12070067 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21057 RED FIR CT CONTRACTOR:FOUR SEASONS PERMIT NO: 12070067
ROOFING
OWNER'S NAME: Cl IU DAVID K AND BETTY Y TRUSTE PO BOX 1668 DATE ISSUED:07/11/2012
OWNER'S PIIONE: 4082310161 SAN JOSE,CA 95109 PHONE NO:(408)278-0330
1C LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL U COMMERCIAL
License Class Lic.N 4-72 ( Oe RE-ROOF 13 SQ-TEAR OFF EXISTING WOOD SHAKE
c '�-( j2 ROOF,
Contractor IN Date o— INSTALL 1/2" CDX PLYWOOD THEN 30N FELT
1 hereby affirm that I am licensed under the provisions of Chapter 9 UNDERLAYM 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 penally 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.F1 Floor Area: Valuation:$4500
1 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
APN Number:35905016.00 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 stale 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)agree to save 180 DAYS FROM LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City inconsequence 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.
RE-ROOFS:
Signature Date 7�%'l2 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.
❑ OWNER-BUILDER DECLARATION
I hereby affirm Thal 1 em exempt from the Contractor's License Lew for one of Signature of Applicant Date:
the following two reasons: AL1.ROOF COVERINGS TO BE CLASS"A"OR BETTER
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.70",
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to IIAZARDOUS MATERIALS DISCLOSURE
construct the project(Seo 7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Ilealth&Safety Code,Sections 25505,25533,and 25534. 1 will
1 hereby affirm under penally 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(x)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 Quality 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
I have and will maintain Worker's Compensation Insurance,as provided for by the Ilealth&Safety 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:
permit is issued. Dale:
I 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 ofCalifomia. If,after making this certificate of exemption,I CONSTRUCTION LF.NDINC.AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby o irm that there is a 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
APPLICANT CERTIFICATION Lender's Address
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
to budding 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, ARCHITECT'S DECLARATION
costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting of this permit Additionally,the applicant understands and will comply
with all non-paint 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
16300 TORRE AVENUE -CUPERTINO, CA 95014-3255
CUPERTINO
(408)777-3228-FAX(408)777-3333-buildin-gacupertino.ora
PROJECT ADDRESS APN a
OWNER NAME CIn aio-
PHONE E-MAIL
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STREET ADDRESS CITY. ATE.ZIP FAX
CONTRACTOR NAME LICENSE NUER LICENSE NPE BUS.LIC.a
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COMPANY NAMEE-MAIL FAX
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STREET ADDRESS,,,_ ; CRY.f Z'fP` sp— CA gSlM PH NE
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 Insuection 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 oft/4" 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$126.00. The fee shall be paid before another inspection
can be scheduled.
By my signing below, 1 certify each of the following is true: 1 am the property owner or authorized agent to act on the
property owner's behalf. 1 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:-7—WO-9- ata
ReroofPolicv_201 Ldoc revised 02116111
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REROOF PERMIT APPLICATION ��
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION �
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 1
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LSE OF ❑ SFD or Duplex jif Multi-Family ROOF AREA: Air VALL At ON AD
STRUCTURE. ❑ Commercial3 S S-0o
EXISTING ROOF TYPE. ❑BLILT-UP ROOF 13 �y ASPHALT SHINGLES �YOODSHAKF.S ❑w00DSHINGLES ❑Ol'HF.RISPECIF\'1
RENIONF.REPLACfi VF.S IF NO. PLYWOOD '." ❑ PL1'\D 11 OSB PITCH ROOF
❑ NO -LANFRS THICKNESS ❑ i.S" 1)PE CDY ') CLASS
PROPOSEDROOFTYPE ❑BUILT-UPROOF XASPHALT SHINGLES ❑wDOD SHAKES ❑WOOD SHINGLES 13 OTHER ICC-ES REPORT.
DFSCRIPT10N OF M OR6'
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BV m.signature below.I cenifv to each of the following: I am the property owner or authorized agent to act on the propem owner's behalf have read this
application and the information I have provided is correct. I have read the Description of'A ork and,erifr it is actuate I aeree to compl,with all applicable loyal
ordinances and state laws relating to building cons tion. I a orize rep"S2I1;W-fjoCCuImno to enter the aboNe-identified propertyfor inspection purposes.
Signature of Applicam/Aeem: Date. O 12
SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY
_ If building is associated with a Home Owner's Association.provide letter PLAN CHECK TYPE ROUTING SLIP
of approval from HOA. f7-1v-1.THE-COUNTER BUILDING PLAN REVIEW
_ Provide Planning approval to verifjif there any restrictions. ❑ Fj(PRESS ❑ PLANN'ING PLAN REVIEW
Pr Ide copy of.Manufacturer's Installation Specifications. ❑ STANDARD ❑ FlRE DEPT
Provide sieved copy of Cupertino's Tear-OR-Policy- ❑ OTHER:
ReroofApp_2011.doc revised 03116/11