12070213 CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRI?SS: 20646GARDENSIDBCIR CONTRACTOR:BRADSHAW ROOFING PERM IT NO: 12070213
O\VNER'S NAME: KWONG KINK AND KAN YUEN K 1821 S BASCOM AVIS PNIB 160 DATE ISSUED:07272012
OWNER'S PHONE: 4082537565 CAMPBELL,CA 95008 PHONE NO:(408)246-9930
❑ LICEINSF.D CC NTRACfOR'S DECLARATION
C� BUILDING PERMIT INFO: 131.DC r ELECT r PLUMB r
License Class < -3 q Lie.q r r• r
(1�� MECII RESIDENTIAL COMMERCIALContract
Contractor Rc-n d5�/'�CI s. I11 Date`?I/a
1 herchy affirnn.that [;Ira licensedunder the provisions of Chapter 9 JOB DESCRIPTION:REMOVE L•XIS'fING WOOD SHAKE ROOFING AND
(comm(ncing with Section 7000)of Division 3 of the Business S Professions INS'T'ALL NEW
Code and That my license is in full farce and effect. CLASS A ASPHALT SHINGLES(CERTAINTEED-AGED BARK)
1 hereby affirm under penally of perjury one of the following two declarations:
1 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
Section 3700 of the Labor Code,for the performance of the work for which this Sq. Ft Floor Area: Valuation:$6000
permit is issued.
\PI'LIC.\N'I'CIiR'1'IPIG\PION All\Number:36232035.00 Occupancy'type:
I certify that I have read this applicationand state than 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 accrue against said City in consequence oflhc WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source re latter per the Cupertino Municipal Code,Section
9.18. f _ q'
Signature Date7/- Issued by: �r/1� ,� /y Date: '-�/
❑ OWNER-BUILDER DECLARATION
RF.-ROOFS:
hereby affirm that I am exempt from the Contractor's License law for one of All roofs shall be inspected prior to any roofing material being installed.Ira roof is
the following oro reasons: installed without first obtaining an inspection,I agree to remove all newmaterials for
I,as owner of the property,or my employees with wages as their sole confirmation, inspection.
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business R Pr0tCSSi0aS Code) Signature of Applicant: Date:
I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sce.7044,Business S Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I hereby affirm under penally of perjury one of the fallowing three
Ideclarations:
have and will
HAZARDOUS MATERIALS DISCLOSURE
I have and will mainain a Certificate of Consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California Ilealth S Safety Code,Sections 25505,25533,and 25534. I mill 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 Ilealth.4
Section 3700 of the Labor Code,for the perfommnce of the work for which this Safely Code,Section 25532(x)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 Buy Area Air Quality Management District I will
I certify that in the perfomma ce of the stork for which[his 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 Ilealth S Safely Code,Sections 25505,25533,and 25534.
Compensationlaws of Californin. If,after making this certificate of exemption,I
become subject to the Worker's Compensation provisions oflhe Labor Code,I[trust C>waer.n� nr agerl:
forthwith comply with such provisions or this permit shall be deemed revoked / l.i Date:
APPLICANT CERTI FIC,\TION CONSTRHCHON LENDING AGENCY
I certify that I have read this application and state that the above information is 1 hereby amrm that there is a construction lending agency for the performance of mark's
correct.I agree to comply w ith all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ Q
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 tire City ol'Cupertino against liabilities,judgments. Leader's Address
costs,and expenses which may accrue against said City in consequence of die
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section ARCII ITECI"S DIiCLARATION
9.18. 1 understand my plans shall be used as public records.
Signature Date Licensed Professional
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
C U P E RT I N O Far: 408-777-3333
CONTRACTOR / SUBCONTRACTOR LIST
JOB ADDRESS: PERMIT#
OWNER'S NAME: S CiC `e 4 PHONE # O 0
GENERAL CONTRACTOR: ( BUSINESS LICENSE #
ADDRESS: f V CITY/ZIPCODE: 11 p z5
*Our municipal code requires all businesses working in the city to have a Cite of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
1 am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR 13USINESS NANIE BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring/ Carpeting
Linoleum / Wood
Glass/Glaring
Heating
Insulation
Landscaping
Lathing
Masonry
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
p
Owner/ Contractor Signature Date
CITY OF CUPERTINO 1.2
FEE ESTIMATOR — BUILDING DIVISION
1:21ADDRESS: 20646 Gardenside Cir DATE: 07/26/2012 REVIEWED BV: Sean
APN: BP#: 3 'VALUATION: 56,000
"PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE`. Re-roof
PRIMARY SFD or Duplex PENTAMATION 1SFDWLROOF
USE: PERMIT TYPE:
WORK Remove existinq wood shake roofing and install new class A asphalt shingles.
SCOPE
FEE ID ROOF AREA
s.f.
1REROOFFRES 1,200
Mech. Plan Check Phanb.Plan Check Elec.Plan Check
Alech.Permit Fee: Ph mb. Permit Fee: Eler. Permit Fee:
Other Mech.Insp. Other Phonb Insp. Other Elec.Insp.
Mech.Insp. Fee: Phmtb.Insp. Fee: Elec.Insp.Fee:
NOTE: Thisestimate does not includejees due to other Departments(ie. Planning,.Public Works, Fire,Sanitaq+Smer District,School
District,etc). Thesefees are based on the preliminan information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution /1-053 Eff 7/1/111 FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Suppl. PC Fee
Phanb./Alech./Elee
Permit Fee: $.180.00
Suppl. lnsp Fee
Plumb./A4ech./Elec
Phnnb./Mech./Elec Permit Fee:
Constntction Tax:
Administrative Fee:
Work Without Permit? O Yes 0 No $0.00
Advanced Planning Fees:
Travel Documentation Fees:
Strong Motion Fee: IBSEISAHCR $0.60 Select an Administrative Item
Bldg Stds Commission Fee: JBCBSC 51.00
SUBTOTALS: 1 $181.601 $0.00 TOTAL FEE: ' $181.60
Revised: 07/01/2012
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT- BUILDING DIVISION
ALBERT SALVADOR. P.E., C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE• CUPERTINO,CA 95014-3255
CUPERTINO
(408)777-3228• FAX(408)777-3333•buildingng cuoertino.orq
PROJECT ADDRESS LAPN a /
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w'NER NA E u i PHONE _ E.MAIL
S U ETjYD jUiSS / CITY.STATE.ZIP I O �� ' ` FAX
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C 'TRACTO NA.1E LICENSE NUMBER LICENSE TYP BUS.LIC.M
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COMPANY NAME E-MAI tY FAX _
STREETADD ESS CITY.STATE LP 1 S ONE
6 llcldc
V I UNDERSTAND AND AGREE TO THE FOLLOWING:
I. 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 lnspections, 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$126.00. The re-inspection fee shall be paid before another inspection
can be scheduled.
By my signing below, 1 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 C
Signature of Applicant./Agent: ode Date:
HernofPo1icv_2011.doc reoised 02/16111