12070216 CITY OF CUPERTINO BUILDING PERMIT
BUILDINCADDRESS: 20666GARDENSIDECIR CONTRACTOR:BRADSHAW ROOFING PERMITNO: 12070216
OWNIiR'S NA\IE: LEE TIM J AND YONG 1821 S BASCOM AVE NNIB 160 DA'Z'E ISSUED:07272012
OWNER'S PHONE: 4088732199 CAMPBELL.CA 95008 PI IONS NO:(408)2169930
❑ LICENSED CO\FRACrOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r�
License Class ^y_ Lie.N 0 CJ r r r1
_4 Date DIECIRESIDENTIAL COAt01ERC1AL
Contractor 'Y-n ` 1Qy �
hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: REMOVE EXISTING WOOD SHAKE ROOFING AND
(commencing a Rh Section 7000)of Division 3 of the Business S Professions INSTALL NEW
CLASS A ASPHALT SHINGLES 12 SOFT(CGRTAINTEED
Code and that tov license is in full force and effect. -
AGED BARK)
I hereby affirm under penalty of perjury one of the following tma 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
Section 3700 of the Labor Code,for the performance of One work for which this
permit is issued Sq. Ft Floor Area: Valuation:$6000
A I'I'I,IC,\\I'CI?IfI'IPICA'1'ION
I certify that I have read this application raid state that the above information is ANN Number:36232030.00 Occupancy'1'ype:
correct.I agree to comply with all city and county ordinances and state laws relating
to building construction,and herebyauthorize representatives oflhis city to enter
upon the above Mentioned property for inspection purposes. (We)agree to save
indemnifyand keep harmless the City of'Cupertinougainst liabilities,judgments, PERMIT EXPIRES IF WORK IS NOT STARTED
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally.the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR
with all non-point soure)to latiats per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION.
9.18. //� 7 ,{/' �1 .J
Signature Date '7/K /l.7 Issued by: J zy- ��LTG/-L Date: 7• 7-1 �-
❑ O\\'NF,R-BUILDER DECLARATION
1 herebyaffirm that I am exempt from the Contractor's License Law Formic of RF,-ROOFS:
the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
1,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I agree to remove all new materials for
will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection.
Business R Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: Date:
construct the project(Sec.7044,Business K Professions Code),
1 hereby affinw tinder penalty of perjury one of the following three ALL ROOF COVERINGS T'O 13E CLASS"A"OR BETTER
declarations:
I have and will maintain a Cerificate O(COnsent to self insure for Worker's HAZARDOUS MATERIALS DISCLOSURE
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 read the hazardous materials requirements under Chapter 6.95 of the
I have and Will maintain Worker's Compensation Insurance,as provided for by California Ilealth S Safety Code,Sections 25505,25533.and 25534. 1 will maintain
compliance with the Cupertino Municipal Code.Chapter 9.12 and the Health S
Section 3700 ollhe Labor Code.for the performance ofthe work for which this Safety Code.Section 25532(a)should I store or handle hazardous material.
permit is issued Additionally,should I use equipment or devices which emit hazardous air
I certify that in the performance of due work fonwhich this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District 1 will
not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Compensation laws of California. If,after making this certificate of exemption,I Ilealth S Safety Code,Sections 25505.25533,and 25534.
become subject to the Worker's Compensation provisions of the Labor Code,1 must
fonhwith comply with such provisions or this permit shall be deemed revoked. Or z
i cr
h-SL`.Ln'
ate'
m
A I11'LICAN f CERTIFICATION CONSI'RUCfION LENDING AGENCY
I certify that I have read this application and state that the above information is
correct.1 agree to comply with all city and county ordinances and state laws relating 1 hereby affirm that there is a construction lending agency for the performance of murk's
to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.)
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the Lender's Address
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section ,\RCII I'I'ISCI"S DECLARATION
9.18.
I understand my plans shall be used as public records.
Signature Date
Licensed Professional
Tile
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 20666 Gardenside Cir DATE: 07/26/2012 REVIEWED BY: Sean
07APN: BP#: 'VALUATION: IS6,000
*PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD or Duplex PENTAMATION 1SFDWLROOF
USE: PERMIT TYPE:
WORK Remove existing wood shake roofing and install new class A asphalt shingles.
SCOPE
FEE ID ROOF AREA
s.f.
1REROOFFRES 1,200
Alech. Plan Check Plumb. Plan Check Elec.Plan Check
Mech.Permit Fee: Plumb. Penni;Fee: Elec. Permit Fee:
Other A4ech.Insp. Other Plwnb In Other Elec.insp. El
:11ech.Insp. Fee: Plumb.Insp.Fee: Elea.Insp.Fee:
NOTE: This estimate does not include fees due to other Departments(Le Planning, Public Works, Fire,Sanitary Sewer District,School
District,eta). Thesefees are based on the preliminan•information available and are only an estimate Contact the De t or addn'1 info.
