12070207 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20654 GARDENSIDE CIR CONTRACTOR: BRADSIiAW ROOFING PERNDTNO: 12070207
OWNER'S NAME: CHAO CALVIN AND PAN TUNG-SIIAN TRUST 1821 S BASCOM ANT PNI It 160 DA'Z'E ISSUED:07272012
OWNER'S PlIO,NE: 4082469930 CAMPBELL,CA 95008 PHONE,NO:(408)246-9930
❑ LICENSED CO\fRACI.OR'S DECLARATION
p/ BUILDING PF;RNIIT INFO: BLDG r ELECT r-
PLUMB r
License Class �.'- Lie.N O b
NECH r RESIDENTIAL r • COMMERCIAL r
Contractor 5Vuj Date '��
1 hereby affirm that I am licensed under the precisions of Chaptert) JOR DESCRIPTION:REMOVE EXISTING WOOD SHAKE ROOFING AND
(commencing with Section 7000)of Division 3 of the Business S Professions INSTALL NEW
Code and that niv license is in fall force and effect. CLASS A ASPHALT SPIINGLGS 12 SQFI'(CERTAINTBED-
AGED DARK)
I hereby affirm under penalty of perjury one of the follow ing 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.
I have and will maintain Workers Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of die work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$6000
A I'I'LIC.\\I'CFR'1'1l>IC,\'PION
I certify that I have read this application and state that the above information is APN Number.36232033.00 Occupancy Type:
correct. I agree to comply with all city and county ordinances and state lays relating
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree t0 save
indenaniN and keep harmless the City of Cupertino against 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 willcomply WITHIN 180 DAYS OF PERMIT ISSUANCE OR
.with all non-point source regulations per the Cupertino Municipal Code,Section Igo DAYS FROM LAST CALLED INSPECTION.
9.18. /� � -/1/ -7 r-r
Signature Ill &� Date � / ��� Issued by: ��'�/✓ � They Date: 7. 97-1p-
OWNER-BUILDER
7' t-OWNE12-BUILDER DECLARATION
hereby affirm than I am exempt front the Contractor's License Law for one of RP-ROOFS:
the following two reasons: All rools shall be inspected prior to my roofing material being installed.If a roof is
I,as owner of the property,of my ennployees"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(See.7044, inspection.
Business&Prolcssions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to Signature of AppliamC Date:
construct the project(Sec.7044,Business K Professions Code).
I hereby affirm under penalty of perjury one of the following three ALI,ROOF COVERINGS TO BE CLASS"A"OR BETTER
declarations: -
I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSUIiIi
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 far by Cul ifortia I lealth S Safety Code,Sections 25505,25533,and 25534. I will maintain
Section 3700 of the Labor Code,for the performance of the work for which this compliance with the Cupertino Municipal Code,Chapter 9.12 and the(lealth S
Safety Code,Section 25532(x)should I store or handle hazardous material.
permit is issued. Additionally,should I use equipnnenl or devices which emit hazardous air
I certify that in the performance of the work fonvhich this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District I will
not employ any person in any manner so as to become subject to the Worker's maintain com plimtce with the Cupertino Municipal Code,Chapter 9.12 and the
Compensation laws of Cali forma. If,after making this certificate of exemption,I I lealth S Safcty Code,Sections 25505.25533.and 25534.
become subject to the Worker's Compensation provisions of the Labor Code,I must
Yr� agent 7�2Z�z
forthwith comply with such provisions or this permit shall be deemed revoked. o 'cd(
Date:
API'LIC,\N'1'CFK"I'IPICA"PION CONSTRUCTION LENDING AGENCN'
I certify.that I have read this application and state that the above information is
correct.I agree to comply with all city ark]county ordinances and state Imus relating I hereby affirm that there is a construction lending agency for the performance of work'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 Cit in consequence of the Leader'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
9.18. ARCI I I"I'FCI"S DF;CL,\R,\"I-ION
1 understand my plans shall be used as public records.
Signature Date
Licensed Professional
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
:911 ADDRESS: 20654 Gardenside Cir DATE: 07/26/2012 REl'IEIVED BY: Sean
APN: BP#: 'VALUATION: 1$6,000
*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
Mech. Plan Check Plumb.Plan Check Elec.Plan Check
:Meth. Permit Fee: Plumb. Permit Fee: Elec. Permit Fee:
Other A4ech.hup. Other Plumb Itsp Other Elec..In
:Meeh.Insp.Fee: Plumb.Insp.Fee: Elec.Insp.Fee:
NOTE: This estimate does not include fees due to other Departments(Le. Planning, Public Works, Fire,Sanitary Sewer District,School
District,eta). These ees are based on the preliminan•information available and are onh•an estimate Contact the De t or addn'I info.
FEE ITEMS (Fee Resolution 11-053 Eff 7/1/11) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Suppl. PC Fee
Phanb./Afech./Elec
Permit Fee: $180.00
SuppL Insp Fee
Plumb./Afech./Elec
Plumb./Afech./Elee Permit Fee:
Consnixtion Tax:
Administrative Fee:
Work Without Permit? O Yes e) No $0.00
Advanced Planning Fees:
Travel Documentation Fees:
Strone Motion Fee: 1RSEISWCR $0.60 Select an Administrative Item
Blde Stds Commission Fee: IRCRSC $1.00
SUBTOTALS: $181.60 $0.00 TOTAL FEE: F$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(a)cuoertino.org
PROI R DO 5 APNN
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C11 NA, E LICENSE NUMBS LICENSE TYP BUS.LIC.M
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COMPANY NAME E-MAI
STREETADORESS ` ' \ C� CITY.STATE7IP , , 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.Nailing-.Ihspections, 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 lnspections'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 authnrized 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:—!!_�_- _
ReroofPo1icv_201 l.doc reviser)02/16/11