administrative Item
131du,Stds Commission Fec: IBCBSC $1.00
SUBTOTALS: $1.501 $182.001 TOTAL FEE: 1 $183.50
Revised: 0 613 0/2 01 2
REROOF PERMIT APPLICATION
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