12070068 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21055 RHD FIR CT CONTRACTOR: FOUR SEASONS PERMIT NO: 12070068
ROOFING
OWNER'S NAME: SIMON LEUNG PO BOX 1668 DATE ISSUED:0711112012
OWNER'S PHONE: 4086900407 SAN JOSE,CA 95109 PIIONE NO:(408)278-0330
T_ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11 CONIAIERCIAL
LJ
License Class C-31 Lie.q 41 ZI OP RE-ROOF 13 SQ-TEAR OFF EXISTING WOOD SHAKE
a1�- I�JC-. Date 7"��'/Z ROOF,
Contractor INSTALL I/2" CDX PLYWOOD THEN 30# FELT
1 hereby affirm that 1 am licensed under the provisions of Chapter 9 UNDERLAY ENT CLASS A
(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 which this permit is issued. Sq.FI Floor Area: valuation:$4500
1 haverind 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
APN Number:35905015.00 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 slate laws relating WITHIN l80 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 FROM LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which ma) accrue against said City in consequence of the ��
granting of this permit Additionally,the applicant understands and will comply Issued by: Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18,
�_/Z RE:ROOFS:
Signature Dale All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection.I agree to remove all new materials for
inspection,
❑ ON'NF,R-BIIILDF,R DECLARATION
Signature of Applicant Uatc: 7-,/ft
1 hereby affirm that 1 am exempt from the Contractor's License Lew for one of
the following two reasons: ,ALL ROOF COVER VO BE CLASS"A"OR BETTER1,as owner of the property,or m)'employees with wages as their sale compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to IIA7.ARDOIJS hI ATE:R IA LS DISCLOSURE;
construct the project(Sec.7044,Business&Professions Code). 1 have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Cade,Sections 25505,25533,and 25534. 1 will
1 hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Health&Safety Code,Section 25532(1)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 use 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
1 have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safely Code,Sections 25505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
Owner or authorized agent: Dale:? /O�1
permit is issued.
1 certify that in the performance of the work for which this permit is issued,I shall
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,1 must I hereby affirm that 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 C.)
Lender's Name
APPLICANT CERTIFICATION Lender's Address
I certify that I have read this application and state that the above information is
correel. I agree to comply with all city and county ordinances and stale 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, ARCIIITECT'S DF.C.L.%RATION
costs,and expenses which may accrue against said City in consequence of the 1 understand my plans shall be used as public records.
granting of this pernit.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
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-buildinaCdcuoertino.ora
PROJECT ADDRESS r APNa
OWNER NAME •a PHONE EMAIL
(_Qu - to,? 0 41 0
STREET ADDRESSCITY.ST ZIP FAX
CA q&Ql!J
CONTRACTOR NAME LICENSE NUMBE LICENSE TYPE BUS.LIC.P
COMPANY NAME E-MAIL FAX
STREET ADDRESS5762-
� CITY.ST . PHONE
S I UNDERSTAND ANDAGREE TO THE FOLLOWING:
1. The re-roof project shall comply with all applicable provisions oflthe 2010 California Codes.
2. An inspection request can be scheduled up to the day before the1taspection 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 Y<" 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 at tear-off or plywood nailing inspection and the work is not complete, you will be
charged a re-inspection fee of$126.00. The re-inspection fee shall be paid before another inspection
can be scheduled.
By my signing below, I certify each of the following is true: I am the property owner or authorized agent to act on the
property owner's behalf., I understand and agree to comply with the re-roof policy stated above. I also understand that
smoke detectors and carbon monoxide detectors are required to be installed in accordance with Sections R314 and R315 of
the 2010 California Residential Code.
Signature of Applicant/Agent: Date:
Re,00fPolicY_NIl Ldoc,rvi.�rd 02116/11
REROOF PERMIT APPLICATION
[Ell i
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO. CA 95014-3255 �� \
CUPERTI WO (408)777-3228• FAX(408)777-3333•buildino(atcupertino.oro \
PROJECT AODRESS
0\VNER NAME (-&UAQ
go J I E-MAIL
SAAOA r
STREE I'ADDRESS CITI. ST GIP FAS
V
CONTACT NAME PHONE EJIAIL
STREEI ADDRESS CIT) STATE ZIP
S02 S FAF
❑ ON'NFR ❑ 0\\NER-ROLDER ❑ ONSER AGENT 11 CO\TRA('r0R 1-1 CONTRACTOR AGENT ❑ ARCHITECT ❑ENGIIFFR ❑ DE\'ELOPER ❑ TEN INT
COSTR\CIOR NAME LICE.N$E NCSIBEB LICENSE T PE EL'S 1-11.1 01_3Q,1
COMPANY NAME E-MAIL FAX
STREET ADDRESS CIT1'.STATE_ZIP PHONE
T107- w ose C 8-0
ARCHI-ECT ENGINEER NAME LICENSE NUMBER BLS.LIC.�
COMPANY NAME E-\IAIL FAY
STREET ADDRESS CITT.STATE.LIP PHONE
USE OF ❑ SFD or Duplex jif Multi-Family ROOF AREA: \'ALL At O\ O
sTRccn'aE' ❑ Commercial II�� 3 S
EAISTINGROOr TYPE. ❑BCILT-LP ROOF ❑ASPHALTSHINGLES 0%%OODSHAI:ES ❑MOODSHINGLES ❑OTHFRISPECIFYI
RENIOYF:REPLACE YF.S IF[O. PLY\100D '.! ❑ PU'\\D ❑ O$a PITCH ROOF
❑ \' .0\"FR dd THICK' SS ❑ S.S" TYPE' CDX ')Z LASS A
PROPOSED ROOF TYPE. ❑BLILT{'PROOF i/NSPHALTSHINGLES ❑NOODSHAAES ❑\\OOD SRI?GLES 13 OTHER ICC-ES REPORT.
DESCRIPTION OF\\ORE
g g. 14" apx
C#
B\ m,signature below.I cenifv to each of the folio\\'ins: I am the propem'wcner or authorized aecnt to act on the propeM oA\ner's behalf. I have read this
application and the information I have provided is correct. I have read the Description of Work and Merit%it is accurate. I agree:O comply with all applicable local
ordinances and state laws relalmB to building cons Zion, I a ori represe Iic of Cupertino to enter the abox e-identified property'for inspection purposes
Signature of Applicant/Asenr. Datea*12
SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY
_ Ifbuilding is associated\.ith a Home O\%ner's Association.pro\ide letter PLAN CHECK TYPE ROUTING SLIP
ofappro\'al from HOA. ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW
Provide Planning approval to veri F, if there any restrictions. ❑ EXPRESS ❑ PLA561N'G PLA\REVIEW
Provide copy ol'Manufacturer's Installation Specifications. ❑ STANDARD ❑ FIRE DEPT
Provide signed copy ofCupertino's Tear-Off Policy. ❑ OTHER:
Reroof.4pp.-2011.doc revised 03/16/11