FEE ITEMS (Fee Resolution 11-053 F_lf 711111) FEE QTYIFEE MISC ITEMS
Plan Check Fee:
SuppL PC Fee
Phnnb./AlechAlec
Permit Fee: $180.00
Suppl. Insp Fee
Plumb./Alech.lElec
Phimb./Alech./Elec Permit Fee:
Construction Tax:
Administrative Fee:
Work Without Permit? O Yes (D No $0.00
Advanced Planning Fees:
Travel Documentation Fees:
Strong Motion Fee: 1BSEISA9CR $0.60 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC S1.00
SUBTOTALS: 1 $181.60 $0.00 TOTAL FEE: 1 $181.60
Revised: 07/01/2012
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
ALBERT SALVADOR. P.E., C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE •CUPERTINO, CA 95014-3255
CUPERTINO
(408)777-3228• FAX(408)777-3333- building(dcuoertino.org
PROJECT �RE$S 1^ APNN DWI_
OWNER NAME (V— \ PHONE E-MAIL
'T S CITY,STA 2IPO (�� I ` FAX
C Cm NA, E LICENSE P'UMBER (( LICENSETYP �-( BUS.LIC.9
COMPANY NAME E-MAI
STREET ADORES$ CITY.STATE ZIP1 HONE
V 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 Nail injIhspections, you must also call on the day of the inspection only after that
phase of the work is c6mpleted. 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, 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:�k�1C--_ _0
RerooJPolicv_?011.doc revised 02116/11
12,07 2- 1
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION-
10300 TORRE AVENUE •CUPERTINO,CA 95014-3255 '
CUPERTINO (408)777-3228• FAX(408)777-3333•building0cuoertino.oro -
PROLE ADD S APNM _ O
OWNE�JAM1fE NON E-MALL -
5[REET ADDRESS CRYOSTATE,ZIP (� FAX ilz
CONTACT NAME PHONE E4WL
STREET ADDRESS CRY,STATE, ZIP FAX
❑ OWNER ❑ OHNFA-BOH m ❑ OtvNERAGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITEcT ❑Etcirmm ❑ DEVELOPER ❑TENANT
CONTRACT M1NAM1IE LICENSENUaaa ER LICENSE TYPE BUS.LIC.0
-32
COMPANY NAME ESL\ �C nC FAX _
STREET ADDRESS CFl-.STATE IF
IP PHONE
CCLC
ARCHITECTIENGINEER NAME LICENSE NUNMER BUS.LIC.M
COMPANY NAME E41ALL FAX
STREET ADDRESS CRY.STATE,ZIP PHONE
USE OF ❑ SFD or Duplex ❑ Multi-Fa1Ril V, ROOF AREA: VALUATION:
STRUCTURE. ❑ Commercial
EXISTING ROOF TYPE:',//❑BUILT-UPROOF ' ❑ASPHALTSHINGLES 2WWOODSHAKES ❑WOODSHINGLES CI OTHER(SPECIFY)
REMOVE AUSPLACE f9i4ES I IF 44), PLYR'OOD L7 t5" 11PLvwB ❑ OSB PRCH: -12 ROOF
CI NO M RS' J.� , S. ❑ SIS" E' ❑ D
CLASS A
PROPOSEDROOFTYPE: 1:1 BUILT-UP ROOF &6RALTSHINGLES ❑WOODSHAKES ❑WOOD SHINGLES ❑OTHER ICC-ESREPORTa
DESCRIPTION OF WORK. '_
r
By,lily signature below.I certify W each of the following: I am the proper'owner or authorized agent to act on die property owner's behalf. t 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 W comply with all appficable local
ordinances and state laws relating to buil/ggQqur o�sl/9�gion. I au nz presenmtives of Cupertino to enter rhe+obove-iJemu d property for inspection purposes.
Signature of Applicant/AgenC���/�� Date: �r�(7}Z
v
SUPPLEMENTAL WFORMATION REQUIRED OFEICEUSE ONLY _
_If building is associated With a Home Owners Association,provide letter PLANCHECKTYPE ROUTING suP.
of approval from HOA. -14 OVER-THECOUNTER ❑ BUILDING PLANREVIEW
_Provide Planning approval to verity if there any resuicdons. ❑ E,FRESS ❑ PLAKMNG Pus REVIEW '
_Provide copy of Manufacturers Installation Specifications. ❑ STANDARD ❑ FIRE DEPT
Provide signed copy of Cuperfino's Tem-Off Policy. ❑ OTHER:
Reroojdpp_3011.doc revised 03/16!11