12070177 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21081 RED FIR Cr CONTRACTOR:FOUR SEASONS ROOhING PERMIT NO: 12070177
OWNEWS NAME.: HUNG TI-IIEN LUONG PO ROX 1668 DATE ISSUED:0724/2012
OWNER'S PRONE: 4082589725 SAN JOSE,CA 95109 PHONE NO:(4081278-0330
LICIiNSIiD CO\I'R,\CI'f1''R'(S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLPLUMBr
License Class C ,A
Sq Lie.# VL 7 at b0 r r e rr
DIECII RESIDENTIAL CONINIERCL\L
Contractor Es 2 i�,�. Date�-a� - i a
JOB DESCRIPTION:TEAR OFF EXSISTING WOOD SHAKE ROOF.INSTALL 12"
I mmeereby icing%,Ilan I aril 7000) under the oftiroN rIanu in Chapter 9 CDX PLYWOOD THr:N 30#FELT UNDERLAYMENT.FINALLY,
(commencing,rich Scetse is in
of Irce and 3 of the Business&Professions INSTALL.CERTAINT'EED PRESIDENTIAL CONI SIIINGLES.
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 have and will maintain a certificate of consent to self-insure for Worker's
Compensation,asprovided for by Section 3700 of the Labor Code,for the
performance of the work,for which this permit is issued. q
1have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work forwhich this Sq.Ft Fluor Area: Valuation:$4500
permit is issued.
,\I'I'LICAN'1'CER'1'IFIC,%'PION APN Number:35905030.00 Occupanc3 Type:
I certify that I have read this application and sate that the above information is
correct.I agree to comply with all city and county 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 save PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrueagainst said City in consequence of'the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting o(this pemnit. Additionally,the applicant understands and will comply n, r
with all non-point source regulatie,s per the Cupertino Municipal Code,Section
180 DAYS FROM LAST CALLED INSI ECTIOn.
9.18,
Signature Dae -7 -711-(Z Issued by:
❑ O\YNlilt-BUILDER DECLARATION
RE-ROOFS:
I hereby affirm that 1 am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roaring material being installed.Ira roof is
the fullowing two reasons: installed withota first obtaining an inspection,I agree to remove all new materials for
1,as owner of the property,or my employees with wages as their sole compensation, inspection,
will do the work,and die structure is not intended or offered far sale(Sec.7044,
Business&Professions Code) Signature of Applic ric '� ate: —2-
1,
2I,as owner orthe property,am exclusively contracting with licensed contractors to
construct the project(See.7044,Business&Professions Code). ,V,I.KOOI CO\'ERR S T BE CLASS"A"OR ISI•:ITER
I hereby affirm under penalty of perjury one of the following three
Ideclarations;
have and evil] IIAZARDOUS NIATERIALS DISCLOSURE
I have and aillmaintuin a Certificate of Consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the I lune read the hazardous materials requirements under Chapter 6.95 of the
performance or the work fur which this permit is issued. California Ileal th&Safety Code.Sections:5.5115,25533,and 25534. 1 will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code.Chapter 9.12 and the I Iealih&
Section 3700 of the Labor Code,for the performance of dhe work for which this Safety Code Section 25532(a)should 1 store or handle hazardous material.
Additionally,should I use equipment or devices which emit hazardous air
permit is issued. contaminants as defined by the Ila),Area Air Quality Management District I rill
I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code.Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's llcalth&Safety Code.Sections 25505,25533.and 25534.
Compensation laws of California. If,aller making this certificate ofesemption,I
become subject to the Worker's Compensation provisions of the Labor Code,I must O`wae r nu � age :
forthwith comply with such provisions or this permit shall be deemed revoked Date. �2 G1
LIN S'I'RUCTION LENDING AGI?NC\'
APPLICAN"1'CERTIFICATION
I certify that I have read this application and state that the above inlunnation is 1 hereby affirm that there is a construction lending agency for the performance of lark's
correct.I agree to comply with all city and county ordinances and slate laws relating for which this permit is issued(Sec.3097,Cie C.)
to building construction,and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, Leader's Address
costs,and expenses which may accrue against said City in consequence of d,c
graving of this permit.Additionally,the applicant understands and will comply ARCIITTEC`I"S DECLARATION
with all non-point source rcgulmions per the Cupertino Municipal Code,Section
9.18. 1 understand my plans shall be used as public records.
Signature Date Licensed Professional
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(d)cupertino.org
PROJECT ADDRESS 2108I Red F1r APN0
OWNER NAME Cy ,e LU PHONE O?I�rO- ,ES-M�AIL
OA
STREET ADDRESS '� N CITY,S ZIP J U FAX
Zial e C
CONTRACTOR NAME LICENSENU BER LICEN'SC��E�1'P� BUS.LIC.a
COMPANYNAME E-MAIL FAX
o S
STREET ADDRESS CIN. TE.ZIP PHONE
$a2 oSe C S l2 �2 8-030
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. 1 understand and agree to comply with the re-roof policy stated above. 1 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:
RerooJPolicT,2011.doc revised 02/16/11
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO, CA'95014-3255
(408)777-3228• FAX(408)777-3333•buildino(ccupertino.oro
CUPERTINO
PROJECT ADDRESS aloe I APN L
2 7- os
OWNERNAME PHONE ;J� 1 E-MAIL
ii on i
STREEI'ADDRESS CITY. S TE.LIP FAS
21 0 [ C • �
CONTACT N>AIF PHONEI EAIAIL
e o -0 301
STREETADDRESS CITY.STAT E. ZIP I FAx
SO2 $ an ase, CA qT112
❑OIVNFR G OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TEFnxr
L'ONTRACI'ORNIAMEI LICF.NSENI:NIBER I LICENSE TYPE BCS.LIGg
20
COMPANY NAME SAAE E-MAIL I FAX
STREET ADDRESS CITY.STATE.ZIP PHONE
T07- CITY.
-lose C -2 2-0
ARCHI'rECTrENGINEER NAME LICENSE NUMBER I BUS.LIG n
COMPANY NAME I E-NIAIL FAN
STREET ADDRESS ❑T1 ST.ATE.ZIP PHONE
USE OF ❑ SFD or Duplex $ Multi-Family ROOF AREA: VALUATION: _per
STRUCTURE: ❑ Commercial Z 3 g roo
EXISTING ROOPTYPE: ❑BUILT-UPROOF ❑ASPOALTSHINGLLS P./ill!WOODSHAKES ❑UOODSHINGLES ❑OTHER(SPECIFY)
RENIOCE:REPLACE YES IFNO. PLYWOOD PLYWD ❑ OSB PITCH: ROOF
❑ NO I e A\'F.RS' THICKNESS' J TN CD." Lj :I Z LA A
PROPOSED ROOF TYPE: ❑BUILT-UPROOF XaSPHALTSHINGLES ❑LCOOUSHAKES 1-1 WOOD SHINGLES Cl OTHER ICC-ES REPORT
DESCRIPTION OF N'ORK: `/Z t/
S
e O# UrIl8erialm P,A, F*jeallu . 1A0rCM
1
a so re a ,w M^ Offer �.'_ cuA CA rGy
By my signature below.I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building conn• tion. I a' orize reprose tiv g of Cupertino to enter the above-identified property for inspection purposes.
Signamreof Applicanl/AgenG �� Data: &O 12
SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY
_ I f building is associated with a Home Ovrner's Association.provide letter PLAN CHECK TYPE ROUTING SLIP
of approval from HOA. ❑ OYER-THE-COUNTER ❑ BUILDING PLAN REVIEW
_ Provide Planning approval to verify if there any restricuOnS. ❑ EXPRESS ❑ PLAN'\TNG PLAN REVIEW
Provide copy of Manufacturer's Installation Specifications. ❑ STANDARD ❑ FIRE DEPT
Provide Signed copy of Cupertino's Tear-OTPolicy. ❑ OTHER:
ReroojApp 2011.doc revised 03/16/11